Hip OA / mobility CPG Flashcards Preview

OCS Ciccarello > Hip OA / mobility CPG > Flashcards

Flashcards in Hip OA / mobility CPG Deck (13):
1

Hip OA

 

General:

  • moderate pain lateral/anterior hip while WB
  • >50
  • limited PROM in 2/6 directions
  • AM stiffness, improves in < 60 min

 

Altman

  • Hip internal rotation less than 15° (24o?) AND
  • Hip flexion less than or equal to 115° AND
  • Age greater than 50 years

OR

  • Hip internal rotation greater than or equal to 15° AND
  • Pain with hip internal rotation AND
  • Duration of morning stiffness of the hip <= 60 min AND
  • Age greater than 50 years

Sn 86%; Sp 75%; +LR 3.44, -LR, 0.19

 

2

Hip OA exam - outcome

A

  • Western Ontario
  • McMaster Universities OA index
  • LEFS
  • Harris hip score

3

Hip FAI

  • Risk factors: genetics & gender (M>F)
  •  

4

Hip outcome tools - non-OA

(STRONG evidence)

  • Hip coutcome score
    • MDC 3 pts
    • MCID 9pts ADL, 3 pts sports
  • Copenhagen hip and groin outcome score (HAGOS)
    • MDC 5.2
  • International hip outcome tool (iHOT-33)
    • MCID scope 6 points

5

Hip OA Risk Factors

  • Age
    • 60-64 AOR 1.3
    • 65-69 AOR 2.38
    • 70-74 AOR 2.38
  • Developmental disorders
    • LCP, SCFE, dysplasia
  • Previous injury
  • Reduced ROM, presence of osteophytes, lower socieconomic status, higher bone mass, higher BMI

 

6

Hip outcome tools - OA

(strong evidence)

  • WOMAC
    • MCID 12-22%
  • LEFS
    • MCID 9 pts
  • Hip Disability and OA Outcome Measure (HOOS)
  • LEFS
  • Harris Hip Score
  •  

7

Hip OA interventions

  • NSAIDs - Level I
  • CSI / visco supplementation - Level I
  • Glucoasmine/chondritin NOT recommended - Level I
  • Education - activity mod, exercise, weight reduction - Grade B
  • Functional, gait & balance training - Grade C
  • Manual therapy - Grade B-->A
  • ROM, flexibility/strength, aerobic conditioning - Grade B-->A
  • Ultrasound --> Grade B

8

Hip OA exam measures

  • 6 minute walk
  • 30-sec chair stand
  • stair measure
  • self-paced walk
  • timed up and go
  • timed single leg stance
  • four square step test
  • step test
  •  

9

FAI diagnosis

Clinical

  • anterior / lateral hip pain
  • "aching or sharp"
  • aggravated by sitting
  • reproduced with FADIR
  • IR < 20o at 90o of flexion
  • FLEX / ABD also limited
  • popping, locking, clicking

10

FAI diagnosis

(radiological)

  • Cam impingement
    • increased femoral neck diamter
      • alpha angle > 60
      • head-neck offset ratio < 0.14
  • Pincer impingement
    • increased acetabular depth
      • coxa profunda (lateral-center edge >35)
      • acetabular protrusion
    • decreased acetabular inclination
      • Tonnis angle <0
    • acetabular retroversion
      • crossover sign
      • ischial spine projection into pelvis

11

structural instability

(dysplasia)

Clinical

  • anterior groin, lateral hip, generalized pain
  • FADIR/FABER rpeduces
  • + hip apprehension
  • IR > 30 at 90o flexion
  • popping, locking, clicking

Radiographic

  • increased acetabular inclination
  • Tonnis angle > 10
  • Lateral center edge of WIber < 25
  • Anterior center edge angle < 20

12

Intra-articular injury

Clinical

  • anterior groin pain or generalized pain
  • +FADIR/FABER
  • popping, clicking, locking, snapping
  • may report feelings of instability

Radiological

  • MRA labral tear

 

13

Evidence-based tests & measures

(NOT OA)

Reliability

  • Trendelenburg 0.58
  • FABER 0.63
  • FADIR 0.58
  • Log roll 0.61
  • MMT (ABD)