1
Q
What is the center edge angle in the hip?(3)
A
- The angle between the acetabulum and femoral head in the frontal plane
- Normal angle 30°
- A angle greater than 30° signifies dysplastic changes
2
Q
What is normal angle of inclination of the hip?
What is increased and decreased angle of inclination called.
A
1.120-130 Degrees
- Increased angle coxa valga <130deg
- Decreased angle coxa vara >120deg
3
Q
What does coxa vara cause?
What does coxa valga cause?
A
- Coxa vara Potential sharing forces that can damage epiphyseal plate of femoral head
2.Coxa Valga
-more erect head
—Altered muscle activity and intraarticular forces in the CFJ
—-Altered Cartlidge response
4
Q
What are potential pain generators of the
buttock region? (10)
A
Sciatic nerve, piriformis syndrome Sciatic nerve, hamstring syndrome Ischial bursitis Coxafemoral joint Labral affliction Trochanteric, gluteal bursitis Lumbar disk radiculopathy Lumbar zygapophyseal joint Sacroiliac joint Sacrococcygeal joint
5
Q
What are hip issues related to age? (6)
A
- Age 4 -10 highest incidence- transient synovitis, Legg-Calve-Perthes disease, (LCPD), and juvenile RA
- Females 11-13 and males 13-15-Epiphysiolysis
- 15-25 -Articular osteochondritis dissecans(OCD) is most common
- 35-50-ischemic femoral necrosis and synovial osteochondromatosis
- 18-40 Labral lesions
- Greater than 40-labral cysts, sacral pathologies, and stress fracture of the femur and/or pelvis
6
Q
Which patient typically present with a capsular pattern of limitations?(2)
A
- Hip arthritis
2. Hip arthrosis
7
Q
What is traumatic arthritis of the hip?(2)
A
- Consequence of forceful or repetitive hyperextension, rotation, or combination of movements
- <20 y.o.
8
Q
Signs and symptoms of traumatic arthritis of the hip?(3)
A
- Groin and anterior tight pain
- Pain with functional activities like: Sitting walking and then ascending stairs
- Internal rotation ROM most limited compared to others
9
Q
What factors increase the likelihood of hip OA?(5)
A
- Self reported squatting has a aggravating factors
- Active hip flexion causing lateral hip pain
- Scour test with adduction causing lateral hip or groin pain
- Active hip extension causing pain
- Passive internal rotation less than or equal to 25°
10
Q
What early treatment is recommended for micro traumatic and macrotraumatic synovitis(arthritis)?
A
- Early mobilization
2. Joint specific low velocity mobilization manipulation applied with traction
11
Q
What mobilization and positions can help restore hip flexion?(4)
A
- Preposition hip in flexion to limit
- Can add, submaximal abduction and ER
- Stimulate the position of landing in gait
- Or submaximal abduction and IR to increase stretch to the capsule
12
Q
What mobilization and positions can help restore hip extension?(4)
A
1.Preposition hip in extension to limit, submaximal adduction & submaximal external rotation
13
Q
When our joint specific mobilization/manipulations contraindicated for hip?(3)
Systematic disorders?(5)
A
- Joint instabilities with synovitis
- Degenerative bone disorders
- Anticoagulant therapy
Systematic disorders
- RA
- Gout
- Reiter disease
- Paoriasis
- Ankylosing spondylitis
14
Q
What can cause a nontraumatic capsular pattern of the hip?(4)
A
- Transient and/or septic synovitis
- Most common male patients ages 4 to 10
- Cause viral or autoimmune response
- Increased risk for LCPD
15
Q
What does Iliofemoral Ligament restrict? (3)
AKA?
A
1.Restricts hyperextension,
▪ Superior Portion: Taut with adduction
▪ Inferior Portion: Taut with abduction
2.Inverted Y
16
Q
What does Pubofemoral Ligament restrict? (2)
A
1.Hyperextension and abduction
17
Q
What does Ischiofemoral Ligament restrict? (2)
A
1.Hyperextension and internal rotation
18
Q
What are special tests for hip intra-articular pathology?(3)
A
- FABER Test (Patrick’s Test), (+: pain or decreased ROM)
- Scour (quadrant) Test, (+: pain, apprehension, catching or clicking)
- Resisted Straight Leg Raise (Stinchfield), (+: pain)
19
Q
What does FABER test for?(3)
A
- May indicate anterior hip/groin pain
- Posterior hip pain
- Iliopsoas/capsular pathology
20
Q
What does scour test for?(3)
A
- Indicates arthritis
- AVN
- Labrum defect
21
Q
What does Resisted Straight Leg Raise (Stinchfield) test for?(4)
A
- Indicates labral tear
- Synovitis
- Arthritis
- iliopsoas tendonitis/bursitis)
22
Q
What is femoroacetabular impingement(FAI)?
A
Abnormal contact between the femoral head/neck and the acetabular margin and has been associated w/ labral and chondral damage.
23
Q
What is Cam impingement?(4)
A
- Asphericity of the femoral head
- Related to slipped capital femoral epiphysis or other epiphyseal injury
- Protrusion of the head-neck junction occurring at the proximal femur
- x2 as prevalent in males than females
24
Q
What is Pincer impingement?(2)
A
- Acetabular abnormalities
- Anterosuperior acetabular overcoverage of the femur
- More common in middle-aged, active women.
25
What is Hip instability?
Causes?(2)
1.Extraphysiologic hip motion that causes pain with or without the symptom of hip joint unsteadiness.
