HIP Flashcards
(82 cards)
1
Q
MSK: hip
traumatic hip arhritis
A
trauma can damage the cartilage and/or the bone, changing the mechanics of the joint and making it wear out more quickly. The wearing-out process is accelerated by continued injury and excess body weight.
2
Q
A
- Subtrochanteric Fx
- Young or middle aged
- If ORIF fails (non-union), then it is repeated with bone grafting
3
Q
MSK: hip
Acetabular fracture MOI
A
trauma
femoral head is driven into pelvis
4
Q
MSK: hip
Complaints of morning stiffness, stiffness after sitting, and hip pain with weight-bearing are suggestive of joint involvement, such as
A
- OA
- RA
- avascular necrosis
5
Q
MSK: hip
Advantages of THR anterior approach surgery
A
- reduced risk of dislocation since no damage to to short external rotators muscles.
- Barelly any precautions:
- soft tissue precautions
6
Q
MSK: hip
Meralgia paresthetica:
A
- Is pain or an irritating sensation felt over the anterior or anterolateral aspect of the thigh due to injury, compression, or disease of the lateral femoral cutaneous nerve.
7
Q
MSK: hip
Which THR approach is technically easier, takes less OR time, less blood loss, less impact on abductor function?
A
Posterior Approach
- “This is the classic approach that many older surgeons refuse to give up” (Dr. M).
8
Q
MSK: hip
The piriformis is an___________of the hip at less than 60 degrees of hip flexion. At 90 degrees of hip flexion, the piriformis reverses its muscle action, becoming an ___________ of the hip
A
- external rotator
- internal rotator and abductor
9
Q
MSK: hip
Disadvantages of THR lateral approach approach surgery
A
abductor weakness
10
Q
MSK: hip
OUTPATIENT HIGH PRIORITY CHECKLIST for THR
A
- Hip IR/extension ROM
- Neuromuscular control of gluteal muscles
- Lumbopelvic control
- Balance and proprioception
- Gait training
11
Q
MSK: hip
HIP ARTHRITIS:
A
- Capsular pattern limitation (IR, FLX)
- Groin or anterior thigh pain
- Nontraumatic or traumatic.
12
Q
MSK: hip
Acetabular fracture will require what type of examination?
A
Neurological examination (sciatic nerve)
13
Q
MSK: hip
MOI of femoral shaft Fx:
A
trauma
14
Q
MSK: hip
Mobilization to increase IR
A
- supine
- flx & add, posterior glide
15
Q
MSK: hip
THR, greatest factors associated with adverse outcomes:
A
- Advanced age (>70)
- Medical co-morbidities: CHF, CRF, DM
16
Q
MSK: hip
Which THR approach has the highest rate of hip dislocations?
A
posterior approach
17
Q
MSK: hip
Walking on heels test which dermatome?
A
L4, dorsiflexion
dermatome: medial leg, medial foot
18
Q
MSK: hip
displacement of femoral neck fracture will disrupt the blood supply and cause and may cause:
A
avascular necrosis
19
Q
MSK: hip
During a resisted testing (prone), a manual isometric resistance given for hip extension.
What muscle istested if the test is performed with the knee in flexion?
What muscle istested if the test is performed with the knee in extension?
A
- Hip extension, knee flexion: glut maximus
- Hip extension, knee extension: hamstrings
20
Q
MSK: hip
A post menopausal woman with osteoporosis steps out of the shower, then falls. What type of Fx is most likely to occur in this situation?
A
Fx of the femoral neck
21
Q
MSK: hip
Special test Straight Leg Raise results:
A
- (+) bet 50-70 deg = discs
- >70 deg = hamstring muscle lenght
22
Q
MSK: hip
Traction to increase hip extension:
A
- prone:
- indirect: ext limit + ADD/ER
-
direct mob:
- with knee flx ((towel under ISIS), PA mobs
- FABER
23
Q
MSK: hip
Legg–Calvé–Perthes disease (LCPD) AKA
A
Ischemic necrosis of the femoral head
24
Q
MSK: hip
which THR has the lowes rate for dislocation?
