Pelvis and Hip- Fx thru Functional Testing Flashcards
(104 cards)
1
Q
What are hip fractures most commonly due to?
A
trauma
2
Q
How many hip fractures are non-traumatic and pathological?
A
<5%
3
Q
Are hip fractures increasing in prevalence? Why or why not?
A
- incidence increasing and proposed to reach 7-21 million per year
- aging population, people living longer
4
Q
Hip fractures are the MOST frequent fracture _________ to the _____
A
reporting to the ER
5
Q
What is the average age of a hip fracture?
A
80 years old
6
Q
What are risk factors for hip fractures?
A
- prior fall
- gait dysfunction (catch foot, etc.)
- vertigo (outside spinning, influences steadiness)
- medications influencing BP, dizziness, etc. (older population, more meds which alter vitals, cause dizziness, and potential orthostatic hypotension)
7
Q
What is a functional questionnaire for hip fractures?
A
- HFRS ( hip fractures recover scale)
- tells us how well a patient will do
8
Q
What structures are involved in a hip fracture?
A
- BONE: most commonly femoral neck
- Ligaments: rarely but sometimes damages with dislocations
9
Q
What are S&S of a hip fracture in observation?
A
- typical fx S&S
- LE possibly shortened and in an externally rotated position
10
Q
What special tests are there for a hip fracture?
A
- positive patellofemoral pubic tab test
11
Q
What types of hip fracture are there?
A
- intertrochanteric hip fracture
- femoral neck fracture
- subtrochanteric hip fracture
12
Q
What is our PT rx for hip fractures primarily treating?
A
consequences of immobilization of other tissues
13
Q
At what time after the fx does the patient most often show up for out-patient PT?
A
- after clinical union: cant see fx line on radiograph anymore
- should have bony callus
** SLOWER clinical union in older populations
14
Q
What are some other terms for adhesive capsulitis?
A
ACH or frozen hip
15
Q
What are risk factors for adhesive capsulitis?
A
- associated with systemic low-grade inflammation
- thyroid disorder
- diabetes
- alcoholism
- middle aged
- biological females
16
Q
What is the primary etiology of adhesive capsulitis?
A
unknown
17
Q
What is the secondary etiology of adhesive capsulitis?
A
concomitant injury/pathology - such as hip fracture and period of extended inflammation and immobilization
18
Q
What is a proposed but NOT proven contribution to adhesive capsulitis?
A
biomechanical contributions
19
Q
What is the pathogenesis of adhesive capsulitis?
A
- synovial inflammation to capsular fibrosis
20
Q
What structures are involved with adhesive capsulitis?
A
hip capsule and ligaments
21
Q
What are symptoms of adhesive capsulitis?
A
like impingement plus…
- gradual and progressive pain and loss of motion
22
Q
What is a UNIQUE characteristic of adhesive capsulitis?
A
- PROGRESSIVE PAIN
gradual worsening
23
Q
What mechanism or type of impingement will MOST likely occur with adhesive capsulitis?
A
hypomobility
24
Q
What are signs in ROM of adhesive capsulitis?
A
multiple direction of limitations but no consensus on capsular pattern of restriction
25
What will we find with combined motions with adhesive capsulitis?
consistent block
26
What will we find with resisted/MMT with adhesive capsulitis?
possibly weak and/or painful depending on stage
27
What will we find with stress tests with adhesive capsulitis?
distraction possibly positive depending on stage
28
What will we find with accessory motion with adhesive capsulitis?
hypomobility
29
What is stage I of adhesive capsulitis?
Initial
30
What are symtoms of stage I, Initial, for adhesive capsulitis?
- gradual onset
- achy at rest
- sharp with use
- night pain common
- unable to lie on involved side
31
What is the irritability of stage I of adhesive capsulitis?
HIGH
32
What will we find with ROM with stage I of adhesive capsulitis?
Limited but no deficit under anesthesia
33
What will the end feel be for stage I of adhesive capsulitis?
empty and painful
34
What is stage II of adhesive capsulitis?
