Hip, groin and thigh Flashcards
(105 cards)
0
Q
For increased anterior pelvic tilt, what muscles are lengthened and which are shortened?
A
lengthened:Abs, piriformis, gluteus medius (stretched weakness)
Shortened: iliopsoas, gluteus maximus, TFL
1
Q
What are some problems at the hip that can occur?
A
- decreased flexibility
- joint hypomobility
- muscle strength imbalance
- nerve injury
- referred pain
- weight-bearing forces and movement transmitted to spine
2
Q
What can restriction in the TFL cause besides anterior pelvic tilt?
A
greater trochanteric bursitis and ITB syndrome associacted with knee and patellofemoral pain
3
Q
If you have increased anterior pelvic tilt, what observations might you see and what other movement might be resitricted?
A
Movement restricted: external rotation Observations: -forward head posture -increased thoracic kyphosis -IR of the femur -Genu Valgum -Pes Planus -Hallux Valgus
4
Q
Which muscles are stretched and which are shortened with an increased posterior pelvic tilt?
A
Stretched: iliopsoas, gluteus max, back extensors (stretched weakness may be present)
shortened:rectus femoris, hamstrings, abs, gluteus medius
5
Q
With an increased posterior pelvic tilt, what can happen with decreased lumbar lordosis?
A
you have decreased shock attenuation, possible increase risk of injury
6
Q
what observation might you see with increased posterior pelvic tilt?
A
- hip extension
- IR or the femur
- genu recurvatum
- genu varum
- pes planus
7
Q
Describe swayback posture?
A
- entire pelvis shifted anteriorly
- hip extension
- increased lumbar lordosis and thoracic kyphosis
- forward head
8
Q
What muscles are shortened and which are lengthened with swayback?
A
Shortened: upper abs, lower lumbar extensors, glute max, and hamstrings
lengthened: lower abs, thoracic extrensors, iliopsoas and recuts femoris
9
Q
What observations might you see with swayback?
A
- frontal plane asymmetry
- pelvic drop
- may shift weight to one side
10
Q
Observations of military posture?
A
- decreased in curves of spine
- depressed scapula
11
Q
what muscle dysfunctions can you have that is associated with military posture?
A
- anterior cervical
- thoracic erector spinae
- scapular retractors
12
Q
With military posture what observations might you see?
A
- protracted or retracted jaw (TMJ problems?)
- thoracic outlet syndrome
- decreased shock attenuation
13
Q
What can joint pain and hypomobility be due to?
A
- degenerative changes (OA and RA)
- aseptic necrosis
- slipped capital femoral epiphysis (SCFE)
- congenital deformities
- dislocations or fractures
- post-immobilization after fracture or surgery
- swelling after surgery
14
Q
describe aseptic necrosis
A
it's the same as avascular necrosis -death of the bone -blood supply to bone is disrupted can be caused from: --trauma --chemottherapy --perthes disease
15
Q
what is perthes disease?
A
- occurs in kids 4-10 years old
- etiology unknown
- can be because blood supply is disrupted
16
Q
What congenital deformities can occur at the hip?
A
- congenital hip dysplasia
- femoral retroversion (grasshopper patella, tibial ER)
- femoral anteversion (squinting patella, tibial IR)
- coxa vara or coxa valga
17
Q
What can muscle imbalances cause in the hip?
A
- dominance of one muscle over another
- strength deficits
- length deficits
- altered proprioception and neuromuscular control
- postural impairments
- TFL dominates glute med
- ITB syndrome
- PFPS syndrome
- iliopsoas is weak
- the other hip flexors dominate ( rectus femoris, TFL, Sartorius)
- hamstrings are strong, glute max disuse
18
Q
When the TFL dominates the glute med what does that mean?
A
- glute medius is weak
- increased tension on ITB- pull on ITB
- valgus collapse at the knee-can cause patellar femoral pain because of hip muscle weakness- can cause ACL injury
- dynamic increase in Q-angle
19
Q
When your hamstrings are too strong what can happen?
A
loss of flexibility of glut max results in loss of hip flexion ROM
- compensate with excessive lumbar spine flexion
- increased tension on ITB (associated knee pain or greater throchanteric bursitis possible
20
Q
When you have overuse of hamstrings what can happen?
A
- cramping
- decreased flexibility
- imbalances with quads ( altered pull on the tibia may result in PFPS)
22
Q
What does PFPS stand for?
A
patellar femoral pain syndrome
23
Q
What nerve injuries can happen at the hip?
A
- sciatic nerve
- obturator nerve
- femoral nerve
- radiculopathy (treat source?)
24
Q
How can you injure the sciatic nerve?
A
entrapment as nerve passes under (sometimes through) piriformis
25
How can your injure the obturator nerve?
rare, but may be damaged during labor due to uterine pressure
26
How can you injure the femoral nerve?
