MSK 2 > Hip > Flashcards

Hip Flashcards

(70 cards)

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1
Q

purpose of patella-pubic percussion test?

A

rule out fracture in femur and pelvis

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2
Q

purpose of fulcrum test

A

rule out stress fracture of femur

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3
Q

purpose of resisted external derotation test. What should be done if negative test?

A

rule out or confirm glut tendinopathy

- if negative supine test, test again in prone

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4
Q

purpose of Flexion-Adduction-IR (FADDIR) test

A

rule out intra-articular hip pathology

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5
Q

purpose of Thomas test

A

rule out intra-articular hip pathology (+ if clicking/popping/anterior groin pain)
- also looks at rectus femoris flexibility and ITB tightness

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6
Q

What is pelvic cross syndrome? What muscles are shortened (tight) and lengthened (weak)?

A
  • excessive lumbar lordosis
  • tight iliopsoas and erector spinae
  • weak abdominals and glut max
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7
Q

What muscles are shortened (tight) and lengthened (weak) w/ flat back?

A
  • shortened hamstrings

- lengthened hip flexors

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8
Q

What is the purpose of the hip scower test?

A

confirm intra-articular hip pathology

- compress into ER and IR

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9
Q

What is the purpose of FABER test (Patrick’s Test)

A

confirm intra-articular hip pathology

- figure 4 stretch

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10
Q

symptoms and physical exam findings of hip fracture

A

Symptoms
- severe groin pain

Physical Findings

  • shortening of LE
  • painful/limited A/PROM in all directions
  • painful/weakness MMT
    • Fulcrum and pubic percussion tests
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11
Q

Symptoms and Physical Findings of AVN of femoral head

A

Symptoms
- deep groin, buttock, knee pain

Physical Exam

  • limited/painful A/PROM (especially IR)
  • painful/weakness MMT
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12
Q

Patients who are ___________, are more likely to develop osteoarthropathy over time.

A

hypermobile

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13
Q

Symptoms and physical exam findings of hip osteoarthropathy

A

Symtpoms

  • dull buttock, groin, thigh, knee pain
  • C-sign (hands on hip - “it hurts here”)
  • hip stiffness (especially after inactivity)
  • mobility limitations
  • stair ambulation limitations

Physical Findings

  • limited hip A/PROM, painful at endrange (greatest IR, flexion, abduction)
  • joint hypomobility
  • +/- weakness/pain w/ MMT
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14
Q

excessive hip _______ is difficult with hip osteoarthropathy. This causes difficulty with what daily task?

A
  • excessive hip flexion
  • difficulty donning/doffing pants and shoes
  • difficulty with stairs
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15
Q

Cam vs Pincer deformity

A

Cam - increased size of femoral head

Pincer - increased protrusion of acetabular rim

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16
Q

Symptoms and Physical exam of femoral acetabular impingement (FAI)

A

Symptoms

  • sharp, deep anterior groin pain
  • pain w/ deep squat, cutting, lateral movements, painful ER

Physical Exam

  • Cam deformity - hip flexion/adduction/IR ROM painful
  • +FABER and FADDIR tests
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17
Q

What motions are limited with Cam deformity?

A

hip flexion, adduction, IR ROM painful/limited

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18
Q

loose bodies symptoms and physical exam

A

Symptoms

  • anterior groin pain
  • catching, locking, clicking, giving way of LE
  • sudden pain w/ weight bearing

Physical Exam

  • inconsistent ROM deficits
  • springy end feel w/ PROM
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19
Q

During what motions is most pain felt w/ anterior snapping hip?

A
  • when hip extended to flexed position

- movement from FABER to extension, adduction, IR

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20
Q

What aggravates external snapping hip?

A
  • running on slanted surfaces

- directional change on planted LE - tends to hurt as pt practices for longer duration

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21
Q

What is a common MOI for hamstring strain?

A

sprinting w/ trunk flexion and fast running

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22
Q

What is a common MOI for adductor muscle strain?

A

directional change while running

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23
Q

What is a common MOI for iliopsoas muscle strain?

