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AT 531: Pathology > Hip > Flashcards

Hip Flashcards

1
Q

Coxa Vara

A
  • Angle is approximately 90 degrees (<125)

- Excessive stress through femoral epiphysis, (short leg)

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2
Q

Coxa Valga

A
  • Angle > 125 degrees

- Excessive stress on femoral head (long leg)

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3
Q

Femoral Anteversion

A
  • Greater than 15 degrees anteverted
  • Causes in-toeing/excessive hip IR
  • xray/craig’s test
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4
Q

Femoral Retroversion

A
  • Less than 12 degrees ante version
  • Causes out-toeing/excessive hip ER
  • Xray/Craig’s test
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5
Q

Legg-Calve-Perthes Disease

A

“Coxa Plana”

  • Avascular necrosis of the femoral epiphysis with onset between 4-8 years
  • Death of tissues at femoral head
  • S&S: Pain in hip, thihg, or knee; limping; loss of abduction, ext and ER; thigh atrophy
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6
Q

Slipped Capital Femoral Epiphysis (SCFE)

A
  • Epiphysis gradually or suddenly slips downward and backward in relationship to the femoral neck
  • Most common in boys 10-16
  • Risk Factors: obesity, coxa vara, medications, hypothyroid, radiation tx, bone problems
  • S&S: Pain in groin, limp, knee; flexion comfort; loss of AROM IR hip; SLS difficulty; passive flexion hip will ER
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7
Q

Femoral Acetabular Impingement

A

-Bone spurring from overuse can cause damage to the labrum as well as the cartilage
-FAI can be resolved with the bone spurs being burred or remodeled
Types:
-Cam = on femoral head
-Pincer = on acetabulum
-Mixed

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8
Q

Precursors to FAI

A

Ages: 25-60

  • Retroversion
  • Hx of femoral neck fx
  • Hx of SCFE
  • Hx of L-C-P disease
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9
Q

FAI Presentation

A
  • C Sign dull, aching pain
  • Positve FADIR
  • Limited hip IR ROM with hip 90 degrees flexion in supine
  • Leads to labral tear, which leads to Osteoarthritis
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10
Q

5 Causes of Labral Tear

A
  1. Trauma
  2. FAI
  3. Capsular laxity/hypermobility
  4. Dysplasia
  5. Degeneration
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11
Q

DX of Labral Tears

A
  • Groin Pain: C sign
  • Painful/limited IR and Abduction
  • +FADIR’s
  • +FABERs
  • +Hip Scour
  • +MRI
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12
Q

TX of Labral Tears

A

10-12 week rehab tried before surgery

  • Optimize hip alignment
  • Stabilize hypermobile hip
  • Joint mobes and stretching on hypo mobile hip
  • Limit activities for healing
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13
Q

Hip Pointer

A
  • Contusion to iliac crest

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

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14
Q

Hamstring Strain Tx

A
  • Acute rehab: onset of injury - 3 days (0-3 reduce swelling)
  • Subacute rehab:day 4-7
  • Chronic Rehab: around day 7
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15
Q

Hip Dislocations

A

Etiology: MVA most common; in sports occur with force through long axis of femur when knee is flexed
Types:
-Anterior = MOI: forced hip flexion, abduction, and ER
-Posterior = MOI: landing on a flexed knee while the hip is flexed, adducted and IR

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16
Q

Posterior Hip Dislocation

A

S&S:

  • severe hip and thigh pain
  • Referred pain in knee
  • Hip positioned in flexion, adduction, and IR
  • Inability to walk
  • Possible neurovascular complaints
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17
Q

Hip Dislocations: Management

A
  • Stabilize and transport to ER
  • Need closed reduction within 24 hours
  • Post reduction, limb is held in traction 1-2 weeks
  • 5-7 days post reduction, open chain AROM exercise is initiated
  • Screen for AVN, acetabular tear and future hip OA(50% of all pts)
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18
Q

Apophysitis

A

-Inflammation of the apophysis from overuse: often seen in long distance running= can lead to avulsion fx
S&S: loss of strength, loss of hip motion, point tender

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19
Q

Hip Stress Fractures

A

-Seen mostly in distance runners with femoral neck and pubic ramus(abs and adductor pain) (women>men)
S&S: groin pain, aching in thigh with activity, hard for SLS
Tx: rest, min weight bearing 2-5 monte, rehab

20
Q

Femoral Fracture

A

MOI: direct trauma or indirect, such as landing on a leg in an extended and rotated position
S&S: sudden severe pain, loss of function, direct and indirect tenderness
-Could lead to AVN
Tx: fixation intramedullary rod

21
Q

Trochanteric Bursitis

A

MOI: inflammation of the bursa or gluteus medius from overuse, muscle imbalance, LLD, SLE(lupus) and RA
S&S: lateral hip pain that may refer distally, point tender
Tests: Asymmetrical leg length, weak glute med, tight TFL
Rx: RICE acutely, find cause and fix

22
Q

Iliopectineal Bursitis

A

MOI: Excessive compression during hip flexion(long distance runners)
S&S: deep anterior hip pain, pain w/ deep palpation(pectineus), pain with resisted hip flexion
-Negative FADIR’s

