Lecture 5B

Question 1

AVN (Legg Perthes) mainly affects what age?

Answer 1

2-8

“there will be Q on final about this” - Dr. A”

Question 2

What is the age range for people with slipped epiphysis and osteochondritis dissecans

Answer 2

10-14 yrs

Question 3

What is the age range for people with stress fx synovitis FAI

Answer 3

14-25

Question 4

What is the age range for those that have OA and synovitis

Answer 4

45-60

Question 5

People above 65 typically present with that pathology ?

Answer 5

Stress Fx OA

Question 6

Females above 50 + will typically present with

Answer 6

Glute Medius tendinopathy / tears

Question 7

What are some common intraarticular injuries in the hip

Answer 7

Labrum tears
Chondral OA, Inflammatory arthritis
Capsule: sprain tightness tear laxity
Ligamentum Tears DDH

Question 8

What are some examples of Extraarticular issues ?

Answer 8

Muscle strains
Glute Med, Iliopsoas, Hamstring, Adductor Tendonitis
Bursitis

Question 9

If a patient reports with Clicking or Popping in the hip you would think that the issue is

Answer 9

Extraarticular

Question 10

If a patient reports with catching or ROM loss the issue in the hip can be found

Answer 10

Usually intracapsular

Question 11

What hip problem commonly affects newborns

Answer 11

congenital dislocation

Question 12

slipped capital epiphysis and osteochrondritis dissecans commonly affects what age

Answer 12

10-14

Question 13

Glute medius tendinopathy/tears commonly affects what age

Answer 13

Females 50+

Question 14

Stress fractures and FAI commonly affect what age

Answer 14

14-25

Question 15

How will the hip present with congenital hip dislocation

Answer 15

More females, L > R

Shortened limb, hip flexed and abducted

Limited Abd range of motion

Galeazzi sign and ortolani sign

Question 16

Male pt presents with ache in hip, thigh, knee

observation: Shorter limb, higher greater trochanter, quad atrophy, adductor spasm

ROM: limited into abd and ext

gait: antalgic

Age RANGE 2-13

Answer 16

Legg Calve Perthes

Question 17

Legg Calve Perthes radiographically presents how ?

Answer 17

Inc density, fragmentation, flattening of epiphysis

Question 18

Which pathology usually do better in PT Legg Calve Perthes or SCFE ?

Answer 18

Legg Calve Perthes

Question 19

Radiographically how does SCFE present ?

Answer 19

Displacement of upper femoral epiphysis especially in frog position

Question 20

Gradual onset vague pain in knee, hip, and thigh. Pain with extreme motion

observaton: Shortened limb, obese, quad atrophy, adductor spasm, hip abducted and ER

ROM: limited IR, abd, and flexion

gait: antalgic during acute, tendelenberg sign w/ ER in chronic

Answer 20

slipped femoral capital epiphysis

Question 21

What population does SCFE typically affect

Answer 21

Male 10-17 yrs
Female 8-15 yrs
MALE more likely

Question 22

Urgent or emergent: Slipped Capital Epiphysis

Answer 22

Urgent: They can drive to ER or have someone drive them. Don’t need an ambulance

Question 23

What is a complication that can occur if the SCFE is not corrected ?

Answer 23

Avascular Necrosis

Question 24

Pt is 30-50, more likely male than female

Sharp pain or intermittent pain with extreme motion

ROM decreased

limping

Answer 24

Avascular necrosis

Question 25

Radiographically what does avascular necrosis look like?

Answer 25

flattening followed by collapse of femoral head

Question 26

Pt is over 40, female insidious onset, pain w/ weight bearing often obese, joint crepitus atrophy of gluteal muscles limping

Answer 26

Degenerative joint disease

Question 27

DJD or OA radiographically present as what ?

Answer 27

Increasing bone density, osteophytes, subarticular cysts, degenerative cartilage

Question 28

With OA and DJD what is clear sign that you have either ?

Answer 28

You have limited ROM in a CAPSULAR pattern

Question 29

Altman's clinical criteria for hip OA Dr A: This will be on final exam

Answer 29

Hip Pain IR less than 15 Pain with IR Morning stiffness up to 60 mins Age 50+ Have to have ALL of them

Question 30

Sutlive CPR for hip OA 4/5 present = 91% probability

Answer 30

1. Self- Reported Squatting is aggravating 2. Scour test w/ adduction causes groin or lateral hip pain 3. Active hip flexion causes lateral pain 4. Active hip ext causes hip pain 5. Passive hip IR less or equal to 25 degrees

Question 31

what is the probability of having hip OA according to Sutlive 3/5 4/5

Answer 31

68 % 91%

Question 32

After a THR what is the main concern that you are worried POST OP

Answer 32

DVTs

Question 33

What are common soft tissue injuries ?

Answer 33

Muscle strains Myositis Ossificans Gluteal muscle contusion Osteitis pubis or Symphysiolysis Bursitis IT band Syndrome

Question 34

Gradual onset (overuse) Lateral hip, thigh,knee pain snapping over greater trochanter positive Ober's test

Answer 34

ITB syndrome

Question 35

Pain over greater trochanter with resisted abduction **Pain upon palpation**

Answer 35

Trochanteric Bursitis

Question 36

Gradual onset, obese/pregnant pain or paresthesia of anterior/lateral groin and thigh

Answer 36

Dx: Meralgia Paresthesia Abnormal sensory exam of lateral femoral cutaneous nerve

Question 37

What are some signs and symptoms of Myositis ossificans Hx

Answer 37

pain on palpation and motions ecchymosis Direct trauma contusion w hematoma 2-4 weeks prior

Question 38

Meralgia Paresthesia

Answer 38

Pain or paresthesia of anterior or lateral groin or thigh abnormal sensory distribution over the lateral femoral cutaneous nerve Tx Dec compression of nerve and Nerve glides

Question 39

post-menopausal females, 50+ Aggravated by sleeping on side, stair climbing Can occur after hip/knee surgery Gluteal, quad, gastroc wasting

Answer 39

gluteus medius tendinopathy/tear

Question 40

Gluteus medius tendinopathy/tear pain is ____________

Answer 40

**localized & load dependent** diffuse pain with low load is not tendinosis ACTIVE ISSUE

Question 41

Acetabular/labral pathologies are common in ___________

Answer 41

highly active people 20-40

Question 42

Labral pathologies is highly correlated with

Answer 42

Hip OA

Question 43

Cam impingement vs Pincer impingement

Answer 43

Cam impingement - related to **head/neck** morphology pincer impingement - **acetabular over coverage**

Question 44

Pincer impingement usually presents with acetabular _____version

Answer 44

Retroversion

Question 45

FAI w/ anterior-medial pain will have pain with:

Answer 45

flexion + IR

Question 46

FAI with posterior pain will have pain with:

Answer 46

Flexion, abduction, ER

Question 47

Military trainee with inability to passively rotate hip, history of increasing pain mistaken for psoas tendonitis or adductor strain/hernia

Answer 47

Femoral stress fx

Question 48

The long axis manipulation happens in what hip position What is the target

Answer 48

Open packed Flexion, ER, Abd target: overall capsule "Reset button" may require 1+ to acheive goal

Question 49

The prone PA mobilization is for

Answer 49

anterior capsule: decreased ext

Question 50

Lateral hip mob is for:

Answer 50

lateral capsule, lack of horizontal ADD

Question 51

Inferior capsule mob with patient supine with hip flexed to painfree range is for...

Answer 51

loss of flexion

Question 52

When is the highest occurrence of re-straining a hamstring strain

Answer 52

Within the first 2 weeks of return to activities