A

forced hip extension during active hip flexion

- getting tackled from behind while running

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24
Q

__________ strains have worse prognosis and longer recovery time

A

rectus femoris - crosses 2 joints

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25
Greater trochanteric pain syndrome symptoms
- pain greater at night - pain w/ standing > 15 min - radiating symptoms - pain in FABER position - donning/doffing socks
26
Greater trochanteric pain syndrome physical exam
- excessive hip abduction vs adduction during gait - tender lateral hip - ITB tightness - +FABER and Resisted External Derotation test - pain/limitations w/ hip adduction ROM - pain/weakness w/ hip abduction and ER AROM
27
How will someone w/ Greater trochanteric pain syndrome compensate during walking?
vaulting to shift center of mass over leg to decrease tension
28
potential areas of compression for sciatic nerve
- piriformis - ischial tub - long head of biceps femoris
29
potential areas of compression for obturator nerve
overlying fascia
30
Motor and sensory distribution for sciatic nerve
Motor - hamstrings - fibular and tibial distributions Sensory - lower leg tibial and fibular distributions
31
Motor and sensory distribution for obturator nerve
Motor - adductors/IR Sensory - medial thigh and knee joint
32
What does diminished achillies and hamstring DTR mean?
sciatic nerve entrapment
33
What additional things can lead to obturator nerve entrapment?
- hx of pelvis fracture - THA - pelvic operation - prolonged labor
34
potential areas of compression for femoral nerve
inguinal canal
35
potential areas of compression for lateral femoral cutaneous nerve
inguinal canal
36
motor and sensory distribution for femoral nerve
Motor - knee extensors Sensory - anterior thigh/lower leg
37
Sensory distributions for lateral femoral cutaneous nerve
anterio-lateral thigh
38
other clinical indicators of femoral nerve entrapment
diminished patellar reflex | - aggravated w/ hip extension
39
Who is more common for avulsion fractures of hip and in what decade?
males in 2nd decade
40
What is normal anteversion at hip? At what degree is it excessive and what is the patient at risk of doing?
normal - 10-15 degrees excessive - > 40 degrees - risk for anterior dislocation
41
Piriformis does what muscle action when hip is extended? When hip is flexed?
extended - ER flexed - abductor
42
action of TFL
IR of hip acts on knee during hip extension
43
pes anserine attachments
sartorius, gracilis, semitendonosis
44
What action do hamstrings do during flexed knee?
IR and ER of tibia
45
What hip adductor helps w/ hip flexion? What helps w/ hip extension?
adductor longs - helps w/ hip flexion adductor magnus - helps w/ hip extension
46
glute min action
ABD and IR of hip
47
open and closed packed position of hip
open - ~ 30 flexion, 30 abduction, and slight ER closed - full extension w/ abduction and IR
48
Phase 1 to Improve mobility of hip
- activation/coordination exercises - mobility exercises - inhibitory exercises (reciprocal inhibition - strengthen hip extensors to losen hip flexors) - STM ad joint mobs
49
Phase 2 to improve mobility of the hip
- progression to strength/endurance training - strength in newly improved ROM
50
Phase 3 to improve mobility of hip
- increase challenge of exercises | - sport specific activities
51
What muscles are typically weak with hip osteoarthropathy?
- hip ER - extensors - abductors
52
What interventions are good for osteoarthropathy?
- patient education (B) - flexibility, strengthening, and endurance exercises (A) - manual therapy (A)
53
What type of exercises are good for ankylosing spondylitis?
extension based exercises
54
Phase 1 to improve hip stability
- exercise - physiologic effects - activation/coordination exercises - joint mobs
55
Phase 2 to improve hip stability
- progression to strength/endurance training of stabilizers
56
Phase 3 to improve hip stability
- increase challenge of exercise
57
What activity should be avoided during phase 1 of labral tear operative recovery?
single leg raise - focus on isometric and closed chain exercises - open chain hip flexion, extension, AB/ADDuction
58
What muscles are typically involved with greater trochanteric pain syndrome? What motion is ill-advised?
hip abductors and ER - ITB stretching (hip adduction) is ill-advised
59
What type of exercises can help rehab a hamstring strain in athletes?
- eccentric (B) - progressive agility and trunk stabilization (B) - Nordic hamstring exercises (A)
60
High score on the LEFS means what?
high score = more function | - highest score is 80/80
61
high score on WOMAC means what? What type of patients is this outcome measure used on?
higher score = more functional impairment, pain, and stiffness hip/knee OA
62
posterior hip precautions
- no flexion > 90 degrees - no adduction past neutral - no IR past neutral
63
lateral hip precautions
- depends on MD | - avoid abduction
64
anterior hip precautions
- no hyperextension | - no ER past neutral
65
transtrochanteric precautions
- no AROM hip abduction | - weight-bearing restrictions (TDWB or PWB)
66
Wells Criteria for DVT scoring
- =0 - low probability - 1-2 - intermediate probility - /=3 - high probability
67
Advantages and disadvantages of posterior hip replacement
Advantages - hip abductors are not disrupted Disadvantages - higher risk for dislocation - post-op precautions limiting ADLs
68
Advantages and disadvantages of lateral hip replacement
Advantages - decreased risk for dislocation Disadvantages - prolonged hip abductor weakness - greater risk for heterotrophic ossicans
69
Advantages and disadvantages of anterior and anteriolateral hip replacement
Advantages - ADLs less affected - decreased risk for dislocation Disadvantages - prolonged hip abduction weakness IF anterior glut med released for access
70
Advantages and disadvantages of transtrochanteric hip replacement
Advantages - preserves attachment of hip abductors Disadvantages - WB limitations until bony union - Risk for non-union - prolonged hip abduction weakness
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