A
anterior approach
25
# MSK: hip
Precaution after surgery is not becasue surgeans are concerned about the prothesis not being able to handle the compressive forces. Surgean are concern about...
the **soft tissue** disection had no had a chance to heal
26
# MSK: hip
Normal gait speed:
* **Normal 1.2 - 1.4m/s**
* \< 1.0m/s require rehab
* \< 0.6m/s increase fall risk
27
# MSK: hip
**predictors** that increase the likelihood of OA:
* Self-reported **squatting** as an aggravating factor
* **Active hip flexion** causing lateral hip pain
* **Scour test with adduction** causing lateral hip or groin pain
* **Active hip extension** causing pain
* Passive IR ≤ 25°
* 4/5 present +LR 24.5
28
# MSK: hip
Treatment of **avulsion fractures:**
* 4-6 wk pain control
* rest
* gradual return to activity
29
# MSK: hip
Causes of dislocation with posterior approach:
* Bending forward while putting on shoes
* Twisting the trunk sit/standing with feet planted
* Rising from a low toilet with hip in ADD/IR position
30
# MSK: hip
how does the leg presents in a **femoral neck fracture**?
shorter and externally rotated
31
# MSK: hip
Advantages of THR **lateral** approach approach surgery
* good exposure of acetabulum
* reduced risk of dislocation (no damage to short ER)
* reduced injury to sciatic nerve
32
# MSK: hip
disanvantages of THR **posterior approach:**
* Dettachment of ER muscles:
* Fascia lata is incised, fibers **glut max** are split
* Detachment of short ER, incise posterior capsule
33
# MSK: hip
Treatment of **femoral shaft Fx** in adults:
* Intramedullary rod for open Fx
34
# MSK: hip
Which myotome tests active resistance of **knee extension**?
**L3-L4** (L3 in board exams)
L2 ant mid thigh, L3 distal ant-medial thigh
35
# MSK: hip
True or false: intertrochanteric fx prognosis is better than femoral neck fx
true
36
# MSK: hip
Objective **examination** order:
1. Structural Inspection
2. Screening exam
3. Movement analysis
4. AROM
5. PROM
6. Resistive test (mmt)
7. Muscle lenght if needed
8. Special tests
9. Palpation
37
# MSK: hip
**Ischemic necrosis of the femoral head** (AKA Legg–Calvé–Perthes disease) occurs mostly in children of what age?
Children between 3-10 yr
38
# MSK: hip
types of disorders **with limitations:**
**(classification)**
* **Capsular pattern limitations**
* Ex. hip arthritis
* **Noncapsular pattern limitations:**
* ****Ex. Sliped capital femoral epiphysis
* Ischemic necrosis of the femoral head
39
# MSK: hip
Does a pt that walks at 0.8 m/s require rehab?
yes
less than 1m/s require rehab
40
# MSK: hip
"Rotator cuff" of the hip:
* Glut medius/ max
* Sup/inf gemelus
* Obturator intternus
* Quadratus femoris
* Must function: **_decelerate the femur in close kinetic chain motion_**
* Proximal stability
41
# MSK: hip
Sharp pain:
labral tears, articular loose bodies, accompanied by a click, giving way, and a feeling of catching or locking
42
# MSK: hip
types of disorders **without limitations:**
## Footnote
**(classification)**
* **Buttock pain:**
* ****emerging from lumbo-scral/SIJ, hamstring syndrome, piriformis syndrome, hamstring tendinopathy, throcanteric bursitis
* **Groin pain:**
* ****Tendinopathy, osteitis pubis, femoroacetabular impigement.
* **Snapping hip:'**
* ****intra/extra articular
43
# MSK: hip
What is **Atelectasis**?
is the collapse or closure of a lung resulting in reduced or absent gas exchange
(a complication of THR)
44
# MSK: hip
**Complications** and **acute care** of THR:
* DVT or PE
* Pulmonary/cardiac issues:
* OH, anemia, pneumonia
* Acute care: **screening and prevention**
* ****Vitals, auscultations of lungs
* LE aligment (dislocation)
45
# MSK: hip
Hip arthritis, passive movement testing reveals capsular limitation with\_\_\_\_\_\_ being the greatest
**Internal rotation**
46
# MSK: hip
What does the CRAIG TEST measure?
the angle of **anterversion** / **retroversion** /
47
# MSK: hip
Posterior dislocation **treatment** and **complications**:
* Tx: closed reduction within 6 hours
* Complications:
* **avascular necrosis** over time
* Sciatic nerve injury
* Post-traumatic arthritis
48
# MSK: hip
Periarticular pain that is not reproduced by passive motion and direct joint palpation suggests an alternate etiology such as
bursitis, tendinitis, or periostitis
49
# MSK: hip
Posterior hip dislocation presentation:
short leg, adduction, and internal rotation
50
# MSK: hip
Most common indication for THR:
**osteoarthritis**
51
# MSK: hip
Which myotome test is useful to diagnose disc herniation problems?
**great toe extension L5**
52
# MSK: hip
After a hip replacement, what is the OUTPATIENT HIGH PRIORITY CHECKLIST?
1. Restablish hip IR/extension
2. Neuromuscular control of gluteal muscles
3. Lumbopelvis control
4. Balance and proprioception
5. Gait training
53
# MSK: hip
which THR surgical approach have less impact on **abductor function?**
**posterior approach**
54
# MSK: hip
What are the weight bearing precautions on **cemented implants** (THR)?