23
Q

Snapping Hip Syndrome

A

Anterior: SLR = iliopectineal bursitis or Labral tears
-palpate pectineal area for bursitis, FABERs/FADIRs for labral tears
Lateral: Proximal ITB friction w/ or w/out pain
-With pain = greater troch bursitis

24
Q

Hip Osteoarthritis

A

S&S:
-deep joint aching
-Sore in morning; better throughout day; worse at night
-could refer to knee
Tests: Scour test, radiograph
Management:
-Stretch tight muscles, light cardio, joint moves to decompress, open chain exercises

25
Q

Total Hip Replacement

A 
Avoid: 
-Flexion greater than 90
-Hip adduction
-Hip extension with IR
Complications:
-INFECTION
-DVT= blood clot
-DVT in calf leads to embolus
26
Q

Sports Hernia

A 
-Tear in muscular tendons of hip adductors, RA, and Obliques at pubic ramus = could lead to surgery because of low healing rate of tendons
S&S: inguinal pain with palpation
Tests: resisted oblique MMT
-Resisted adductor test
-Kicking w/ flexion/adduction
-MRI
27
Q

Self-Locked (CPP) of SI joints

A
  • Full posterior innominate rotation; lifting in a squat

- Sacral Nutation during active flexion and extension of the spine

28
Q

Pelvic girdle in Open pack position

A
  • Spine neutral

- supine, standing, sitting upright, and during gait cycle

29
Q

Form Closure

A

-The ability to transfer loads through the PG, while keeping the joint surfaces stable
Includes:
1. Ligaments
2. Bony and joint integrity

30
Q

Force Closure

A

-Optimal muscle function provides the PG with dynamic stability

31
Q

Local muscle Force Closure

A
  • Pelvic floor muscles
  • Diaphragm
  • TA
  • Lumbo-sacral multifidi
32
Q

Global muscle Force closure

A
  • Opposite Lats and flute max
  • Abdominal Obliques and adductors
  • Gluteus medius in weight bearing
33
Q

Posterior Oblique Sling

A

-Left lats and right glute max

34
Q

Anterior Oblique Sling

A

-External Oblique and opposite adductors

35
Q

The Lateral Sling

A

-Stance leg glute med and adductors and opposite side quadratus Lumborum

36
Q

Deep Posterior Sling

A
  • Biceps femoris coupled with the erector spine through the sacrotuberous ligament
  • Contraction of the biceps femoris pulls the sacrotuberous taut, assisting in stabilization of the sacroiliac joint
37
Q

Emotional-Awareness

A
  • Chronic pelvic pain may be tied to chronic stress and negative lift experiences
  • May result in hypertonic muscle firing
  • Over-activationt of pelvic muscles = overly compressed joint surfaces = pain
38
Q

Hyper-Abduction of hip

A

-Separation force of the pubic Symphysis

39
Q

Hyper-flexion of hip

A
  • Posterior ilial rotation

- Stressed sacrotuberous and ilio-lumbar ligaments

40
Q

Hyper-Extension of hip

A
  • Anterior ilial rotation

- Stressed Short and long SI ligaments

41
Q

Hyper ER of hip

A

-Possible damage to anterior SI ligament and Pubic symphysis separation

Caused by:

  • Weak lateral sling
  • Hormonal= relaxin
  • Systemic hypermobility
  • Restricted hip motion may compensate at SI joint by becoming hypermobile
  • Beighton scale (Ehlers danlos syndrome-extreme weak collagen)
42
Q

Active SLR sign

A

SI joint hyper mobility

-0.9 SPIN and SNOUT

43
Q

Hypomobile SI joint

A
    • March and flare test
  • Local ligament tenderness
  • Referred pain in butt/thigh
    • pain provocation (squish test)
  • ASIS or PSIS asymmetry
  • Bilateral hip ROM Asymmetry
  • Negative hyper mobility tests (ASLR and posterior ilial translation, stork standing)
44
Q

Hypermobile Pubic Symphysis

A
  • MOI= childbirth or forced Hip abduction or ER
  • systemic hypermobility: beighton over grade 5
  • Hormonal influences
  • Poor tolerance to sitting, standing, walking
    • pain over pubic tubercles
    • pain/spasm of adductors or RA
    • ASIS gapping test
    • FABER test
45
Q

Hypermobile SI joint

A
  • Hx of systemic hyper mobility
  • Hormonal
  • SIJ pain or referred to butt/thigh
  • Difficult holding trendelenberg
    • squish test, ASIS gapping and or FABER’s
    • ASLR
    • Posterior ilial translation test
  • BIlateral hip ROM asymmetry
46
Q

Prolotherapy

A
  • The intraligamentous or intratendinous injection at a fibro-osseous junction (SI or PS) of a solution that induces a temporary inflammatory reaction
  • This causes an influx of fibroblasts that synthesize collagen at the injection site leading to the formation of new ligament and tendon tissue
47
Q

Candidates of Prolotherapy

A
  • Patients with disabling joint pain and instability that has lasted greater than 6 months
  • Significant joint instability

AT 531: Pathology (2 decks)

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