- fracture
- reduction of dislocation
- during labor and delivery
27
What can cause a muscle strain, pull or tear?
- stretched muscle is forced to contract suddenly
- fall or direct blow
- overstretching
- overuse
28
What muscles are mostly injured by strain, pull or tear in the hip? and why are they most commonly injured?
- hamstrings, quads, adductors
| - because they are big, strong muscles groups
29
Which muscles between hamstrings, quads and adductors are most commonly injured and why?
hamstrings and quads because they cross the hip and knee and they are used in high speed activities
30
What can predispose (risk) for muscle strains?
increases if prior injury to the area
31
What is the severity of muscle strains?
stress/strain curve
- mild (strain or pull)
- moderate (tearing of some fibers)
- severe (tear)
32
What are the signs and symptoms of a muscle strain?
- pain
- redness
- warmth
- swelling
- loss of strength (depends on severity)
33
Describe Grade 1 for a muscle strain?
minimal loss of strength
34
Describe Grade 2 for a muscle strain?
strength is compromised
35
Describe Grade 3 for a muscle strain?
rupture of the muscle
36
Describe what is going on if a muscle strain is strong and painful?
suggests minor problem with muscle, tendon or attachment
37
Describe what is going on if a muscle strain is strong and painless?
Nothing wrong with the contractile structures
38
Describe what is going on if a muscle strain is weak and painful?
- suggest partial tear
- pain causing non-compliance with the test (patients do not like pain)
- painful inhibition due to fracture or tumor (rare)
39
Describe what is going on if a muscle strain is weak and painless?
- complete rupture of muscle/tendon
| - impaired nerve function q
40
What do you do for rehab during the acute phase of an injury?
- price
- isometrics
- OKC exercises
- upper body and core strengthening
41
What is the clinical milestone for the acute phase of remodeling?
Concentric adduction against gravity
42
What do you do for rehab during the subacute phase of an injury?
- initiate concentric adduction exercises
| - initiate CKC exercises
43
What is the clinical milestone for the subacute phase of remodeling?
injured side approximately 75-80% strength of the uninjured side
44
What do you do for rehab during the return to sport phase of an injury?
- sport specific activities
- plyometrics
- advanced strengthening
45
What is the clinical milestone for the return to sport phase of remodeling?
strength 90-100% of uninvolved side
46
What is the risk for injury for the adductors?
- adductor muscle strength
- ratio or ABD/ADD strength
- flexibility
47
Which adductor is most commonly injured?
adductor longus
48
What sports are adductor muscle injuries common in?
hockey and soccer
49
How do you prevent muscle injuries?
By strengthening and flexibility
50
What does the adductor muscles do in CKC?
stabilizes the lower extremity and trunk
51
How are the hamstrings injured?
rapid acceleration or deceleration with an eccentric load (any sport with sprinting)
52
What are the risk factors for hamstring muscle injury?
- strength deficit
- flexibility
- endurance
- poor core stability
- poor lumbar posture
53
What is the make up for the hamstrings?
primarily fast twitch
| respond to powerful movements
54
is a hamstring muscle injury common or not?
it is very common and it has a high reoccurrence rate (22-34%)
55
Which quad is most commonly injured?
rectus femoris
56
Where is the most common location, in the hip, for an avulsion fracture?
- ischial apophysis
- ASIS
- AIIS
57
how do you treat an avulsion fracture?
- rest initially
| - pain free progression of ROM and strengthening
58
What is the MOI for an avulsion fracture?
-sudden, forceful, eccentric or unbalanced contraction of the musculotendinous unit at the apophysis
59
What is an apophysis?
a bony projection of the epiphysis and does not play a role in longitudinal growth of the bone
60
In which population is avulsion fractures common in?
- adolescents
| - in adults the same MOI would result in a torn ligament or tendon
61
Describe a Hip pointer?
- trauma at the iliac crest
| - can be contact (sports) or non contact (fall)
62
Describe grade 1 for hip pointer?
pain and tenderness, but gait and posture are not abnormal
63
Describe grade 2 for hip pointer?
painful, tender, swelling, gait deviations
64
Describe grade 3 for hip pointer?
severe pain, swelling, bruising, and limited ROM and gait deviations
65
How do you rehab a hip pointer in all phases?
- acute: protection
- subacute: restore full ROM and flexibility
- return to sport: progress strengthening pain free
66
if a bruise is not treated correctly what can occur?
it can turn into a myositis ossifican
67
Describe grade 1 for hip contusion?
mild discomfort on palpation
68
Describe grade 2 for hip contusion?
attempting to continue activity will cause injury to become progressively disabling
69
Describe grade 3 for hip contusion?
muscle herniates through the fascia
70
How do you rehab a muscle contusion?
