Hip

Question 1

phase where emphasis is placed on:

• protection of the injury
• management of pain and inflammation
• gentle protected ROM/stretching exercises
• light strengthening exercise as appropriate

often acute injury/immediate and early post-surgery

Answer 1

maximal protection phase

Question 2

phase where emphasis is on progression of activity within pt tolerance and healing to include:

• continue to progress ROM and stretching in larger ranges
• increased strengthening, advancing and/or adding OKC exercise as appropriate

sub-acute conditions or middle post-op stages

Answer 2

moderate protection phase

Question 3

phase where emphasis is on:

• advance OKC to CKC strengthening
• emphasis on functional activity
• progress activity as tolerated with goals of returning to PLF (normal ROM, str, return to sports, etc)

chronic conditions, normal healing, later post-op stages

Answer 3

minimal protection phase

Question 4

progression of phases is dictated by: (3)

Answer 4

• tissue healing
• successful achievement of goals within each phase
• pt tolerance

Question 5

restore hip/pelvis function goals (8)

Answer 5

• postural alignment and dynamic stability of lumbopelvic region
• awareness of pelvic positioning
• activation of core and pelvic stabilizing mm
• strengthening of the hip and trunk mm
• working on overall alignment of LE kinematic chain
• hip jt mobility and soft tissue extensibility
• coordinated neuromuscular control between core and LE mm to ensure safe ADLs, IADLS, work, etc
• function of associated body systems (ie. cardiovascular endurance)

Question 6

fracture type:

• fracture occurring between the greater and lesser trochanter
• more common in pts with OA

Answer 6

intertrochanteric

Question 7

fracture type:

• occurs at femoral neck
• disrupts blood supply to hip joint with 65-85% developing avascular necrosis

common in pts with osteoporosis

Answer 7

femoral neck fx

Question 8

fracture type:

• fx below greater and lesser trochanters, usually along the proximal 1/3 of the shaft of the femur

malunion, delayed union or non-union of bone is common

loosening of fixation devices also common d/t increased force load through femur

Answer 8

subtrochanteric

Question 9

5 complications of hip fx

Answer 9

• poor healing/union of bone
• avascular necrosis
• blood clots/PE 40-90%
• infection, pneumonia d/t poor mobility
• death

Question 10

Hip fx maximum protection phase rehab (5)

day 1 - 21

Answer 10

• ankle pumps, breathing ex. for DVT prevention
• pain and swelling control
• gentle protected assisted ROM (supine, seated)
• sub-maximal isometrics
• protected weight bearing

Question 11

hip fx precautions:

Answer 11

• no combined/diagonal motions
• no SLRs
• no bridging

Question 12

Hip fx moderate protection phase rehab (~3-6 weeks) (4)

Answer 12

• progress from supine/seated to standing exercise
• isometric to streight plane OKC –> con/ecc based on pain tol. (quads, glutes, abd, hams)
• progress to CKC once pain free FWB achieved
• progress hip ROM and strengthening as tol.

Question 13

hip fx minimum protection phase (6-8 weeks) (3)

Answer 13

• continue to advance exercise OKC to CKC
• promote normal gat
• functional activities

Question 14

pelvic fx stable rehab:

Answer 14

bed rest of days to 1 week followed by AROM exercises and isometric strengthening exercises

Question 15

pelvic fx unstable rehab:

Answer 15

require ORIF follwoed by AROM exercises and isometric strengthening exercises

Question 16

pelvic fx WB status:

Answer 16

NWB to PWB for ~2 months (unstable)

Question 17

indications for THA

Answer 17

• severe arthritis
• severe pain
• severe decrease in ability to ambulate
• decrease in ADLs functional mobility and activity tolerance
• complex hip fx
• hip osteonecrosis
• deformity or instability
• congenital hip issues

Question 18

cemented THA:

