Boards Prep - MSK > Hip > Flashcards

Hip Flashcards

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1
Q

Hip Osteoarthritis CPG - Activity Limitation/Physical Performance Measures

A
  • Should use valid physical performance measure such as 6MWT, TUG, SLS, and others (I)
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2
Q

Hip Osteoarthritis CPG - Physical Impairment

A
  • Document PROM, hip muscle strength, FABER over episode of care (I)
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3
Q

Hip Osteoarthritis CPG - Outcome Measures

A
  • Activity Limitation
  • Use valid measures such as Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and others such as VAS (I)
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4
Q

Hip Osteoarthritis CPG - Diagnosis

A
  • IR < 24 degrees or IR/Flex 15 degrees less than non painful side
  • passive IR increases pain
  • Morning stiffness after awakening
  • moderate ant or la hip pain when WBing
    (I)
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5
Q

Hip Osteoarthritis CPG - flexibility, strengthening, and endurance

A
  • individualized exercises to address impairments
  • 1-5 x/week for 6-12 weeks with mild to mod hip osteoarthritis
    (I)
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6
Q

Hip Osteoarthritis CPG - Manual Therapy

A
  • manual therapy for mild to mod hip OA that may include soft tissue mobs, thrust, and non thrust
  • 1-3x/week over 6-12 weeks
    (I)
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7
Q

Avascular necrosis - ROM

A
  • decreased in flex, IR, and abduction
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8
Q

Avascular necrosis - diagnostic tests

A
  • x ray
  • bone scan
  • CT
  • and/or MRI
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9
Q

symptoms of Avascular necrosis

A
  • pain in groin and/or thigh
  • tenderness with palpation at hip joint
  • coxalgic gait
  • pain that increases with WBing
  • night pain
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10
Q

injury of what ligament can cause Avascular necrosis

A

ligamentum teres

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11
Q

What is coxalgic gait

A
  • pt leans toward affected side while pelts stays level or elevated on contralateral side due to normal abductors on affected side
  • lateral shift reduces forces exerted on stance leg
  • due to arthritis/avascular necrosis
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12
Q

Avascular necrosis - medications

A
  • acetaminophen for pain
  • NSAID for pain/inflammation
  • corticosteroids are contraindicated since they may be causative factor
  • pts taking steroids for other conditions should have dosage decreased
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13
Q

PT goals for Avascular necrosis

A
  • joint/bone protection strategies
    -maintain/improve joint mechanics and connective tissue function
  • aerobiccapcity
  • post surgical intervention includes regaining functional flexibility, improving strength, endurance, coordination, and gait training
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14
Q

surgical options for Avascular necrosis

A

core decompression or replacement

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15
Q

Is avascular necrosis bilateral?

A

50-80% of the time

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16
Q

Coxa vara

A

angle of femoral neck with shaft of femur (angle of inclination) is <115 degrees
- “knock knee”
- compensates with gene valgum at knee
- foot forced pronation
- lateral knee joint compression, medial knee joint gapping
- VMO weakness, pes anserine, medial capsule

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17
Q

Coxa valga

A

angle of femoral neck with shaft of femur (angle of inclination) is >125 degrees
- “bow legged”
- compensates with genu varum at knee
- increased medial compression, increased stress on popliteus, LCL, Lat HS/gastroc/ITB

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18
Q

Coxa vara effect on foot

A
  • forced pronation = pain in arch of foot, medial malleolus, post tib tendonitis at insertion
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19
Q

Coxa valga effect on foot

A
  • tibial varus –> rapid pronation –> post tib tendonitis –> complaints of proximal medial leg symptoms
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20
Q

what does coxa vara usually result from

A

defect in ossification of head of femur

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21
Q

coxa vara and coxa valga may result from…

A

necrosis of femoral head occurring with septic arthritis

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22
Q

What is femoral anteversion?

A

increased angle of torsion (angle between femoral head/neck and an axis through the distal femoral condyles)
- “pigeon toed”
- heel strike with pronated foot –> forefoot varus compensation

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23
Q

What is femoral retroversion

A
  • decreased angle of torsion
  • toes out
  • results in lateral contact with calcaneus –> excessive pronation during loading response
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24
Q

What is angle of torsion supposed to be?

