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517 Ortho > Hip > Flashcards

Hip Flashcards

(83 cards)

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1
Q

degrees of freedom of hip joint

A

3, 6 osteokinematic directions

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2
Q

capsular pattern

A

joint specific pattern of restriction of passive movement

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3
Q

hip capsular pattern

A

flexion>IR>abduction limitations

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4
Q

open packed capsular restriction

A

flexion and ER

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5
Q

How does hip joint congruency differ from other joints?

A

Very congruent, meaning less accessory movement so mobilizations are less effective
increased stability with mobility

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6
Q

femoral head vascularity

A

ligamentum teres - 1/3
circumflex
superior/inferior gluteal arteries

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7
Q

4 major ligaments of the hip

A

iliofemoral: anterior, Y
pubofemoral: anterior
ischiofemoral: posterior
ligamentum teres: blood supply and stabilize at 90 flexion

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8
Q

stabilizer muscles of the hip

A

psoas, hip rotaters

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9
Q

hip clock orientations

A

felt around greater trochanter
12: glut med
1-2: glut min
3: glut max
4-5: vastus lateralis
6-7: quadratus femoris
8-10: conjoint tendon
10-11: piriformis

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10
Q

flexors of the hip

A

iliacus
TFL
sartorius
rectus femoris
adductor longus
pectineus

assist: gracilis, adductor brevis, glut min anterior fibers

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11
Q

extensors of the hip

A

glut max
hamstrings
adductor magnus posterior fibers

assist: glut med

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12
Q

abductors of the hip

A

glut med
TFL
superior glut max
glut min

assist: sartorius, rectus femoris, piriformis

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13
Q

adductors of the hip

A

adductor group
pectineus
gracilis

Assist:
obturator externus

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14
Q

internal rotaters of the hip

A

no pure internal rotaters
TFL
glut min
glut med
adductor longus/brevis
semimebranosus/tendinosis

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15
Q

external rotaters of the hip

A

obturator internus/externus
gemellus sup/inf
quadratus femoris
piriformis
glut max
posterior glut med
biceps femoris

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16
Q

functional mobility at hip

A

shoe tying: 120 flexion
sitting: 112 flexion
squatting: 115 flexion/ 20 abduction/20 IR
up stairs: 67 flexion
down stairs: 36 flexion
put on pants: 90 flexion

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17
Q

normal angle between head of femur and neck

A

125 degrees

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18
Q

How does the angle at the femoral neck change the hip?

A

increased angle: coxa valga
decreased angle: coxa vara

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19
Q

coxa valga

A

creates increased stress across joint surfaces
shortens hip abduction moment arm to be disadvantageous
increased LE length
creates varus at knee, stress to medial side
more likely to get FAI

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20
Q

coxa vara

A

more horizontal femoral neck
increased downward shear force
decreased angle of pull for hip abduction
creates valgus at knee, stresses lateral side
more prone to fx due to increased torsional/shear force

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21
Q

femoral anteversion

A

neck is oriented anterior, smaller angle of head and neck in transverse plane
results in hip IR and in toeing

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22
Q

femoral retroversion

A

increased angle of femoral neck and head in transverse plane
results in hip ER and out toeing

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23
Q

avascular necrosis of femoral head

A

dead bone/bone marrow into subchondral plate cause by lack of blood flow to femoral head

