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ortho test 2

202: hip

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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