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ortho test 2
202: hip
Question | Answer |
---|---|
closed pack position | •Ligaments and joint capsule in their most taut position |
close pack position of hip | Occurs with hip extension, abduction and internal rotation; Stabilizes the hip joint and reduces "joint play" or accessory motion |
loose pack position of the hip | Occurs in some flexion, external rotation and abduction; Best position for "joint play" or accessory motion |
iliofemoral ligament | Often known as the Y ligament Common description of "hanging of their ligaments" in a standing position |
pubofemoral ligament | from pubis to femur |
ischiofemoral ligament | From ischium to femur |
sacrospinal ligament | •sacrum to ischial spine |
sacroilliac ligament | Sacrum to ilium |
sacrotuberous ligament | •large ligament from sacrum to ischial tuberosity |
ligamentum teres | Connects femoral head to acetabulum |
ligamentum teres function | •Provides stability to the hip •Supplies blood to the femoral head through the ligamentum teres artery |
when is ligamentum teres taught | adduction |
when is hip joint capsule taught | •Taut in flexion, external rotation, and abduction |
purpose of hip joint capsule | Protects internal components of joint; Keeps synovial fluid within the joint |
most commonly affected/treated hip bursa | Trochanteric bursa - under iliotibial band |
illiospoas bursa | protects the psoas and iliacus tendons |
ischiogluteal bursa | at the hamstring origin |
symptoms of slipped femoral epiphysis (SCFE) | Pain in groin, Difficulty with walking, Stiffness in the hip |
who is affected by slipped capital epiphysis | young children |
femoral acetabular impingement (FAI) of hip types | pincer and cam |
pincer FAI | Acetabulm is excessively large and covers femoral head; can be some osteophytes |
what is cause of pincer FAI | overgrowth of bone |
cam FAI | Excess bone growth on femur, such as a bump |
what does cam FAI cause | Does not allow femur to move smoothly in acetabulum |
what sport is cam FAI commonly seen in | soccer |
FAI of hip symptoms | Pain in the groin, hip or the lumbar region, Stiffness or restriction of mobility of the hip, Lack of hip flexion greater than 90 ˚, Difficulty with hip mobility in weight bearing during squat |
•Untreated FAI may eventually lead to ____ | osteoarthritis |
labral tear symptoms | Symptoms similar to FAI and FAI's often cause labral tearing, Clicking sensation or lack or stability |
Up to ____% of asymptomatic hips have labral issues upon MRI | 25% |
is surgical intervention successful for labral tears? | not greatly successful, but will consider repair if healthy, younger individual |
non surgical tx for labral tear | focus on hip stability/strength |
most common direction for hip dislocation | posterior |
when does hip dislocation often occur | in MVA with dashboard injury; Hip is positioned in flexion and some adduction if reaching for brake, can allow femoral head to dislocate |
what causes Isolated fracture with intact pelvic ring | Avulsion fractures of ASIS or AIIS from severe muscle pull; Direct blunt force trauma or fall on pelvis; Osteoporosis causing compression fracture of pubic rami |
treatment for isolated fx with intact pelvic ring | rest and analgesics, but WBAT is often indicated |
what causes fractures that disrupt pelvic ring | MVA, crush injury, or falls |
fractures that disrupt pelvic ring often have how many fracture sites? | 2 or more |
fractures that disrupt pelvic ring often affect ____ stability of pelvis | ligamentous |
complication of fractures that disrupt pelvic ring | genitourinary issues |
surgical intervention for fractures that disrupt pelvic ring | •ORIF or OREF (open reduction internal or external fixation) |
when does acetabulum fracture | high fall and landing on outstretched LE or in MVA from dashboard |
what occurs between the bones in an acetabular fx? | • femoral head into the acetabulum thus causing the acetabulum ring to shatter |
complications from acetabular fx? | Avascular necrosis due to ligamentum teres disruption; Sciatic nerve injury; Osteoarthritis |
types of hip fx proximal to the subtrochanteric line | Intracapsular or Extracapsular Fracture |
intracapsular fracture | •Femoral neck fracture or fracture of the head of the femur |
are complications more common with intra or extra capsular fx? | intracapsular leads to Secondary osteoarthritis - will eventually need replacement |
Non-union occurs in ___% intra capsular fx cases. Avascular necrosis of the femoral head occurs in ____ of the cases | 25%, 40% |
•Extracapsular (Intertrochanteric or Subtrochanteric) fx incidence | 80% in females over 60 secondary to osteoporosis; In younger women it is due to trauma, alcoholism or anorexia |
what causes extracapsular fx | •planted foot/twisting activity of the hip •May occur with a fall |
S&S of extracapsular fx | •Severe pain, unable to move leg or bear weight, the lower extremity is positioned in external rotation with apparent shortening |
surgical repair for _____ fractures is often necessary | femoral |
most common surgical tx for femoral fx | ORIF, May need to replace femoral head to prevent necrosis, hemiarthroplasty; Or in severe cases, total hip arthroplasty |