A

12-15 degrees in adult
- 25 degrees in infant

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25
What is trochanteric bursitis
- inflammation of deep tronchanteric bursa from a direct blow, irritation by/tight ITB, poor posture/biomechanics causing repetitive micro trauma, weak glute med
26
Trochanteric bursitis clinical presentation
- pain complains to lateral hip --> point to specific spot - local tenderness over greater trochanter - may have pain with resisted abduction - symptoms increase with walking, stair climbing, laying on effects side, and crossing legs
27
trochanteric bursitis intervention
- pt education on activity modification and positioning for relief - stretch tight structures causing postural deviations or asymmetries - strengthening weak muscles causing instability or faulty movement patterns
28
trochanteric bursitis is common in pts with..
RA
29
Psoas bursitis clinical presentation
- pain anterior hip or thigh - aggravated by excessive hip flex - can be related to OA or iliopsoas muscle tightness
30
Ischial bursitis clinical presentation
- pain in buttock/posterior thigh - aggravated by stairs/incline walking (when hip is flexed and extensors are contracted) - avoidance of sitting on affected hip
31
diagnostic test for bursitis
- none - diagnosis made by clinical examination
32
What two tests may be positive for ITB tightness
- noble compression test - Ober's test
33
What does Craig's test measure
- femoral anteversion and retroversion
34
Different angles of piriformis
- ER of hip at < 60 degrees hip flex - IR of hip at > 90 degrees hip flex
35
tightness, straining, or spasm of the piriformis can result in
compression of sciatic nerve and/or sacroiliac dysfunction
36
signs and symptoms of piriformis syndrome
- pain worse with sitting, stair climbing, crossing leg - restriction in IR - pain with palpation to piriformis - referral of pain to post thigh - weakness in ER - + piriformis test
37
What should you rule out when looking at piriformis syndrome
involvement of lumbar spine and/or SI dysfunction
38
Pt goals for piriformis syndrome
- treat strain or improve length of tight muscle - correct biomechanical asymmetries - pain reduction - functional training and resistance training
39
Etiology of acetabular labral tears
- FAI - dysplasia (acetabulum is too small for femoral head) - capsular laxity and degeneration - direct trauma - sports injury --> frequent ER of hip, sprinting - can occur with hyperextension, hyperextension with ER, or hyperabduction - 74% not associated with any specific event or cause; may be secondary to micro trauma
40
FAI - CAM type
impingement of a large aspherical femoral head in a constrained acetabulum
41
FAI - pincer type
- over-coverage of the femoral head by a prominent acetabular rim
42
Clinical presentation of acetabular labral tears
- F>M - anterior hip/groin pain - clicking, catching, "sharp", "giving out" - decreased ROM (most commonly decreased rotation) - may have + FABER - difficult to diagnose
43
what is the gold standard diagnostic test for acetabular labral tears
arthroscopy
44
Hip arthroscopy for labral tear - rehab considerations
- brace 2-6 weeks - NWB or Foot flat WB 2-8 weeks - rehab can start POD 1-2; some surgeons wait - continuous ROM - 4 hrs - prone laying to reduce tightness of iliopsoas
45
What is a sports hernia
- tear of oblique aponeurosis --> thought to be stronger pull of adductors on pelvis vs oblique mm
46
sports hernia is common in...
sports requiring kicking, rapid acceleration/deceleration and sudden change of direction (hockey, soccer, etc)
47
sports hernia may be related to pathology in
- adductor - iliopsoas - inguinal - pubis
48
what should you rule out in sports hernia
hip involvement
49
length of rehab period for sports hernia
- 8-12 weeks - may come back with activity - surgery if conservative methods fail
50
Slipped capital femoral epiphysis
- posterior and inferior slippage of the femoral epiphysis on the femoral neck - occurs in early adolescent with growth spurt - common initial complain is hip and/or knee pain
51
Legg Calve-Perthes Disease
- idiopathic osteonecrosis of the epiphysis of the femoral head - 5x > in M - 3-12 yo - hip or groin pain, limp, decreased ROM in IR and ABD - work to restore ROM
52
What is Coxa Saltans
- snapping or clicking hip
53
intra-articular causes of Coxa Saltans
- loose bodies - subluxation of hip
54
Extra articular causes of Coxa Saltans
- ITB over greater troch - iliopsoas tension over labrum and femoral head (AKA iliopsoas impingement --> work on lengthening iliopsoas) - iliofemoral ligament over femoral head - biceps femoris over ischial tuberosity
55
Hip resurfacing candidates
- male; < 60 yo - normal functioning kidneys - active lifestyle - BMI < 30
56
Anterolateral THA
- anterior 1/3 of glute med and min released and repaired - no hip flex > 90 - no hip ext, abd, ER past neutral
57
Posterolateral THA
- short ERs and pirifomis released and repaired (glute med intact) - no hip flex > 90 - no IR, add past neutral
58
hip convex/concave rule
convex moving on concave
59
hip OPP/CPP
OPP: 30 degrees flexion, 30 degrees abduction, slight lat rotation CPP: full extension, abduction, internal rotation
60
hip capsular pattern
flex > IR > abd
61
hip normal flex/ext
flex: 110-120 ext: 10-15
62
hip normal abd/add
abd: 30-50 add: 30
63
hip normal ER/IR
ER: 40-60 IR: 30-40
64
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