Hip Flashcards
1
Q
what type of joint
A
synovial
ball and socket
2
Q
Acetabulum faces
A
ant, inf, and lat
3
Q
Labrum function
A
deepens the acetabulum
increases stability
4
Q
Angle of inclination
A
through neck of femur, down shaft of femur
5
Q
Angle of inclination - small
A
coxa vara
greater shear force on the neck of the femur
abduction ROM decreases
6
Q
Angle of inclination - large
A
coxa valga
7
Q
Angle of anteversion
A
HOW TO MEASURE
40 in infants
12-14 in adults
8
Q
Angle of anteversion - small
A
Retroversion
toe out
9
Q
Angle of anteversion - large
A
Anteversion
toe in
10
Q
Articular capsule - strong in what way
A
dense and strong ant
thin and loose post
11
Q
Iliofemoral ligament
A
limts add
excessive ext
ER
12
Q
Pubofemoral
A
limits abd
ext
13
Q
Ischiofemoral
A
limits excessive ext
IR
add
14
Q
Transverse acetabular lig
A
inc stability in inf direction
prevents dislocation with abd
15
Q
LIgamentum capitis
A
protects blood supply
16
Q
Osteokinematics - open chain
A
femur on pelvis
convex on concave
OPP
17
Q
Osteokinematics - closed chain
A
pelvis on femur
concave on convex
SAME
18
Q
Most congruent/stable position is what
A
ext, abd, IR
19
Q
Intracapsular pressure
A
less than atmospheric - stabilizes
20
Q
Area with no trabeculae
A
Wards triangle
21
Q
Joint reaction force with gait
A
high just after heel strike and during toe off
22
Q
With knee extended, hip flexion is
A
limited by passive insufficiency of the hamstrings
active insufficiency of the rectus femoris
moment arm of gravity
23
Q
With knee flexed, hip extension is
A
limited by active insufficiency of the hamstrings, passive insufficiency of the rectus femoris
24
Q
Trendelenburg SIGN
A
Lean towards side of pain and instability
dec JRF
unload the painful side
Pelvis will drop to other side because of weakness
25
Flexors are innevated by
femoral nerve
26
Flexors
```
psoas major
iliacus
TFL
sartorius
rectus femoris
```
27
Extensors are innervated by
sciatic nerve
28
Extensors
```
glut max
glut med
semitendinosus
semimembranosus
biceps femoris
```
29
Adductors are innervated by
obturator nerve
30
Adductors
```
adductor magnus
adductor longus
adductor brevis
gracilis
quadratus femoris
```
31
Abductors are innervated by
gluteal nerve
32
ER
```
glut max
piriformis
obturator internus and externus
gemelli
quad femoris
sartorius
iliopsoas
post glut med and min
biceps femoris
```
33
IR
```
ant glut med and min
TFL
adductor longus
adductor brevis
pectineus
semitendinosus
semimembranosus
```
34
Hip pain can be referral from
```
lumbar
SI
viscera
testicle
hernia
lymphadenopathy
ovaries
pelvic inflammatory disease
prostatitis
UTI
systemic disease
```
35
Common path based on age - 0 to 2
congenital dysplagia/dislocation
| importnatn to catch early
36
Common path based on age - 2 to 5
transient synovitis
| infections
37
Common path based on age - 5 to 10
legg calve perthes disease
transient synovitis
slipped femoral epiphysis
38
Common path based on age - 10 to 20
OA from injury
hip fracture from trauma
labral tear
39
Common path based on age - 20 to 50
OA from injury
hip fracture from trauma
labral tear
OP
40
Common path based on age - over 50
OA
hip fracture from fall
OP
41
barlow maneuver
listen for click while mvoing baby hp down
42
ortolani
listen for click rotating hip in/out
43
Tx for congenital hip dislocations
neo - hip abd, ER, flex (pavlik)
6m - 6yrs = reduction is needed (LE immobilized)
7-10 yrs = maybe surgery depending
11+ = usually surgery
44
Leg calve perthes is what
osteochondritis of the femoral capital epiphysis
ossification center necrosis
cause is unknown
eipphyseal plate breaks down and become necrotic
45
Leg calve perthes - more common in
males (5x)
ages 2 to 12
caucasians
46
Leg calve perthes s/s
pain with ambulation
| gradual insidious onset of pain, aching in hip, thigh, knee and tender hip casule
47
Slipped capital femoral epiphysis
displacement of the femoral head on the femoral neck
painless and weak
Idiopathic
48
Slipped capital femoral epiphysis s/s
minimal vague pain
referred pain to the knee
Dec hip IR, abd, flex
antalgic gait - but not painful
49
Transient synovitis
idiopathic, inflammation of synovial membrane
quick onset
very severe pain
immediate flare up
50
Transient synovitis - who does it happen to
males before puberty
51
Transient synovitis - presentation
limping, hip pain, possible low grade
52
Inflammatory synovitis
history of RA
ankylosing spondylitis
systemic lupus erythematosus
53
Avascular necrosis
lack of blood circulation to the head of the femur
usually is secondary to something else
asymptomatic at first and then deep throbbing pain in hip/groin/thigh
loss of ROM
mm spasm
54
Septic arthritis
infection of the joint
acute pain
extremely painful
if not caught early can destory the joint
55
Degenerative joint disease (OA)
groin/throchanteric pain
morning sitffness, dec ROM
mm spasm, crepitus, pain with ambulation
56
OA - pos exam findings
```
Scour
FABER
tight iliopsoas and rectus
weak hip abd
antalgic gait
radiographs
```
57
OA - tx - acute
decrease inflammation
increase ROM
unload joint (aquatic)
58
OA - tx - subacute