hip is a common joint for ____ changes to occur | degenerative |
symptoms of osteoarthritis | stiffness, gait changes, and low back pain |
osteoarthritis often leads to | total joint replacement |
•Sacroiliac joint and hip dysfunctions are often an issue of ____ vs ____ | slack muscles vs. taut muscles |
muscles of the hip that can be affected by mm imbalances | Hip flexors. Piriformis, Hamstrings, Multifidus, Quadriceps, Gluteals, Abdominals |
trochanteric bursitis | •Affected by TFL and ITB •Generally a cause of hip rotator weakness and thus overutilizing TFL |
iliopectineal bursitis | •Groin pain •Aggravated with resisted hip flexion or passive hip extension |
ischiogluteal bursitis | •Pain at the ischial tuberosity •Aggravated with sitting |
piriformis syndrome symptoms | •Most notably tender at sciatic notch |
piriformis syndrome is often as cause of ____ pain | sciatic |
piriformis function | •quite active, acting as a stabilizer and functions throughout gait phase |
when is piriformis in a constant stretch | in sitting |
piriformis is always working or being stretched except for what postions | lying supine or prone with feet in neutral |
tx for piriformis syndrome | sacral mobility- mobilizes piriformis |
lateral femoral cutaneous nerve impingement | Causes paresthesia along the upper lateral thigh (Meralgia Parasthetica), Most often a unilateral issue |
what often relives lateral femoral cutaneous nerve impingement | Walking/standing relieves symptoms |
what often aggravates lateral femoral cutaneous nerve impingement | sitting |
gait assessment | Biomechanical assess of LE positioning; Anterior, posterior or neutral pelvis; Anteversion or retroversion of femoral head |
Trendelenburg gait | Weakness of gluteus medius on weightbearing side allows drop of contralateral |
circumduction | Weakness or restriction of hip flexor of ipsilateral |
hip hiking | Joint stiffness/restriction of contralateral |
postural assessment looks at | Iliac crest, PSIS and ASIS, base of sacrum and ILA: Assess of leg length discrepancy; Greater trochanter and lateral malleoli: Assess femur and tibia length in hooklying position |
positions for postural assessment | standing, sitting, supine and prone |
long sit test | differentiates true LLD as opposed to pelvic obliquity, compares supine leg length vs long sit leg length |
what does LLD look like in long sit test | leg length difference stays same in supine and long sitting |
ROM assesment | active and passive |
MMT assessment | Most concerned with gluteal and rotational strength |
palpation assessment | Soft and connective tissue restriction |
joint mobility assessment | Lateral, inferior and posterior accessory motion- can use mob strap |
what is Thomas test used for | •Hip flexor tightness/restriction |
how to perform thomas test | •Performed on edge of plinth, Patient pulls one knee towards chest while lying supine, Opposite LE is being tested |
positive thomas sign | •Positive sign is LE that is <90 ˚ at knee or thigh is not parallel with table |
obers test is used for | •Iliotibial band tightness/restriction |
how to perform obers test | •Performed in sidelying, top LE is tested; Passively move top LE into flexion, then abduction, then extension and lastly allow LE to go into adduction |
positive ober test | •LE not able to adduct to neutral position |
elys test is used for | •Rectus femoris test for tightness/restriction |
how to perform ely test | •Performed in prone •Passively flex the knee |
positive ely test | ipsilateral pelvis flexes and lifts off table |
craigs test is used for | •Testing for femoral anteversion |
how to perform craig test | Performed in prone with knee at 90 ˚; Allow LE to internally rotate and measure for excessiveness |
how to interpret craigs test | excess IR signals anterverted hip |
faber test is used for | •Assess for pathology of the hip, lumbar and/or sacroiliac |
how to perform faber test | Place tested LE in hip flexion, abduction and external rotation; Maintain pelvis neutrality and apply downward pressure to knee |
positive faber test | pain provocation |
FADDIR test | asses for FAI, anterior labral tear, illiopsoas tendinitis |
how to perform FADDIR test | flexion, adduction, IR; apply pressure to outer portion of knee to move further into IR |
FADDIR test positive sign | pain provocation |
scour test is used to | Assess for labral tear |
how to perform scour test | •Place tested LE in flexion at 90 ˚; Apply pressure through knee to compress hip joint and rotate internally and externally |
how should joint feel in scour test | like ¼ moon shape |
positive sign for scour test | pain and clicking |
PT tx for common hip pathologies | address obvious dysfunctions: gait and postural assessment, ROM, MMT, joint mobility, and special tests --> do they indicate mm imbalance or pathology. |
modalities for hip dysfunction | •Anti-inflammatory •Pain reduction |
therex for hip dysfunction | •Soft tissue mobilization/joint mobilization •Range of motion activities •Gait training •Strengthening/stabilization exercises •Functional activities •Patient education |