- PRICE
- initiation of AROM
- initiation of pain free strengthening and return to function
- stretching occurs late phase of rehab (why?)
71
Describe a myositis ossifican?
- ectopic bone production occurs after an injury to the periosteum of the bone
- can occur without injury to the bone if the contusion is severe enough
- can be removed surgically but you should wait 1 year if you do
72
Describe anterior hip dislocation
- extension, ER, and ABD
| - force the femur out of the front of the acetabulum
73
Describe posterior hip dislocation
- flexion, IR, and ADD
| - force the femur head out of the back of the acetabulum
74
how can you dislocate the hip by trauma (most common)?
motor vehicle accidents, after total hip replacement surgery
75
Is a hip dislocation a medical emergency? why?
FUCK YES!
| -nerves and vascular shit like arteries are in the way
76
how can you tear the labrum in the hip?
twisting movement during weight bearing
77
labral tear is a predisposition for what?
hip osteoarthritis
78
what is the acute signs and symptoms for labral tear?
- pain in the groin or front of the hip
- pinching sensation
- giving way of the leg
79
which type of labral tear do you operate on?
large tears because they cause instability
80
How do you manage the joints without surgery?
- stronger the muscles are that support the joint
- better weight distribution across that joint
- better control of the body
- reduce weight will recuse forces across the joint
81
Describe the posterior lateral approach for total hip arthroplasty?
- muscles/structures cut: ITB, glut max, short ER
- glut med intact
- highest incidence of post op instability
82
why is hip in neutral for hip arthroscopy?
- flexion brings sciatic nerve too close to the joint
| - extension brings femoral nerve too close to the joint
83
What is the rehab for 4-8 weeks post op?
- NWB for 4-8 weeks
- but can only do OKC exercises
- stationary bike my be ok also
84
What is the rehab for acute phase after surgery?
- restore ROM
| - pain free exercises->isometric (LE and core exercises)
85
What is the rehab for repair and remodeling phase after surgery?
- restore strength and ROM
- pain free progression (don't forget balance)
- return to ADL or sport activities
86
describe a bursitis and how it can occur
- inflammation due to excessive fiction or shear forces
- overuse, altered mechanics
- post traumatic: direct blow or contusion resulting in inflammation
87
Where is the most common bursitis?
greater throchanteric bursitis
88
how do you treat a bursitis?
- restore flexibility and strength balance
| - may need to assess walking or running mechanics
89
Describe intraarticular snapping hip
- loose bodies
- labral tears
- osterocartilaginous exostosis
- synovial chondromatosis
- subluxation
90
Describe extraarticular snapping hip
- ITB snapping over the greater trochanter
| - iliopsoas snapping over the pelvic brim
91
how do you treat a snapping hip?
- restore balanced ROM, flexibility and strength
| - dynamic assessment (walking or running gait)
92
What can pathologically cause hypomobility?
- osterarthirits
- Rheumatoid arthritis
- necrosis
- congenital deformities
93
What can naturally cause hypomobility?
- aging
- trauma
- repetitive stresses
- obesity
- disease
94
What are some degenerative changes that can occur in the hip?
- loss of motion
- loss of strength
- cartilage breakdown
- capsular fibrosis
- osteophytes
95
What are the three different type of hip surgeries?
- total hip athroplasty (precautions depend of surgical approach
- hip hemi arthroplasty
- hip resurfacing
96
What are the precautions for posterior lateral approach for total hip arthroplasty?
no flexion beyond 90, ADD, IR in combination
97
Describe the anterior approach for total hip arthroplasty?
- muscles/structures cut: rectus femurs can attach on the joint capsule
- less blood loss
- less pain
- shorter hospital stay
- faster functional recovery in the short term
98
What are the precautions for anterior approach for total hip arthroplasty?
TRICK QUESTION!!! there are none!
99
What are weight bearing considerations for post op rehab?
- may be partial weight bearing or ORIF (open reduction internal fixation)
- depends on the surgeon
100
What can you do in acute phase for post op rehab?
- get them functional so they can go home
| - home care PT
101
What can your do in repair and remodeling phases for post op rehab?
- restore ROM and strength
| - restore functional abilities
102
What hip surgeries all need an open reduction internal fixation (ORIF)
- femoral neck fracture
| - femoral shaft fracture
103
In what population is hip surgeries most common in?
- elderly
- 75-85 years old
- age related loss of strength balance, and gait deficits
- osteoperosis
- did the trauma cause the fracture or did the fracture cause the fall?
104
is it common or rare for a person is PROM after hip injury
- rare that a person is PROM after a lower extremity injury or surgery
- may be NWB or have use limitation instead
105
How do you know if the patient is doing the exercise correctly?
- stabilization appropriate
- position of patient is appropriate
- resistance occurring in proper plane of motion (change the resistance?)
