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MSK II > Pelvis and Hip 3 > Flashcards

Pelvis and Hip 3 Flashcards

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1
Q

etiology of hypermobility at the hip

A

traumatic like fx, ligament tear, or labral tear

atraumatic from extreme motions in sports, labral tear with FAI/IPI, and systemic connective tissue disorders

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2
Q

if there is a bony abnormality, what factors may contribute to hypermobility of hip

A

shallow acetabulum

inferior acetabular insufficiency

excessive femoral torsion or version (only one we can pick up clinically)

excessive femoral neck angle

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3
Q

what is femoral torsion

A

in transverse plane

angle between femoral condyles and femoral head and neck

excessive anteversion = toeing in

excessive retroversion = toeing out

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4
Q

what is the femoral neck angle

A

in frontal plane the angle between the shaft and neck

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5
Q

what is coxa valga

A

larger inclincation angle

leads to genu vara or bow legged

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6
Q

what does valgus mean

A

distal segment moves laterally

i.e. coxa valga = bow legged stature

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7
Q

what is coxa vara

A

smaller inclination angle

leads to genus valga or knock kneed position

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8
Q

prevalence of hypermobility at the hip

A

inconsistent with gender differences

5-35% of those with hip pain

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9
Q

risk factors for hypermobility

A

genetics
injury
nature of pts activities
-running
-ballet
-golf
-hockey
-soccer
-excessive RT, FLX, and hyper EXT

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10
Q

symptoms of hypermobility of hip

A

like impingement due to hypermobility plus:

anterior groin or lateral hip pain
popping, locking, or snapping
feeling of instability, especially when squatting

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11
Q

signs of hip hypermobility

A

like impingement plus

ROM: hip IR>30 at 90 flx

combined motion: possibly inconsistent

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12
Q

special tests for hip

A

hip apprehension

abnormal femoral version or torsion

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13
Q

what is the hip apprehension test

A

in prone

move hip into ext and abd while applying anterior inferior force on femur

specific to pubofemoral ligament test

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14
Q

PT Rx for hypermobility of hip

A

primary focus on cartilage integrity and stabilization

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15
Q

predominant innervation to the L4-S1 Z joints

A

L4 dorsal Rami

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16
Q

predominant and most consistent innervation to the L4-S1 discs

A

L1, 2 dorsal root ganglia

L4 and L5 sinuvertebral nn

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17
Q

iliolumbar ligaments are innervated by

A

L1-4 spinal nn

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18
Q

if there is a instability at L4-S1, what muscle groups would be more likely to excessively recruit due to the predominance of L1-L4

A

hip flexors (L1/2)
hip adductors (L3)
knee extensors (L3/4)
Ankle DF (L4/5)

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19
Q

main function of iliopsoas and where does it attach

A

primarily a hip flexor and trunk stabilizer

attaches to iliocapsularis

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20
Q

functions of iliocapsularis and where does it attach

A

primarily a dynamic stabilizer for capsule

also a hip flexor

attaches to iliopsoas, anteromedial capsule, and rectus femoris

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21
Q

rectus femoris attaches to

A

the capsule

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22
Q

the capsule attaches to

A

the labrum

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23
Q

nerve roots for iliopsoas, iliocapsularis, and rectus femoris

A

iliopsoas= L1-4

iliocapsularis = L2-4

rectus femoris = L2-4

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24
Q

simplify the hip consequence of excessively recruited hip flexors

A

muscles are overrecruited and pull on attachment to capsule that ultimatley pulls on the labrum as well

