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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 |
Created by:
bdavis53102
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