Freezing
35
What are the symptoms of stage II, freezing, of adhesive capsulitis?
- constant pain
- particularly at night
36
What is the irritability of stage II, freezing, of adhesive capsulitis?
HIGH
37
What is the ROM with stage II, freezing, of adhesive capsulitis?
Moderate limitation, similar under anesthesia
38
What is the end feel with stage II, freezing, with adhesive capsulitis?
empty and painful
39
Why is the ROM the same/ similar under anesthesia with stage I and II of adhesive capsulitis?
capsule hasn't become fibrotic yet, and inflammation hasn't been around long enough to create changes
- only creates pain
40
What is happening in general from stage I to stage II of adhesive capsulitis?
Getting worse :(
41
What is stage III of adhesive capsulitis?
Frozen
42
What are the symtoms of stage III/frozen of adhesive capsulitis?
Stiffness > pain
43
What is the irritability of stage III / frozen of adhesive capsulitis?
moderate
44
What will we find with ROM of stage III / frozen with adhesive capsulitis?
severe limitations with pain at end range
- similar under anesthesia
45
What is the end feel of stage III / frozen of adhesive capsulitis?
Firm
46
What is stage IV of adhesive capsulitis?
thawing
47
What are the symptoms of stage IV, thawing of adhesive capsulitis?
Minimal pain
48
What is the irritability of stage IV / thawing of adhesive capsulitis?
low
49
What will we find with ROM during stage IV, thawing, with adhesive capsulitis?
gradually improving
50
What is the end feel during stage IV, thawing, with adhesive capsulitis?
Firm
51
Is symptom reproduction okay with adhesive capsulitis?
NO
52
Is there a gold standard for tests and measures for adhesive capsulitis?
NO, done by exclusion
53
Why is early dx of adhesive capsulitis difficult?
Due to irritability
54
What is the MOST common test and measure to determine presence of adhesive capsulitis?
Clinical presentation
55
What are the PT rx for adhesive capsulitis?
- POLICED
- inflammatory management
- pt education
- promote pain free mobility
- tissue remodeling
56
What kind of patient education can we do with adhesive capsulitis?
- avoid motions that cause pain in the hip
- dont give too many instructions / rules
- 4 stages, varying timeframes for different people
- pain free functional activity
57
What kind of JM can we do with adhesive capsulitis?
- Grade III-V= moderate evidence for short and long term benefits
58
What is the evidence for STM for adhesive capsulitis?
Moderate
59
What functional ROM in flexion is required for stairs?
~70 degrees
60
What amount of flexion is required for sit to stand and squatting?
~ 115 degrees
61
What amount of hyperextension is required for gait?
~10 degrees
62
What functional ROMs is ideal for MOST ADLs?
- 120 degrees flexion
- 20 degrees abduction
- 20 degrees external rotation
- 10 degrees hyperextension
63
What characteristics does a rigid body type have?
- less lumbar lordosis
- less hip motion, especially into IR
- less foot and ankle EV or pronation aka higher arches
64
What characteristics does a flexible body type have?
- more lumbar lordosis
- more hip motion, especially into IR
- more foot and ankle EV or pronation aka lower arches
65
What activities can be correlated with a rigid body type?
sprinter, anerobic sports
66
What activities can be correlated with a flexible body type?
distance runner, dancer, golf
67
What happens along with right heel strike?
- right hip maximally flexed to 30 degrees with adduction and external rotation
- right innominate posterior rotation
68
What happens along with right foot flat to mid-stance?
- right hip extension begins with right innominate anterior rotation
- right hip internal rotation and adduction as pelvis begins to rotate right on right femur
- eccentric then isometric right hip abductors and external rotators for right unilateral stance
69
What happens along with right heel off to toe-off?
- right hip extension, abduction and internal rotation
- maximal potential energy occurs in lengthened right hip capsule/ligaments and hip flexors
- right psoas lengthening further assists with trunk right side bend, extension and left rotation if T10 rotation WNL
70
What happens along with right acceleration to mid-swing?