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25
etiology of L4-S1 regional interdependence
L4-S1 hypermobility instability most common segments
26
pathomechanics of L4-S1 regional interdependence x5
1-excessively recruited hip flexors that attach to capsule/labrum 2-this causes excessive traction on anterior medial portion of capsule and labrum (3/9 oclock) 3-this can lead to labral attrition WITHOUT bony changes 4-also inhibited hip extensors and abductors 5-these things lead to imbalnce of optimal axis of motion and joint support as well as easily overworked muscles due to lowered recruitment so overuse/lower supply occurs
27
hypertonicity of hip extensors and abductirs is due to what
being overworked even without overuse often reported as tightness that stretching helps short term but doesnt resolve
28
describe why L4-S1 regional interdependence is self perpetuating without address of lumbar stabilization
iliopsoas is a stabilizer of LORDOSIS in standing iliopsoas maintains its size or grows in those with LBP indicating continued/excessive recruitment excessive recruitment can further add to the anterior shearing most often occurring with lumbar hypermobility/instability excessive recruitment = more pull = more anterior shear = more LBP = more recruitment (cycle)
29
what is iliopsoas impingement
impingement without dysplasia or bony changes
30
etiology of iliopsoas impingement
not fully clear conditions that lead to excessive hip flexor recruitment lumbar hypermobility/instability with regional interdependence
31
symptoms of iliopsoas impingement
like FAI possible lumbar hypermobility/instability symptoms if aggravated
32
signs of iliopsoas impingement (PROM, tracking, inhibited muscles, neuro, palpation, and thoracolumbar scan/BE)
like FAI plus: -IR limited at 90 flexion with elastic end feel -hip maltracking at 90 flx (hip deviated into abd while passively flexing) -possible hip ER inhibition at 90 with RST -possible inhibition of extensors and abductors -possible hypersensitivity with neuro -TTP over ant hip (3/9 oclock) -thoracolumbar scan/BE findings for lumbar hypermobility
33
explain why IR is lost in PROM at 90 flexion
because of the inhibition and hypertonicity of extensors; primarily glut max inhibition which is also the main external rotator at 90 flexion
34
explain why jip maltracking at 90 flx occurs with iliopsoas impingement
due to inhibition and hypertonicity of piriformis that is an abductor at 90 flx; draws hip out and wont let it stay in line elastic end feel into flexion if deviation is not allowed
35
why might there be inhibited ER at 90 flx with iliopsoas impingement
due to glut max inhibition bc it is the main ER at 90 flx
36
if a pt has iliopsoas impingement and you ask them to squat what might you see
quad dominant squat pattern knees over toes due to inhibited hip ext and excessive knee ext
37
PT Rx for iliopsoas impingement
"culprit Rx" for lumbar hypermobility/instability "victim Rx" like FAI Rx
38
MD Rx for iliopsoas impingement
iliopsoas surgical release
39
Describe gluteal tendinopathy
lateral hip P! usually diagnosed as greater trochanteric bursitis called tendinopathy b/c usually there are already structural changes (more accurate description) aka GTPS
40
prevalence of gluteal tendinopathy
most prevalent in LE women > men > 40 sedentary > athletic
41
risk factors for gluteal tendinopathy
female BMI excessive hip ADD weak hip ABD coxa vara plyometric overuse
42
structures involved with gluteal tendinopathy
primarily greater trochanteric bursa primary muscle = glut med secondary muscle = TFL/IT band
43
describe insertions in releation to the R greater trochanter
12 oclock = Gmed 11= piriformis 10 = GOGOs 9 = QF
44
etiology and pathomechanics of gluteal tendinopathy
abnormal mechanical loading is the primary driver excessive loads may be applied longitudinally or perpindicularly excess loads can also occur with impaired LE control including but not limited to excessive femoral ADD
45
when do tensile loads occur
with concentric loads
46
when do tensile and compressive loads occur
with eccentric loads particularly in lengthened ranges
47
how does L4-S1 rehional interdependence play a role with gluteal tendinopathy
TFL/IT band overrecruitment known to hypertrophy indicating excessive recruitment
48
symptoms of gluteal tendinopathy
gradual and unknown onset but possible overuse/lower supply increasing lateral hip pain and maybe lateral thigh decreased pain with rest possible lumbar hypermobility/instability symptoms if aggravated
49
when are symptoms increased with gluteal tendinopathy
walking, running, stairs, any single leg loading prolonged sitting, especially crossing legs as IT band tension increases thru Gmax lengthening, particularly in lower seat and then first few steps lying on involved side
50
observation/functional tests for gluteal tendinopathy