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24
Q

PT treatment of avascular necrosis

A

the aftermath, we can catch condition but primary treatment is surgery

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25
subjective findings of avascuar necrosis
groin pain radiating to lat hip, knee, buttock deep throbbing intermittent gradual onset antalgic shift
26
risk factors for avascular necrosis
corticosteroid high cumulative dose alc use systemic lupus sickel cell trauma cancer
27
objective findings of avascular necrosis
painful ROM esp IR OP pain w SLR antalgic gait
28
complications of avascular necrosis
incomplete Fx superimposed degenerative arthritis
29
Legg Calve Perthes Disease
osteonecrosis of femoral head in kids 4-10 malformed bone due to less blood supply unilateral 4x more in boys disorder of epiphyseal cartilage
30
subjective findings of Legg Calve Perthes DIsease
vague groin ache radiating medial thigh to inner knee muscle spasm
31
objective findings of Legg Calve Perthes DIsease
limp/leg drag thigh muscle atrophy child small for age positive trendelenberg out toeing involved side decreased abduction/IR hip flexion contracture
32
Legg Calve Perthes DIsease treatment
monitoring by physician if mild/mod severe: operative
33
slipped capital femoral epiphysis
displacement of femoral head from epiphysis/growth plate during growth spurt anterior displacement of femoral neck common in adolescents
34
subjective findings of slipped capital femoral epiphysis
pain worse w activity groin/med thigh pain with some knee or lower thigh pain first dull/aching leg weakness no Hx of trauma necessary
35
objective findings of slipped capital femoral epiphysis
walk w difficulty and limp, ER involved foot decreased hip ROM in IR, adb, flexion IR loss is greater in flexion ER with passive hip flexion involved extremity 1-3 cm shorter
36
risk factors for slipped capital femoral epiphysis
obesity male sports involvement
37
slipped capital femoral epiphysis interventions
relieve symptoms contain femoral head restore ROM surgical fixation if necessary
38
femoral neck stress Fx
result of accelerated bone remodeling as response to repeated stress neck is weak point due to angle and lack of trabeculae in area
39
who gets femoral neck stress Fxs?
military recruits/athletes/runners older persons: superior neck/tension Fx younger persons: inferior femoral head/compression fracture
40
femoral neck stress Fx subjective findings
sudden hip pain associated w change in training deep thigh pain pain in WB and end range motion radiate into knee night pain
41
femoral neck stress Fx objective findings
negative physical exam empty end feel or pain at end range IR/ER pain w resisted hip ER + resisted SLR + ausculatory patellar/pubic percussion test + fulcrum test diagnose w MRI, not xray
42
ausculatory patellar/pubic percussion test
place stethoscope over pubic symphysis tap patella and note sound repeat on both sides + is diminished percussion on side of pain
43
femoral head stress Fx intervention
surgical for tension Fx compression: bed rest to NWB until WBAT once pain free progress weight bearing
44
hamstring strain
1 or more hamstring muscles partial, often in eccentric phase w tension while lengthening
45
hamstring strain subjective findings
distinct MOI running or deceleration pop at injury posterior thigh pain worse w knee flexion
46
hamstring strain objective findings
tenderness with passive stretching tender to palpation pain w resisted knee flexion isolate muscle w IR/ER
47
hamstring strain intervention duration
grade 1: continue activity as tolerated, pain as guide grade 2: 5days-3weeks grade 3: 3-12 weeks
48
sample hamstring strain interventions
prone curls supine stretch machine loaded curls in prone/seated SL bridge good mornings lunges SL squats nordic curls (eccentric) ball hamstring curls and hamstring bridges barbell deadlift SL deadlift dumbbell swing
49
Adductor tendinopathy | MOI, involved muscle
mostly comonly adductor longus common adductor pathology proximally caused by repetitive loading with twisting/running muscular imbalance of stabilizing muscles of hip
50
subjective findings of Adductor tendinopathy
twinge/stab pain in groin edema/ecchymosis aggravated by running, directional changes, kicking, SL exercise, lunges
51
Adductor tendinopathy objective findings
pain w passive abduction or resisted adduction bias different adductors at different levels of hip flexion 0: gracilis 45: add longus/brevis 90 + abduction: pectineus
52
Adductor tendinopathy interventions
acute: RICE or POLICE (protect, optimal loading, ice, compression, elevation) Sub acute: isometrics gentle stretching graded resistance gradual return to full activity good prognosis
53
