MSK III > Hip Pathologies > Flashcards

Hip Pathologies Flashcards

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1
Q

Hip OA clinical criteria

A

-hip pain
-IR < 15
-flexion < 115
-age > 50 y/o
-morning stiffness < 60 min

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2
Q

Hip OA primary s/s

A

joint pain and stiffness

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3
Q

Hip OA radiograph criteria

A

hip pain
osteophytes
joint space narrowing (sup/lat)
**loss of .5 mm is clinically relevant
-mod: < 2.5mm
-severe: < 1.5mm

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4
Q

predictors of success w/ PT in hip OA

A

unilateral hip pain
age < 58
pain > 6/10
40m SPWT < 25.9 sec
symptoms < 1 yr

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5
Q

Hip OA management

A

exercise (aerobic/balance/strength)
pt ed
manual therapy (hip/lumbar)
gait

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6
Q

lateral THA approach

A

-abductors partially released and repaired
-hip lurching gait
-no post op precautions
-dec. dislocation rate

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7
Q

posterior THA approach

A

most common

posterior rotators and capsule released/repaired

dislocation risk

post op precautions:
-flex/IR/Add

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8
Q

anterior THA approach

A

newer; minimally invasive

rare dislocation

no post op precautions

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9
Q

posterolateral THA approach

A

splitting of glute max

release of short external rotators

lots of trauma/healing; precautions

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10
Q

THA post op adverse effects

A

Thromboembolism
implant failure
dislocation
infection
femoral fracture
persistent pain

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11
Q

THA post op acute care

A

medical pain mgmt
gentle exercise
-muscle activation, circulation, skin protection
transfers
gait w/ AD
precaution education
WB status

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12
Q

THA post op DC to home

A

stable pain level
adequate bed mobility
sit to stand
ambulate 100-200’ mod w/ AD
ambulate stairs mod
safe w/ ADLs

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13
Q

posterior THA rehab approach

A

spared abdcutors
pos. rotators/capsule repaired

precautions:
-no flexion > 90
-no adduction past 0
-no IR

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14
Q

lateral THA rehab approach

A

-prolonged trendelenburg
-impaired abductor function
-no precautions

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15
Q

hemiarthorplasty

A

femoral portion replaced

-w/ hip OA, fx

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16
Q

hip resurfacing

A

-does not involved removal of femoral head
-bone retained/reshaped
-prosthetic head
-acetabulum may be fitted
-same approaches as THA

advantages: preserve natural bone structure

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17
Q

hip resurfacing post op mgmt and phases 1-4

A

-precautions based on approach

1: (2 wks)
-full WB in 24 hr
-AD
-transfers, gait, stairs

2&3: (2-8 wks)
-improve ROOM, strength
-manual therapy

4: (2mo +)
-return to sport
-4 months medium impact ex
-6 months high impact ex

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18
Q

femoro-acetabular impingement (FAI)

A

impingement of femur and acetabulum
-combinations of flex, add, IR
-2 types (cam, pincer)

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19
Q

pincer impingement

A

acetabulum rim hits the head/neck of femur w/ full flexion

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20
Q

cam impingement

A

abnormal femoral head alignment into acetabulum w/ hip flexion

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21
Q

FAI characteristics

A

-most common cause of end stage OA
-groin pain w/ sports
-worse w/ sports, prolonged walking and sitting

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22
Q

surgical options for FAI

A

cam: burr osteoplasty of up to 30% of femoral neck

pincer: acetabular takedown and repair of labrum

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23
Q

rehab phases after hip preservation procedures (1-5)

A

1: (24 hrs to 4-6 wks)
-protect healing tissues
-pain control
-maintain prox/distal strength/ROM

