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The Hip - 639
| Question | Answer |
|---|---|
| What happens when the foot hits the ground? | Calcaneus everts, foot pronates |
| What happens to the tibia as we PF and the arch pronates? | Medially rotates, drives into flexion and unlocks the femur= IR, the hip then IR |
| What kind of adapter is the foot when it pronates? | FLEXIBLE adapter |
| What is a quick stretch before a contraction considered? | Plyometrics |
| Position of the talocrural joint when the foot hits the ground | Plantarflexion |
| What happens to the glute max. when the hip IR? | quick stretch!= plyometrics |
| What must you do when someone comes in with hip pain? | check the WHOLE kinetic chain, above and below! |
| What happens when both ends of the LE are fixed? | movement of one link will affect all! |
| What happens to glute max. if we FIX the femur? | pelvis posterior rotator |
| Hamstrings action classicly: | knee flexors |
| Hamstrings action at the hip: | hip extensor |
| What function does glute max. serve at the hip, knee flexed? (UNFIXED) | hip extensor (G max. test=knee flexed) |
| Components of the acetabulum | ilium, ischium, pelvis, lunate surface, labrum |
| What are the purposes of the labrum? | seal, lubricate, nerve endings, position sense, pain perception |
| Where is the force at the acetabulum when WB? | on the lunate surface= superolateral force, not as much lateral though |
| Head of the femur components | head, neck, g. trochanter(L), l. trochanter(M), fovea, trabecular lines |
| What attaches to the g. trochanter? | gluteals, the piriformis, the obturator internus, and the gemelli |
| What is the purpose of the trabecular lines of the femur? | WB and hip function |
| What | |
| What purpose do the 'tubes' aka trabecular lines serve? | SUPPORT, Take AXIAL load very well! |
| How many COMPRESSIVE GROUPS of 'tubes' are there in the proximal femur? | 2! Primary= head of femur Secondary= neck of femur |
| What kind of load do the compressive groups take? | AXIAL |
| What bridges the compressive group forces to take the load? | Tensile group (dorsally located) |
| What inserts into the fovea? | ligamentum teres |
| How many degrees is the femur INCLINED? | 126* |
| What many degrees of torsion are present at the femur and in which direction? | 15, anteverted |
| What happens if the angle of the neck of the femur is larger? | coxa valga= >126....bowlegged |
| What happens if the angle of the neck of the femur is smaller? | coxa vara= <126.... knock knee |
| When do you have maximum congruence of the femur? | while WB |
| What is the loose pack position of the hip? | 30 flexion, 30 abduction, slight lateral rotation "FROG LEG"= DITKA |
| What does the loose pack position do for the LE? | provides least compression on the surfaces |
| What does the joint capsule do for the hip? | provides stability |
| What does the ligamentum teres contain? | obturator artery, nerves |
| What happens if the lig. teres is torn? | head of femur becomes avascular ~50% supply lost |
| what happens if you dislocate your femur at the hip? | decrease blood flow to the head of femur= AVN |
| What are the 3 main structural/functional ligaments at the hip? | iliofemoral, pubofemoral, ishiofemoral |
| What does the iliofemoral ligament check? | extension |
| What does the pubofemoral ligament check? | abduction |
| What does the ischiofemoral ligament check? | flexion and adduction |
| What happens to ALL of the ligaments in standing? | ALL are TIGHT! |
| What happens to the ischiofemoral lig. in the LPP? | unwinds and checks flexion then |
| What force do the H-A-T place on the spine? | axial |
| What force is exerted on the SI joint from up and down forces? | shear (convoluted) |
| How many degrees are there of nutation(flexion) and counternutation(ext.) at the sacrum? | 7* |
| Flexion ROM at hip | 120 |
| EXT ROM at hip | 20 |
| ABD ROM | 45 |
| ADD ROM | 25 |
| IR at 90* hip flexion | 40 |
| ER at 90* hip flexion | 45 |
| where does psoas attach? | femur and spine? |
| where does iliacus attach? | ilium |
| Hip arthritis is indicated with | capsular pattern of restriction (not symm.) |
| What is the role of the iliopsoas at the hip? | influence hip motion... may cause back pain if weak |
| What does the lumbar spine do during Ant. Tilt? | extend |
| What does the hip do during Ant. Tilt? | flex |
| What direction does the ASIS point in Ant. Tilt? | down |
| Ant. Tilt may be indicative of what lumbar spine condition? | Lordosis |
| What does the lumbar spine do during Post Tilt? | flex |
| What does the hip do during Post Tilt? | extend |
| What direction does the ASIS point in Post. Tilt? | UP |
| Movement of the sacrum is in how many directions? | 3 dimensions |
| Unilateral pelvis are what axis? | oblique, superior R=forward, inferior L=back |
| Are all the muscles active simulatenously? | YES |
| What is the role of piriformis at 0* | ER |
| what is the role of piriformis at 90* | IR |
| Synergy= | redundancy |
| what are the 3 bursa of the hip | trochanteric, iscial, iliopectineal |
| What is the iliopectineal bursa do? | acts as a pulley over which psoas and iliacus run |
| What is an acetabular dislocation? | a fx that did not occur |
| what is hip tendinitis? | cumulative trauma or strain on muscles/tendons |
