Hip

Question 1

Coxa Vara

Answer 1

Angle is ~90 degrees–normal 125

places excessive stress through femoral epiphysis, shortens leg

Question 2

Coxa Valga

Answer 2

> 125

places excessive stress through femoral head, increases leg length

Question 3

Femoral Anteversion

Answer 3

Neck/Shaft angle in transverse plane
Normal is 12-15*
Greater than 15* is anterverted

Causes: in-toeing, excessive hip IR
X-ray and/or Craigs

Question 4

Femoral Retroversion

Answer 4

<15 degrees of anteversion=retroverted

Causes: out-toeing, excessive hip ER
X-ray and/or Craigs

Question 5

Legg-Calve Perthes Disease

Answer 5

Avascular necrosis of proximal femoral epiphysis
90% unilateral

S&S: pain hip, thigh, or knee
limping, loss of ABD, ext, and ER, thigh atrophy

Question 6

Slipped Capital Femoral Epiphysis (SCFE)

Answer 6

epiphysis gradually or suddenly slips downward and backward in relationship to the femoral neck

Question 7

SCFE commonalities

Answer 7

Most common in boys 10-16; girls 12-14
Boys> girls 1.5:1
African Americans > Caucasians
(L) hip > (R)
When onset < 10 years old endocrine disorder likely

Question 8

SCFE Risk factors

Answer 8

Obesity
Coxa Vara
mediacations
thyroid problems (hypo)
radiation treatment
chemotherapy
bone problems related to kidney disease

Question 9

SCFE S&S

Answer 9

painful limp
groin or knee pain
comfort by holding hip in slight flexion
cannot actively IR hip
difficulty standing in single limb support
Passive flexion hip=moves into ER

Question 10

Femoral Acetabular Impingement

Answer 10

femur and acetabulum repeatedly come into abdormal contact in certain positions. Leads to bony issues-spurring and damage to labrum and cartilage surface over time.

Question 11

3 types of FAI

Answer 11

1) Cam
2) Pincer
3) Mixed

Question 12

Precursor to FAI

Answer 12

Acetabular retroversion
Previous Hz of:
femoral neck fx
SCFE
Legg-Calve Perhes Disease

Question 13

FAI profile

Answer 13

B/W ages 25-60

Many FAIs occur in athletes, especially if sport demands hip to work an end ROM

Question 14

FAI presentation

Answer 14

Dull, aching pain= C-sign
(+) FADIR
Limited hip IR ROM at 90* flexion in supine

will lead to labrum tear then to OA

Question 15

Five causes of hip labral tear

Answer 15

1. Trauma-sublux/dislocation
2. FAI-hypomobility
3. capsular laxity/hip hypermobile
4. Congential
5. Degeneration

Question 16

Diagnosis of Hip Labral Tear

Answer 16

Groin pain=C-sign
Limited painful IR and ABD
(+) FADIR, FABER, Hip Scour
MRI

Question 17

Labral tear treatment

Answer 17

Rehab first (10-12wks)—>surgery

Question 18

4 goals of rehab for labral tear

Answer 18

• optimize hip alignment
• work on stabilizing a hypermobile hip
• work on jt mobes and soft tissue stretch on hypomobile hip
• limit activities

Question 19

Labral surgery

Answer 19

piece of labrum is removed or repaired—whichever allows for preservation of more healthy tissue: closer to edges is best

Question 20

Hip Pointer

Answer 20

Contusion to iliac crest

S&S: local pain, swelling, ecchymosis, pain with trunk and hip motion, laughing coughing breathing

Inactive 2-3 days–>MHP, US, TENS, gradual return to ROM exercises….3 weeks recovery

Question 21

Strains-Hamstring, Adductors, Quads

Answer 21

from excessive forcible contraction or stretch

S&S: pain with active contrax, resistance and passive stretch. Weakness ecchymosis, sweeling

Adductors=common when activity requires quick position change or quicl propulsion and acceleration.

Question 22

Avulsion Fx-hamstring

Answer 22

can rule out from palpating ischial tuberosity

Avulsion fracture would hate sitting, MMT would be very weak

Question 23

Hip Sprains

Answer 23

Uncommon due to stability

S&S: acute pain inability to circumduct thigh
Rx: grade 2,3 crutch walking as needed gradual PRE progression when pain free

Question 24

Accessory motion tests

Answer 24

AP glide-flexion/IR
PA glide-extension/ER
Inferior glide-ABD
Lateral dislocation-pull away no specific direction

Question 25

Posterior Hip Dislocation

Answer 25

Most common posteriorly MOI: landing on a flexed knee while hip is flexed, adducted, and IR (FADIR)

Question 26

Anterior hip dislocation

Answer 26

Forced hip flexion, ABD, and ER (FABER)

Question 27

S&S of Post. dislocation

Answer 27

``` Severe hip and thigh pain referred pain in knee hip positioned in flexion, adduction, IR not able to walk possible neurovascular complaints ```

Question 28

Medical tests

Answer 28

X-ray: bone CT Scan: soft tissue damage MRI: post surgery out 2-3 months to screen AVN

Question 29

Hip dislocation complications

Answer 29

AVN Acetabular labral tear Hip OA (most common)

Question 30

Avulsion Fx and Apophysitis

Answer 30

Apophysitis-inflammation of the apophysis from overuse--->can lead to avulsion fx S&S: loss of strength, loss of hip motion, point tender

Question 31

Hip stress fx

Answer 31

seen mostly in distance runners in femoral neck and pubic ramus S&S: groin pain, aching in thigh with activity hard to stand on 1 leg X-ray will be normal for 6-10 wks, use Bone scan Tx: rest, minimize weight bearing 2-5 months rehab

Question 32

Femoral fracture

Answer 32

Direct trauma or indirect S&S: sudden severe pain, loss of fxn, direct and indirect tenderness Complication AVN

Question 33

Trochanteric Bursitis

Answer 33

inflammation of bursa or glut med from overuse, muscle imbalance, LLD, SLE, RA S&S: lateral hip pain may refer distally, point tender Tests: asymmetrical leg length, weak glut med, tight TFL Rx: RICE acutely

Question 34

Iliopectineal bursitis

Answer 34

excessive compression during hip flexion S&S: deep anterior hip pain, pain with deep palpation, pain with resisted hip flexion

Question 35

Snapping Hip Syndrome Anterior

Answer 35

iliopectinal bursitis and/or labral tears

Question 36

Snapping Hip Syndrome Lateral

Answer 36

Proximal ITB friction with or without pain associated iwth it---greater troch suspected if its with pain

Question 37

THR precautions post-op

Answer 37

Avoid: Flexion > 90 Hip Add Hip Ext with IR Most common surgical complications=infection or DVT

Question 38

Sports Hernia

Answer 38

imbalance in muscle strength hip adductors and RA and Obliques at insertion pubic ramus S&S: groin and testicular pain, pain with running and cutting can R/O with inguinal palpation

Question 39

Dynamic tests for Sports Hernia

Answer 39

Resisted oblique MMT Resisted Adductor tests Kicking with flexion/adduction MRI