2:
-restore ROM
-muscular re-ed

3:
-gait normalization
-inc strength to allow ADLs

4:
-muscular endurance, CV endurance
-advanced strengthening

5:
-return to sport

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24
Q

acetabular labral tears MOI

A

repetitive pivoting or twisting
traumatic event
extension + ER w/ FH anterior

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25
labral tears classifications
Radial Flap: -most common -margin of labrum disrupted Radial Fibrillated: -fraying of outer margin of labrum Longitudinal Peripheral: -tear @ acetabular-labral junction Abnormally Mobile: -partially detached from acetabulum
26
hip labral tear findings
subjective: -trauma or gradual -inc pain w/ flexion or activity -groin and ant thigh pain -clicking/catching, restricted ROM objective: - (+) FADIR
27
labral tear post op mgmt
-partial WB 4-6 wks -hip flexion to 90 deg 3-6 wks -avoid ER for 6 wks
28
traumatic hip dislocation MOI
mostly posterior hip flexed/add/knee flexed -force in pos direction
29
hip dislocation complications
-sciatic nerve injury -vascular compromise -fracture dislocation -inc risk of OA if not reduced in 8 hrs
30
hip dislocation ROM restrictions
ant: -Ext + IR pos: -flex + add + IR
31
Greater trochanter bursitis clinical presentation
aching paiin - lateral hip tenderness at greater trochanter 1 of following: -pain at extreme of FABER test -pain w/ resisted ABD -pseudo-radiculopathy
32
Glute med/min tendinosis clinical presentation
-tender greater trochanter -trendelenburg sign -trendelenburg gait -FABER -leg length -hip abductor weakness w/ pain
33
trochanteric bursitis and MOI
-3 bursa lie b/w greater troch and glute max, med, min -inc risk w/ arthritis, fibromyalgia, leg length MOI: -fall on lateral hip -friction of ITB over GT -poor pelvic control
34
glute min/max tendinosis MOI:
overuse, collagen degen d/t: -inadequate pelvic control -inc loads of SLS
35
bursitis and tendinosis mgmt
correct muscular imbalance and deficiencies -eccentrics -glute/pelvic floor/abdominals
36
ITB syndrome MOI and presentation
MOI: -friction of ITB on subgluteal medial bursa -excessive femoral IR -leg length discrepancy -fall on lateral hip presentation: -snapping at hip into flexion from ext - (+) ober's
37
ITB syndrome mgmt
manual therapy lengthening of ITB/TFL glute strength to improve abd/ER lumbopelvic stabilization
38
snapping hip (coxa sultans)
audible snap of hip with movement, mainly ext.
39
intra-articular vs extra-articular snapping hip
intra-articular snapping: -loose bodies, labral tear extra-articular snapping: (d/t imbalance) -internal: iliopsoas over pelvic rim -external: ITB/glute max over GT
40
meralgia paresthetica
lateral femoral cutaneous nerve @ ASIS d/t direct trauma or compression
41
meralgia paresthetica findings
-tingling/numbness/pain in sensory distribution -(+) tinel's at ASIS and inguinal lig
42
iliopsoas tendonitis
MOI: overuse common in runners c/o snapping in hip (external) painful eccentric loading from flexion TTP femoral triangle and psoas belly
43
athletica pubalgia (sports hernia)
injury to ext oblique, rectus abdominus or transversalis fascia -fascia is continuous w/ adductor muscles common in males > females, athletes
44
athletica pubalgia (sports hernia) presentation and MOI
MOI: -repeated forced hip hyperextension w/ rotation activities -presents as lower ab/groin pain -worse w/ trunk flexion, rotation activities, hip adduction
45
athletica pubalgia (sports hernia) mgmt
pelvic floor and abdominal stabilization/strengthening -eccentric adductors and ext oblique -functional mvmt
46
osteitis pubis
collective term for all disorders that cause chronic pain in region of pubic tubercle chronic inflammatory and overuse condition of pubic symphysis (+) squeeze bilateral resisted adduction, pain passive flexion, palpation
47
differential dx groin pain