Adductor tendinopathy sample exercises
supine stretch hamstring stretch sidelying lift SLR resisted hip flexion side plank resisted hip abd/add
54
hip OA subjective findings
insidious onset buttock/groin/thigh/knee dull or sharp worse w activity lastin several hours after antalgic gait hard to climb stairs/put on socks
55
hip OA objective findings
restricted IR/abd/flexion pain at end range pain to resisted hip flexion/adduction +Scour +FABER
56
hip OA interventions
relief symptoms minimize disability reduce progression education modalities for pain relief weight management add AD if needed manual mobilization passive stretch strengthen stabilizers
57
Snapping hip
snapping/pop sensation occuring with moving tendons around the hip over bony proiminences
58
causes of snapping hip
internal: iliopsoas snap over femoral head, lesser trochanter, tenosynovitis external: ITB/glut max snap over greater trochanter intra articular: synovial chondromatosis, Fx fragments, labral tears, loose body
59
snapping hip subjective findings
snap/pop greater trochanter area with ambulation snap caused by subluxed iliopsoas tendon in groin/hip while flexed may be pain if bursa inflamed
60
snapping hip objective findings
IT band subluxing on standing/rotation palpable snapping while extending from flexed Obers Thomas
61
snapping hip intervention
improve muscle length improve strength imbalances often conservative treatment
62
trochanteric bursitis
common cause of lateral hip pain second to OA GTPS: greater trochanteric pain syndrome
63
trochanteric bursitis subjective findings
lateral thigh, groin, gluteal pain worse lying on involved side radiate distally pain worse in sit to stand or recumbent better after a few steps, worse after walking 30 min STM will make bursa worse but muscle better to differentiate
64
trochanteric bursitis objective bursitis
reproduce pain w palpation or stretching of ITB resisted abd/ext/ER painful tight hip adductors Obers modified obers
65
trochanteric bursitis intervention
stretch soft tissue lateral thigh flexibility of ER/quad/hip flexors strengthen hip abductors/muscular balance w adductors orthotic if needed responds well to conservative
66
hip labral tears | MOI
from trauma, FAI, capsular laxity/hypermobility, dysplasia, or degeneration often undiagnosed
67
hip labral tears subjective findings
anterior hip/groin pain click/pop/locl/give way
68
hip labral tears objective findings
+ anterior hip impingement test similar to FAI presentation aggravation w activity painful faber/faddir
69
hip labral tears intervention
conservative management for a few months limit pivoting strengthen assess foot motion surgical: arthroscopic debridement of tear
70
FAI treatment
restore mobility/function decrease pain avoid surgery avoid progression to OA and labral tear
71
prevalence of FAI
20-40 y/o athletes 15% of cases repetitive end range hyperextension/flexion w abduction slip/twist injury
72
types of impingement
CAM: aspherical femoral head impinging rim of labrum; provoked by FADDIR; superior OA; young males PIncer: acetabulum over covers femoral head impinging neck of femur; middle aged females; provoke by hip ext/ER
73
CAM/pincer prevalance
86% have both
74
CAM/pincer ROM limitations
IR/ER, flexion, add progressively more limited
75
FAI symptoms
C sign dull ache worse w prolonged sitting sharp catch w pain in activity faddir increases symptoms limp struggle with ADLs
76
non surgical FAI treatment
activity changes: avoid provoking activities NSAIDs PT: improve hip ROM and strengthen supporting muscles
77
surgical treatment FAI
arthroscopic clean out of damaged labrum/cartilage trim bony rim and femoral head
78
surgical vs conservative FAI treatment
surgical has better statistical difference between pre and post outcomes than physical therapy
79
FAI post op protocol phase 1
1: 4-6 weeks protect, restore ROM, control pain/inflam, NM control progress to 2 when FWB, 75% ROM, NM control patterns, minimal pain
80
FAI post op protocol phase 2
2: CKC exercise, balance, stretching, STM progress to 3 when pain free gait FWB, full ROM, 60% hip flexion strength
81
FAI post op protocol phase 3
3: restore muscular endurance and strength, NM control/balance/proprioception 6-8 weeks post op introduce single leg strengthening, closed chai
82
FAI post op protocol phase 4
4: sports specific, 8-16 weeks post op to return to sport need 85% hip flexion str, full pain free ROM, perform drills at speed, complete sport related testing plyometrics, mechanics, jogging
83
Common hip problems by age
newborn: congenital dislocation 2-8: avascular necrosis, legg calve perthes, synovitis 10-14: SCFE 14-25: stress Fx 20-40: labral tear 40+: OA

517 Ortho (11 decks)

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