Answer 18

an acrylic cement is used to fixate the two components

pros: early WB
cons: more likely to loosen in younger/active pts

Question 19

uncemented THA:

Answer 19

porous-coated components are used so that bone growth can occur

pros: less likely to loosen
cons: NWB 6-8 weeks, slow rehab progression

Question 20

THA posteriolateral precautions:

Answer 20

• no adduction
• no ir
• no hip flexion >90

Question 21

THA anterior precautions:

Answer 21

• no extension
• no ER
• no adduction

Question 22

DO NOT have pt put pillow _______ to sleep or rest with to avoid contractures

Answer 22

under the leg

Question 23

THA maximal protection phase:

Answer 23

follow WB precautinos

perform supine LE exercises within hip precautions: ankle pumps, heel slides, supine hip abduction, quad sets, glute sets

transfer and gait training

Question 24

THA moderate protection phase

Answer 24

6-8 weeks post op (uncemented) several weeks post op cemented

transition from walker to standard cane

add resistance to supine and progress hip exercises

begin CKC pending WB status

Question 25

THA minimum protection phase

Answer 25

3ish months post op (cemented) balance, coordination, proprio activities CKC --> more advanced normal gait w/o assistive device

Question 26

procedure where cap placed over head of femur generally for individuals under age of 60 not appropriate for frail pts at risk for femoral neck fx

Answer 26

hip resurfacing arthroplasty

Question 27

when the femoral head slides beyond its normal articular surface with the acetabulum can occur as a result of hip fx, post-op THA, trauma, instability

Answer 27

hip dislocation

Question 28

predisposition to hip dislocation b/c a person has a shallow acetabulum

Answer 28

congenital hip dysplasia

Question 29

anterior hip dislocation precautions

Answer 29

- no ER - no extension - no adduction

Question 30

posterior hip dislocation precautions

Answer 30

- no IR - no flexion - no adduction

Question 31

_____ often occur in active adults between ages 20 and 40 y/o can be caused by" - repetitive hip flexion and cutting, twisting, and pivoting positions - sports injuries or trauma - hip dislocations or other congenital hip problems - degeneration - altered alignment

Answer 31

labral tears/repairs

Question 32

SandS of _____: - pain in anterior hip/groin region - feeling of hip instability and giving out - snapping within jt - (+) FADIR test - aggravated with standing, sitting, or walking

Answer 32

labral tears

Question 33

inflammation of the trochanteric bursa from excessive compression and repeated friction as the IT band snaps over the trochanter (bursa)

Answer 33

greater trochanteric bursitis

Question 34

Tx for greater trochanteric bursitis (6)

Answer 34

- PRICE - IT band and ABD mm stretching - stretch Hams, quads and hip adductors as needed - strengthen weak mm that cross hip jt - joint mobs - cortisone injections

Question 35

pain in the groin or anterior thigh and possibly into the patellar region. Aggravated with excessive hip flexion activities

Answer 35

psoas bursitis

Question 36

pain around the ischial tuberosities, especially when sitting. Sciatica may also accompany this

Answer 36

ischiogluteal bursitis

Question 37

most common acute mm injury that affects the hip

Answer 37

mm strain

Question 38

grade I mm strain

Answer 38

- stretch of the mm | - < 25% fibers torn

Question 39

grade II mm strain

Answer 39

- mm is torn with 25-50% mm fibers damaged

Question 40

grade III mm strain

Answer 40

- mm is torn with > 50% mm fibers damaged | - rupture of the mm

Question 41

how to treat mm strain initially:

Answer 41

- rest - ice/ decrease inflammation modalities - compression - temporary use of crutches if necessary - positioning Do Not place mm in stretch position

Question 42

how to treat mm strain post 3ish wks

Answer 42

- progress ROM exercises and gentle pain-free stretching to help reorganize the scar tissue that has formed - cross-fiber massage followed by multiple angle submaximal isometrics in pain-free positions - progress to stretching for mm in affected area post 3-6 wks