- release of lengthened capsule, ligament, and psoas creating hip flexion
71
What are the three storehouses of potential energy?
1. non- contractile tissue
2. contractile tissue
3. T10 rotation allows psoas to assist with trunk motion and early and mid-swing of LE - like upper T-spine motion with lower trap
72
What is a example of non-contractile tissue as a storehouse of potential energy?
hip capsule and ligaments lengthen with hyperextension
73
What is an example of contractile tissue as a storehouse of potential energy?
hip flexors lengthen, particularly psoas and iliocapsularis
74
IF we dont maintain out base of support, we _____
Fall
75
If we cant transfer energy, we become ___________
Inefficient
76
What do excessive ground reaction or landing forces lead to?
traumatic or repetitive stress injury
77
What does more friction generate?
additional heat (blisters) and prevents motion (trauma)
78
What does a lack of stored potential energy of lengthened muscles, ligaments and capsules contribute to?
Repetitive stress of overuse injury
79
What are some characteristics of LE induced (NOT TRUNK) walking?
- no give so increased impact
- spinning on the ball of the foot (increased friction)
- actively advancing non-WB LE
- trunk follows the leading LE
80
is LE induced walking efficient? Effective?
Effective yes, efficient no
81
What is a primary driver of gait?
the trunk
82
What is NOT essential for locomotion?
Extremities
83
Can we still walk without extremities?
- still walk without arm swing
- we can locomote while long sitting
84
What do the extremities provide with locomotion?
extra leverage and energy savings for more efficient gait
85
What are the functional goals with optimal human gait? (basic)
- minimize impact and friction
- maximize PE
86
We want to be ________ not just ___________
efficient not just effective
87
What can effectiveness derive from?
Compensations
88
What do compensations during gait do?
decrease efficiency and expend NOT only more but likely the wrong injury = injury
89
What are common areas of excessive stress if storehouses of potential energy do NOT occur?
- hip joint
- hip flexor overuse
- lower lumbar spine under more stress
90
Why is the hip joint a common area of excessive stress if storehouses of potential energy do NOT occur
decreased cartilage integrity by limited motion
91
Why is hip flexor overuse a common area of excessive stress if storehouses of potential energy do NOT occur?
with shorter strides
- due to increased active hip flexion
- demonstrated with iliocapsulatis
92
Why is the lumbar spine a common area of excessive stress if storehouses of potential energy do NOT occur?
- with lack of T10 rotation and / or hip hyperextension
93
What are some functional tests for return to sport or pre-sport screening?
Quantity and Quality
- limb symmetry
- agility tests
94
What should we know about functional tests with hip pathologies?
Not studied
95
What is a functional test for predicting LE basketball injury?
SEBT (star excursion balance test)
- looking for asymmetry or pain
96
What is the single limb squat test looking for?
asymmetry or pain
97
What is the FMS (functional movement screen) used for?
to predict non-contact injury
98
What are the unilateral and bilateral hop tests? What are they used for?
- cross over
- 3 hop forward and lateral
- normative and biological sex values in young athletes
- acceptable threshold ≥ 90% of uninvolved developed with ACL injuries
99
What are some other jump tests that can be used as a functional test for hip pathology?
- Drop vertical jump
- Tuck jump
100
What are agility tests used for with hip pathologies? What is a con?
- may have value in athletic population because of sport specific testing
CON
- not able to discriminate between injured and non-injured limbs
101
What is a practice progression for hip pathologies?
- predictable and non-contact
- unpredictable and non-contact
- predictable and contact
- unpredictable and non-contact
may need to consider distance, time, pace, intensity, etc. as well
102
What is a predictor of LE injury?
Hip ER weakness
103
What is highly active as a stabilizer for ER especially through hip extension?
Piriformis
104
What is a ER only when the hip is flexed?
Glut max
