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Clinical Medicine > Hip Pathology & Rehabilitation > Flashcards

Hip Pathology & Rehabilitation Flashcards

(61 cards)

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1
Q

What is the MOI for Hip OA?

A

Aging process or trauma

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2
Q

What is the patient population for those with Hip OA?

A

Common in >60 y/o
Women> Men

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3
Q

What is the patient presentation of Early DJD?

A

Pain (deep aching) in lateral hip, groin or along L3 dermatome (along anterior thigh & knee)

  • Stiffness in AM (better w/ movement)
  • Pain on WB during gait or at end of day after activity
  • Pain w/ sitting on low chair, crossing legs & putting on sock/ shoes
  • Antalgic Gait
  • ADLs become difficult
  • Commonly accompanied by limitation in back extension
    • finding confirmed w/ plain radiographs
  • Bilateral stance (less than ½ BW on each hip)
  • Unilateral Stance (3x BW due to muscular contraction, pain w/ stair climbing > walking on flat surface
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4
Q

In early DJD of the hip can positive finding be found on radiographs?

A

Yes

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5
Q

In addition to DJD why is osteonecrosis possible?

A

Excessive steroid use
Alcohol abuse
Excessive radiation
Trauma

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6
Q

What is the main symptom during end stage DJD?

A

Unrelenting pain

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7
Q

What is commonly needed because of hip OA?

A

Total Hip Repair

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8
Q

What are some specific things found on a radiogram that are consistent with hip OA?

A

Asymmetrical Joint Space Narrowing
Osteophytes
Subchondral Cysts
Subchondral Sclerosis

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9
Q

What is the clinical criteria for hip OA?

A

Hip internal rotation <15°
Morning Stiffness for < 60 min
Hip Flexion <115°
Pain w/ IR of hip
Age > 50 year

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10
Q

What are some special test used to diagnosis hip OA?

A

Dec flex/ IR ROM
Trandelenberg Sign
Scour
FABER

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11
Q

What are some treatment option to decrease effects of stiffness from Hip OA?

A

Stress importance of daily movement
ROM exercise (Stationary bike)

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12
Q

What are some treatment option to decrease effects of pain from Hip OA?

A

Decrease mechanical strain by using AD
Grade I or II osciliations
Stretching to correct muscle - length imbalances

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13
Q

What are some treatment options to increase ROM / strength in patients with hip OA?

A
  • Joint mobs (grade III or IV)
  • PNF stretching techniques to tight muscles (hip flexors/hip ABD)
  • Self stretching
  • Increase strength in supporting muscles (Hip ABD, Hip ext, quads)
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14
Q

What are some treatment options to increase endurance in patients with Hip OA?

A
  • Stationary bike
  • Swimming
  • Treadmill (has handles)
  • Walking around community
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15
Q

What are the 3 ways to evaluate the pelvis & hip with radiographs?

A

Antero-posterior pelvis
Antero- posterior hip
Lateral frog leg hip

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16
Q

What are some benefit to the AP Hip projection?

A

Enhanced detail
Improved profile greater tuberosity

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17
Q

What is the benefit of the lateral frog leg projection?

A

Allows profile of lesser tuberosity

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18
Q

What is a radiographic grade I ?

A

Doubtful narrowing of joint space & possible osteophyte formation

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19
Q

What is a radiographic grade 2?

A

Definite osteophytes, definite narrowing of joint space

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20
Q

What is a radiographic grade 3?

A

Moderate multiple osteophytes, definite narrowing of joint space, some sclerosis & possible deformity of bone contour

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21
Q

What is a radiographic grade 4?

A

Large osteophytes, marked narrowing of joint space

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22
Q

Grade 2 or greater for radiographic grade is a strong predictor of?

A

Hip OA progression

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23
Q

Grade 3 or 4 radiographic grade indicates?

A

4-5x higher odds ration that patient would have a THA

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24
Q

What radiographic grade will respond the best to treatment?