possible antalgic and or trendelenburg gait impaired LE control -pain/weak with 30 sec SLS -may need to assess higher level ADLs like jumping/running
51
ROM signs with gluteal tendinopathy
possible lateral hip pain and limitation with add and IR in neutral (lengthening fibers of glut med) ER (glut med and min lengthening) and H. ADD (piriformis) in 90 flexion
52
resisted/MMT for gluteal tendinopathy
possible weakness and pain with -ABD (especially in ADD position) -ER in neutral -IR and H Abd in 90 hip flx -ABD and ERs weak and atrophied
53
special tests for gluteal tendinopathy
+ ER (G med and min lengthened) and H add (piriformis lengthened) possible + Obers
54
palpation findings for gluteal tendinopathy
TTP over bursa (hallmark sign) > Glut Med
55
PT Rx for gluteal tendinopathy aside from MET
victim vs culprit? -itis vs osis -regional interdependence pt edu -soreness rule -load management -avoid provoking symptoms (i.e. lying on side/crossed legs) -pillow between knees when on uninvolved side POLICED stretching not recommended (maximally lengthening and compressing structure)
56
shockwave effectiveness with gluteal tendinopathy
shock wave therapy proposed but not substantiated in research
57
primary MET focus for gluteal tendinopathy
tendon proliferation and stabilization (hip and lumbar)
58
MET parameters for gluteal tendinopathy
isometric without compression from lengthening isotonic without compression from lengthening isotonic with compression from lengthening isometric loading in WB (best place to start doing closed chain; should be able to do above first) plyometric loading
59
MD Rx for gluteal tendinopathy
corticosteroid injections -inflammation not primary issue -mainly acts as a analgesic -may hinder tendon from responding to optimal loading -may hinder response to optimal loading platelet rich and other "regenerative" injections lack sufficient support for all soft tissue injuries
60
describe hamstring tendinopathy
glute pain that is more often a tendinopathy common in athletes; rare in general public
61
risk factors for hamstring tendinopathy
prior injury regional interdependence from L4-S1 lumbar hypermobility/instability weak Gmax, Gmed, and or adductors
62
explain how regional interdependence from L4-S1 can affect hamstring tendinopathy
excessive hip flexor recruitment leads to anterior pelvic tilt and adds to excessive tension/compression inadequate ham/quad ratio -excessive quad recruitment -overuse/lower supply with hamstring inhibition advanced age means less pliable tissue = greater tension/compression
63
structures involved with hamstring tendinopathy
hamstring proximal tendon adductor magnus = shared origin and fascial connections with hamstrings ischial bursa rarely sciatic n; possibly adhered if tendinosis
64
etiology of hamstring tendinopathy
abnormal mechanical loading -repetitive hamstring action with hip flexion (running, jumping, training errors) -excessive prolonged stretching -sedentary lifestyle -muscle imbalances -prior injury deceleration - hamstrings eccentrically control knee ext heel strike and foot flat - after lengthening hamstrings act in a lengthened position with hip in flexion
65
symptoms of hamstring tendinopathy
posterior hip/butt pain (deep ache) less symptomatic with warm up worsened with activities that lengthen hamstring with or without m action stiffness after prolonged position, particularly sitting
66
signs of hamstring tendinopathy
observation = possible atrophy if long standing functional tests = pain with activoty involving lengthening with muscle action (i.e. lunge, running, squat, etc) ROM = possible limits/pain with hip flexion and knee extension especially if combined RST/MMT = possible weakness/pain with hip ext and knee flex especially with lengthened position neuro = possible dural mobility limits if sciatic involved TTP over proximal tendon and bursa at ischial tuberosity special test = bent knee test and shortened muscle length test
67
describe the bent knee stretch test
hip and knee flexed PT slowly straightens knee mod to high reliability
68
PT Rx for hamstring tendinopathy
follow general prinicples of gluteal tendinopathy and tendinosis Rx plus pt edu to stand more than sit and avoid low seats/prolonged sitting dry needling has limited support neural mobs for sciatic involvement
69
MET for hamstring tendinopathy
eccentric training to reduce pain and injury lumbopelvic stabilization to improve hamstring activity that supports regional interdependence
70
prognosis for hamstring tendinopathy
good out to at least 6 months with 8-10 weeks if PT
71
MD Rx for hamstring tendinopathy
corticosteroid injections -mainly act as a analgesic -may hinder tendon from responding to normal loading platelet rich other "regenerative" injections (lack support for ALL soft tissue injuries)

MSK II (18 decks)

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