**Functional weight bearing immediately**
55
# MSK: hip
**Walking on toes** tests wich myotome?
**S1**
dermatome **Lateral side of foot**
56
# MSK: hip
Femoral head **blood supply**:
* profunda
* circumflex femoral
* small supply from artery of ligamentum teres
* displacement of femoral neck fracture will disrupt the blood supply and cause an intracapsular hematoma (avascular necrosis)
## Footnote
*(Femoral neck fracture?)*
57
# MSK: hip
What is the normal angle of anteversion?
15 deg
58
# MSK: hip
Intertrochanteric Fx treatment:
**ORIF** to avoid complications
59
# MSK: hip
Resistance to 1st toe extension test which myotome?
**L5**
dermatome: lateral leg
60
# MSK: hip
Treatment of **femoral shaft Fx** in children:
* Conservatively
* External fixation for open Fx
61
# MSK: hip
most hip replacement last how long?
* **\> 90% THR last 10 years, many last 20 years**
* 97% hip resurfacing lasts 8 years
* Rate of revision 3x higher younger males
62
# MSK: hip
Burning pain:
* nerve entrapment may be accompanied by paresthesias, numbness, and/or weakness, or sympathetic changes:
* (femoral, lateral femoral cutaneous, ilioinguinal, genitofemoral, obturator
63
# MSK: hip
Treatment and complications of acetabular fractures:
* Tx: ORIF if displaced
* Complication: post traumatic DJD (osteoarthritis)
64
# MSK: hip
The patient's age may help in the diagnosis. OA of the hip is diagnosed most often in patients over \_\_\_\_\_\_, although it can occur earlier.
60 years of age
65
# MSK: hip
Disadvantages of THR **anterior** approach approach surgery
**abductor dysfunction** secondary glut med tenotomy\*
(the surgical cutting of a tendon)
66
# MSK: hip
OA affects **\_\_\_\_\_%** of adults 65yo or older
33.6%
67
# MSK: hip
What dictates **post-operative walking ability** in primary and revision THR?
**Pre-operative function**
68
# MSK: hip
**Active hip flexion** with resistance test which myotome?
**L1-L2**
* L1 inguinal region
* L2 anterior mid thigh
69
# MSK: hip
Which muscles **decelerate the femur in close kinetic chain motion:**
* Glut medius/ max
* Sup/inf gemelus
* Obturator intternus
* Quadratus femoris
70
# MSK: hip
What are the weight bearing precautions on **non cemented** implants (THR)?
Weight bearing precautions 8 -12 weeks
71
# MSK: hip
predictors for succesful PT response in patients with hip OA:
1. Unilateral hip pain
2. Less that 58 y/o
3. Pain is greater than 6/10
4. 40 m walk test is less than 25 sec
72
# MSK: hip
**Posterior hip** dislocation MOI
* high-energy impact at position of adduction/flexion
* MVA
73
# MSK: hip
**Slipped Capital Femoral Epiphysis** occurs mostly in children what age?
teenagers, boys (13-15), girls (11-15)
74
# MSK: hip
Femoral neck Fx MOI?
caused by or result in **fall**
75
# MSK: hip
Traction to increase **hip flexion** (supine):
* Supine with belt
* **Indirect:** 30 deg flx, abd, ER
* **Direct:** AB/ER or AB/IR
76
# MSK: hip
Most common site for **avulsion fractures:**
* **ASIS** (sartorious, TFL)
* **AIIS** (rectus femoris)
* **Inferior pubic ramus** (adductors)
* **Ischial tuberosity** (hamstrings)
* **Lesser trochanter** (iliopsoas)
77
# MSK: hip
In what population do **avulsion fractures** occur more often?
* **In the younger population**, ligaments and tendons are stronger than bone.
78
# MSK: hip
Aching pain:
bursitis, tendinopathy, arthritis
79
# MSK: hip
Intertrochanteric Fx occurs more often in
Women over 60
80
# MSK: hip
**Treatment** and **complications** of femoral neck fractures:
* **Closed reduction**: may be considered in some patients who are non-ambulators, have minimal pain, and who are at high risk for surgical intervention
* **ORIF:** displaced fractures in young or physiologically young patients indicated for most pts \<65 years of age
* **Complications:** avascular necrosis, non-union,
DJD (osteoarthritis), death in elderly.
81
# MSK: hip
Mobilization to **increase AB:**
* supine, abd + ER
* inferior medial glide
82
# MSK: hip
wich group of muscles decelerate the femur in close kinetic chain motion during ambulation
"Rotator cuff of the hip":
1. Glut medius/ max
2. Sup/inf gemelus
3. Obturator intternus
4. Quadratus femoris