A

Grade 1

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25
What is the symptoms of labral tear?
- Pain experience in groin & hip - Locking or clicking of hip joint - Stiffness of hip - Limited ROM of hip - Sudden appearance of sxm after an incident is noticeable - Gradual development of sxm w/ progressive degeneration
26
What is the Asymptomatic incidence of labral tears?
40-54% (increase w/ age)
27
What is the symptomatic incidence of labral tears?
70% Median age (38 yr for males & 40 years for females) Male patients had a higher incidence of acute injury than females
28
What are the risk factors of labral tears?
Trauma Increased ROM Anatomic abnormalities
29
What are some special test for Labral Tears?
FABER Scour Anterior Labral Tear Test (FADDIR)
30
How are labral tears diagnosed?
MRIO arthrogram
31
What is Femoral Acetabular Impingement?
- Decreased joint clearance b/w femur & acetabulum
32
What does Femoral Acetabular Impingement cause?
Abnormal contact b/w femur & acetabulum ,particular when hip flexion is combined w/ adduction & IR
33
What other pathologies can Femoral Acetabular Impingement cause?
Labral tears Brin about progressive degeneration process leading to OA
34
What is a CAM?
Bony overgrowth of femoral neck
35
What is a PINCER?
Bony overgrowth of acetabulum
36
What are the main goals for Labral tear/FAI?
Relieve sxm Maintain function
37
What are the management strategies for Labral tears/FAI?
- Control inflammation/pain, joint mobs, ROM, maintain muscle length & strength - Limiting activities in frontal & sagittal plane - Lumbopelvic strengthening & stabilization - Surgery if needed
38
What is the population for Greater trochanteric bursitis?
Women > Men Middle aged women most commonly affected
39
What is the etiology of greater trochanteric bursitis?
Repetitive microtrauma Blunt trauma Idiopathic Active or sedentary patients
40
What is the typical patient presentation of those with Greater Trochanteric Bursitis?
Pain usually in region of greater trochanter & possible along lateral aspect of thigh - Usually worse w/ WB, sitting w/ crossed legs or w/ direct pressure - End of day pain is worst - Difficulty sleeping on painful side
41
What are some contributing factors to greater trochanteric bursitis?
- Leg length discrepancy - History of lateral hip surgery - Sports participation that involves running or contact - Running on crowned roads (leg closest to curb most susceptible)
42
What is the clinical diagnosis for greater trochanteric bursitis?
Imagine usually not needed but radiographs may be done to r/o other disorders
43
What diagnosis need ruled out when suspecting greater trovhanteric bursitis?
Hip OA as contributing factor Lumbar pathology
44
With greater trochanteric bursitis will you normally see swelling & ecchymosis?
No, unless direct trauma
45
What are special test for greater trochanteric bursitis?
- ER ROM more painful than IR - ADD more painful than ABD (Ober Test) - Pain & weakness w/ hip ABD (Trandelenberg) - FABER - Palpation
46
What is the treatment options for greater trochanteric bursitis w/ a + Ober Test?
TFL/ITB stretching
47
What can be done for greater trochanteric bursitis to aid in inflammation?
Ice, E-stim, ionto, anti- inflammatory, relative rest
48
What are some additional treatment for greater trochanteric bursitis?
- Hip flexors stretching - Hip Strengthening emphasizing gluteus medius - Check muscle imbalance or possible Biomechanical causes - Lumbar impariments - Pt Education
49
What can be done if there is a lack of response to PT in a patient with greater trochanteric bursitis?
Cortisone injection & rarely surgery
50
What hip muscles are commonly sprained?
Adductor longus Glutesu medius Proximal hamstring Psoas
51
When is pain experienced with hip muscle strength?
After sudden onset w/ incident
52
When are radiographs needed with hip muscle strain?
To rule out avulsion fx if pain is noted w/ palpation at bony insertion site
53
What is the clinical picture of a hip muscle strain?
- Antalgic / altered gait - Ecchymosis in site of injury - Local tenderness to palpation at site of injury - Pain w/ resisted movements of affected muscles - Pain w/ passive movements opposite of muscle action
54
What treatments are done acute hip muscle strain?
- Modalities to promote healing & decrease pain & inflammation - Massage, sub maximal isometric exercises, passive ROM exercises & lumbopelvic stabilizing exercises
55
What treatments are done for subacute injuries?
- Concentric exercises (including functional closed- chain & WB exercises, lumbopelvic stabilization activities, general flexibility exercises & progressive balance & stability exercises)
56
What are treatment are done for chronic/ remodeling phase?
Eccentric exercises & sport specific training
57
What is the common population for Slipped Capital Femoral Epiphysis?
Common hip disorder during adolescent years Usually 10-17 y/o boys & 8-15 y/o for girls
58
What is the incidence rate & risk factor for Slipped Capital Femoral Epiphysis?
Boys 2x vs girls Increased BMI
59
What is the clinical picture for slipped capital femoral epiphysis?
- Progressive worsening sx (min vague pain early) - Antalgic gait & limitation in hip ROM/ strength (non capsular pattern for ROM loss)
60
What is the treatment option for slipped capital femoral epiphysis?
Surgery
61
What is post-op treatment after surgery for slipped capital femoral epiphysis?
ROM, strengthening, maximize function

Clinical Medicine (12 decks)

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