adductor strain: -TTP, resisted testing athletic pubalgia: -pain w/ situps, resisted hip ADD sports hernia: -athletic pubalgia + TTP inguinal ring osteitis pubis: -sharp pain over pubic symphysis -TTP over symphysis and rami -pain w/ adductor stretching and sit to stand
48
femoral nerve injury (L2-4)
may be injured anterior hip dislocation -loss of quadriceps DTR -weak hip flexors, knee extensors -loss of sensation to ant. femoral cutaneous and saphenous nerves (+) femoral neural tension test
49
proximal hamstring injuries
Tear: -1: pain only -2: pain and palpable defect -3: complete tear overuse tendonitis/tendinosis
50
proximal hamstring tears
-eccentric control of hip ext/knee flex -musculotendinous junction -biceps femoris MOI: deceleration during sprinting, eccentric contraction -inc presence w/ weak glute max
51
proximal hamstring tendinosis/tendinitis
-repetitive hip flex/extension w/ knee extended -tender at ischial tuberosity
52
proximal hamstring strain presentation
ecchymosis acutely altered muscle integrity poor motor control (+) resisted hip ext/knee flexion (+) SLR (+) 90-90
53
sciatic nerve entrapment (L4-S3)
decreased strength in hamstring, calf, peroneals, toes altered sensation of pos thigh, leg altered achilles/hamstring tendon reflex **injured in pelvis fx, pos hip dislocation, piriformis region
54
piriformis syndrome
-tenderness of piriformis, greater sciatic notch -pain in buttock w/ referred sciatic nerve sx in leg -aggravated by walking, stair climb, trunk rot (+) piriformis test, SLR
55
superior gluteal nerve injury (L4-S1)
compressed as it passes b/w piriformis and glute min -passes thru greater sciatic notch w/ piriformis -inc pain w/ ambulation -weakness in hip abductors and IRs -TTP lateral to greater sciatic notch
56
obturator nerve L2-4 injury
compressed as it leaves pelvis thru obturator tunnel weak hip adductors, knee flexors, ERs
57
stress fx MOI and findings
most common in femoral neck; compression sided more common than tension MOI: involving running, jump, hike findings: -thigh or knee pain related to activity -relieved w/ rest -local tenderness -pain at end range rotation -pain w/ axial compression -antalgic gait (+) fulcrum test (+) single leg hop test (+) bone scan, MRI, CT
58
stress fx mgmt
compression: protected WB tension: may require screws displaced: need ORIF
59
proximal femur fx MOI and risk factors
fx of proximal 1/3 MOI: low energy fall risk factors: -falls, advanced age, female, caucasion
60
intracapsular vs extracapsular femur fx
intracapsular: -inc rate of malunion, non-union, AVN d/t dec blood supply in femoral neck extracapsular: -intertrochanteric or subtrochanteric
61
hip fx presentation
-groin or lateral thigh pain -TTP -difficulty walking or WB -shortened or ER limb -pain w/ flexion/ROT -signs of fall
62
hip fx goals for acute care, IP/SNF, OP settings
acute care: -safe/independent mobility and ADLs to allow return home IP/SNF: -function in prior living situation OP: -full independence w/ no limitations
63
developmental hip dysplasia
femoral head subluxed or dislocated from acetabulum -affects development -shallow acetabulum, flattened femoral head (+) ortolani or barlow
64
DHD mgmt
caught early: -harness/splint in ABD/ER 6-8 wks caught late: -spica cast 6-18 wks -bracing 6-12 months improve muscle weakness, ROM, and gait
65
legg-calve perthes disease
idiopathic osteonecrosis of femoral head children 4-10 (4x > boys) unilateral
66
legg-calve perthes disease s/s
-knee/thigh pain -limp -reduced ABD and rotation -possible flexion contracture
67
legg-calve perthes disease mgmt
maintain ROM and FH reduced in acetabulum address weakness gait
68
slipped capital femoral epiphysis
displacement of femoral head through physis males, high activity level, obesity findings: -pain w/ activity in groin, thigh, knee -dec IR, ABD, flex ROM
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