1. Traumatic, atraumatic, or secondary to bony or soft tissue abnormality
2. Shallow acetabulum and an excessive femoral anteversion
26
What is the role of the acetabular labrum?(3)
1. Deepens the socket of the hip joint and acts as a buffer
2. Decreasing forces transmitted to the articular cartilage
3. Creates an environment of negative intra-articular pressure, creating a seal
27
What causes Acetabular labral tears?
1. Acute trauma or of insidious onset.
2. Traumatic MOI involve rapid twisting, pivoting, or falling motions
3. Common MOI in the athletic population: forceful rotation with the hip in a hyperextended position.
28
Sign and symptoms of femoroacetabular impingement(FAI)?(5)
1. Often active individuals with hip complaints
2. Pain in anterior hip/groin and/or lateral hip/trochanteric region (aching or sharp)
3. Hip pain aggravated by sitting
4. Hip IR is less than 20 degrees with hip flexed to 90 degrees
5. Mechanical symptoms: popping, locking, or snapping of hip
29
Sign and symptoms of Hip instability?(5)
1. Neck shaft angle greater than 140 degrees
2. EDS, Down, and Marfans
3. Anterior groin, lateral hip, or generalized hip joint pain
4. Hip IR greater than 30 degrees when the hip is at 90 degrees of flexion
5. Mechanical symptoms such as popping, locking, or snapping
30
Sign and symptoms of Ruptured Ligamentum Teres?(5)
1. Tears to this area are associated with labral tears and cartilage injuries
2. Rupture injuries are rare to this area – associated with hip pain and dysfunction
3. Anterior groin pain or generalized hip joint pain
4. May reported feelings of instability in general or with squatting
5. Mechanical symptoms such as popping, locking, or snapping
31
What are hip Anterior-Superior cartilage lesions associated with? (3)
1. Dysplasia
2. Anterior joint laxity
3. Presence of femoroacetabular impingement.
32
Loose bodies in the hip are caused by what? (2)
1. Single fragments typically occur due to dislocation or osteochondritis dissecans.
2. Multiple fragments more common in synovial chondromatosis
33
What are reliable predictors for ambulation following THA?
Pre-operative hip abductor and knee extensor strength
34
What is coxarthrosis?(4)
1.Synovitis from overuse or from an accident
2.Primary arthrosis genetically coded—Secondary articular erosion from:
-joint instability
—dysplasia
—-previous intraarticular fracture
——long standing loose body
3.Pt older 40yo
4.pain wt bearing activities and capsular pattern
35
In order to achieve anatomical hip flexion in parasagittal plane, the femoral head must do what?(3)
1.Flex, abduct, and IR
36
In order to achieve anatomical hip extension parasagittal plane, the femoral head must do what?
Extend, adduct, and ER
37
During gait what are peak forces exerted in the hip?
What increases the hip joints risk of early degeneration?
- 1.8-3.8 Body wt
| - 3x’s body wt
38
What happened at the hip joint if one muscle across has decreased functional?
Compression forces across the Cartlidge can exceed 4x’s body wt
39
What does gluteal atrophy suggest?
S1 and/of S2 nerve root involvement
40
What can cause a loose body in the hip?(6)
1. Acute trauma
2. Oeteochondritis dissecans
3. synovial osteochondromatosis
4. villonodular synovitis
5. Flake fracture
6. OA
41
What are conditions with painful resistive hip adduction?(8)
1. Acute adductor tendinopathy
2. Chronic adductor tendinopathy
3. Rectus abdominis
4. Obturator nerve
5. Osteitis pubis
6. Ossifying myositis
7. Symphysitis
8. Sacroiliac joint affliction
42
What nerves innervates the anterior CFJ?(2)
Radiate pain to where?
1. Femoral N
2. Obturator N
1.Can elicit groin pain when pathology arises
43
What nerves innervate the posterior CFJ?
Radiate pain to where?
1. Sacral plexus
| 1. Can lead to buttock and/or trochanteric pain
44
The presence of acetabular retroversion can result in what?
Related to the development of hip OA.
45
What are risk factors for developing hip OA?(8)
1. Age
2. H/x of hip developmental disorders
3. Previous hip joint injury
4. Reduced hip ROM (especially IR)
5. Presence of osteophytes
6. Lower socioeconomic status
7. Higher bone mass
8. Higher BMI
46
What tests should clinicians do to assess activity limitation, participation restrictions, and changes in the patient’s level of function
over the episode of care?(8)
1. 6-minute walk test
2. 30-second chair stand
3. Stair measure
4. timed up-and-go test
5. self-paced walk
6. Timed single-leg stance
7. 4-square step test
8. step test.
47
Should therapist use ultrasound to treat hip OA?
Yes
Clinicians may use ultrasound (1 MHz; 1 W/cm2 for 5 mins each to the anterior, lateral, and posterior hip for a total of 10 treatments over a 2-week period) in addition to exercise and hot packs in the short term management of pain and activity limitation in individuals with hip osteoarthritis
48
```
Functional ROM for hip?
▪ Gait:
▪ Stairs:
▪ Sitting:
▪Squatting
```
▪ Gait: 30˚ flexion, 10˚ extension
▪ Stairs: 70˚ flexion
▪ Sitting: 110˚ flexion
▪ Squatting: 120˚ flexion, 20˚ abduction, 20˚ ER
49
According to Cryiax, what is considered a capsular hip pattern?
Hip IR>hip ABD>hip flexion
OCS
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