inc ROM
exercise mm to slow disease process
HEP wthopen chain exercises
59
OA - tx - chronic
close chain gentle ex
| functional
60
HIp arthroscopy
remove loose bodies and treat acetabular labral lesions
61
Hip arthrodesis
fusion
indicated for youn (less than 30-35)
active pt with unilateral disease
gets rid of pain
62
Hanging hip
soft tissue procedure
mm release for OA
dec pain and inc function
63
Hip osteotomies
make larger area to absorb pressure
femoral (less than 50)
pelvic/acetabular - stringent pt population
64
Hemiarthroplasty
take femoral head off femur,step down shaft, replace with new metal head
65
Hip resurfacing
bone preserving alternative to THA for young pt
66
Labral tears - usual MOA
twisting/turning
| will hear a click or other noises
67
Labral tears - clinical presentation
pain, clicking, locking, giving way
68
Snapping hip syndrome
hear a pop every time the pt moves a certain way
| can be benign
69
Snapping hip syndrome - external
glut max tendon or ITB moving over the greater troch
70
Snapping hip syndrome - internal
iliopsoas tendon over lesser trochanter or anterior acetabulum
Iliofemoral lig over femoral head
71
Snapping hip syndrome - clinical presentation
dull, aching pain, associated with certain movements but no discrete area of tenderness
audible or palpable snap
normal imaging
72
Greater trochanteric bursitis
overuse injury
forceful adduction is a contributor
quicker onset nd more difuse than tendonitis
73
GT bursitis clinical presentation
achy diffuse tenderness at GT
pain with WB over surfaces in sidelying
pain with resisted abd, passive flex, passive add
pos obers
74
Iliopsoas/iliopectineal bursitis clinical presentation
localized pain/snapping with resisted hip flex or passive hip ext
tough to lift leg straight up, pain in lower abdomen
pt often thinks it is a hernia
75
Piriformis syndrome
compression of the sciatic nerve as it moves through piriformis
76
Piriformis syndrome - clinical presentation
pain with palpation, radiates down leg
dull/achy pain in buttock and point tenderness in buttock
sitting and walking inc pain, going upstairs is painful
paresthesias and weakness
77
Ischial bursitis
often happens in sprinters using hamstrings to push off
overuse injury
can also be from prolonged sitting
78
Classification for hip mm strain/tear
grade I - little tissue damage, mild inflammation, pain with normal strength
grade II - dec strength, ROM, significant pain, disruption of fibers
grade III - complete rupture, loss of strength, limited pain, palpable defect
79
Adductor mm strain - caused by
forceful stretch of mm
most commonly gracillis or adductor longus
acute proximal pain over medial thigh, might radiate into rectus abdominis
80
Adductor mm strain - pain with
active and passive ROM, palpation
81
Hamstring mm strain
most commonly strained mm
usually at origin
Inc risk with excessive hip flex and knee ext
eccentric force injury is common
82
Quad mm strain
often rectus femoris
| often from rapid deceleration
83
Osteitis pubis
inflammation of pubic symphesis from repetitive stress
| pain in groing, mm spasm
84
Iliac crest contusion (hip pointer)
contusion of iliac crest, ASIS, or both
pain and tenerness
if tender at insertion - need xray to rule out avulsion
85
Avulsion fractures are most common in who
adolescents
86
Femoral neck fracture - clinical pres
acute onset of pain
unable to WB
shortened and ER LE
87
Femoral neck fracture - classes
```
class I - incomplete
class II - complete, non displaced
class III - complete, partial displacement
class IV - complete, total displacement
```
88
Intertrochanteric fracture- description
between trochanters
89
Intertrochanteric fracture - types
I - a line
II - displaced a little bit
III - spiral
IV - total displacement
90
Subtrochanteric fracture - description
righ tbelow the trochanters
| classified by degree of displacement and number of fragments
91
Hip dislocations - anterior from what movement
forced into abd, ER, ext
| less common
92
Hip dislocation - posterior from what
forced into add and flex
| more common
93
Meralgia paresthetica
abnodmal distribution of lateral femoral cutaneous nerve on sensory exam
lateral tight goes numb
94
Capsular pattern
IR then flex then abd then ext
95
If strong and painless
normal or isolated minor pathology
96
If strong and painnful
minor/mod pathology of mm, tendon, or burssa
97
If weak and painful
more acute or major path of mm tendon or burs
| could also be fracture
98
If weak and painless
serious pathology
nervous system
tumor
99
Trendelenberg sign
weakness of glut med
pt standing and asked to lift leg
(+) if ipsilateral hip drops
100
90/90 hamstring test - pos if what
knee is unable to reach 10 degrees from neutral (lacking 10 or more of extension)
101
Craigs test
abnormal femoral anteversion angle
pt pron with knee flexed to 90
palpate GT and slowly move hip through IR/ER
when GT feels most lateral stop and measure the angle - normal is 8-15 of IR
less than 8 = retroversion
greater than 15 = anteversion
102
Resting hip position (loose packed)
30 flex
30 abd
Slight ER
103
CLose packed hip
max ext, IR, and Abd