| hip oa results from? | aging: 60^, incidious onset(~6 mo's worse n worse), |
| where will hip oa pain be felt? | groin= medial, centralized, lateral hip pain is rare! |
| Rheumatoid arthritis differs how? | may affect many other joints, widespread, bilateral hips, hands, shoulders, knees (may be uni.) |
| high impact hip fractures | MVA, must remain stable (NWB), do not mobilize unstable fx's, acetabular fx |
| what is the rehab for a high impact trauma fx? | mobility, motor controlled function over that limb |
| how is a fx fixed? | through the posterior aspect, slash through glutes= motor implications |
| how long should an individual typically remain NWB with a fx? | ~6-8 wks depending where the fx occurred |
| what are the 3 most common places for an osteoporosis fx to occur? | neck, intertrochanteric, subtrochanteric |
| which out of the 3 or the 2 MOST LIKELY places for a fx to occur? | neck and intertrochanteric |
| High energy dislocations are associated most with: | adults, MVA, ^ trauma, ant. or post. |
| Low energy dislocations are associated most with: | under 15 y/o, usually posterior, IR and shortened=skeletal immature, leg short= slip superior |
| congential dislocations are associated with: | infancy= hip dysplasia(femur/socket), corrected with ER |
| Post hip arthroplasty precations: | DO NOT: add. past midline, IR, cross leg, flex past 90* |
| legg calve perthes | bony abnormality, males, 3-5 y/o, temp. avasc., spontaneous regain blood flow, can be miserable |
| Acquired: Slipped capital femoral epiphysis | most common: overwt. adoles. boys, bilat, growth plate pops loose |
| how do you treat slipped capital femoral epi.? | NWB ~8wks, if reduced/screw= less time NWB, perform slide board transfers |
| Labral tears are common in who? | dancers, hockey goalies=butterfly stance, sports, |
| True or false: OA and labral tears are commonly seen in parallel? | TRUE, high finding for THA later in life |
| what happens to the synovial fluid that leaks during a tear? | gets reabsorbed, but there is less lubrication now |
| Muscle Strains at lesser trochanter | psoas: avulsion=will bleed, blood may calcify (MYOCYITIS OSSIFICANS) |
| muscle strains at ASIS | sartorius: soccer players |
| muscle strains at AIIS: | RF: soccer, runners |
| where do hip contusions commonly occur and to who? | g. trochanter, iliac crest...lose ALOT of function! football players...must Tx from the immobilization |
| Tendinitis: | ITB=3D= run over g. trochanter= FRICTION! hip flexors=psoas=hypomobile |
| What happens if psoas is hypomobile? | shortened position results in active insufficiency |
| where might psoas pain be felt? | ant hip from repetitive actions, pain in back |
| True or False: Sagittal plane changes to the ITB may affect the frontal plane? | true! |
| What are the 3 cause of hip bursitis? | progressive, mechanical, night pain |
| What is the cause of night pain bursitis? | ischemic in nature= bad blood flow to the area |
| What is the cause of mechanical hip bursitis? | muscles over the bursa, contusion to bursa= ext. force |
| true or false: a sprain is liekly with the joint capsule? | FALSE! |
| Inguinal Ligament sprains: | hip or ligament, mobility can become problematic, hernias, bones are not static (slight flex.) |
| Where would you 'poke' for Piriformis Syndrome? | gluteal fold--> popliteal space. no pain=no sciatic nerve problem |
| What nerve would a tight piriformis restrict? | sciatic |
| how much of the sciatic nerve pierces the piriformis? | 15-30% |
| what age/gender does legg calve perthes typically affect? | boys 3 to 12 y/o |
| How specific is groin pain (posterior or lateral) for OA? | 92%---RULE IN! |
| What might snapping or popping of a tendon in the hip indicate? | snapping= psoas over the iliopectineal bursa |
| How sensitive and specific is popping/snapping of the hip for a labral tear? | 100% sensitive-- RULE OUT if they DONT have it!.... 85% able to rule in that they DO have it |
| how might running irritate a bursa? | ITB runs over the intertrochanteric bursa= bursitis |
| Hip OA may be provoked by squatting(flexion), how sensitive is this? | 76% sensitive...no pain with squat? no OA |
| Do the numbers on Metric tests always correspond to goals? | NO!.... functional questions help to write the goals! ACTIVITY is the GOAL! |
| how might the hip affect the back? | through hypomobility |
| Lurches may involve: | abductor: glute med. extensor |
| What happens in lordosis? | posture of apathy= in ext. you hang on your Y bigelow (iliofemoral lig)... glute max= weak, abdominals= lengthened |
| OKC flexion with lateral pain is how specific for OA? | 82% specific... you can rule it in! |
| OKC abd/add with groin pain is how specific for OA? | 94% specific...rule in!!! |
| PASSIVE MOTIONOKC for OA: no restricted movement= | 100% sensitive, 100% sure they DO NOT have it., restricted motion in all 3 planes= 92% specific= they do have it! |
| Lumbar spine motions couple with: | force couples with the pelvis |
| No ext. in hip? | work through spine! |
| none in spine? | work through hip |
| FABER test: SN and SP #'s | SN= 60%, SP= 18% |
| SCOUR test: SN and SP | SN= 62%, SP= 75% |
| FADIR test: SN and SP | SN= 78%, SP= 10% |
| Ant. Labral test: SN and SP | SN= 75%, SP=43% |
| Will an acetabular labral test show up on a plain MRI? | NO! use MRI arthrogram= better resolution |
| Bone scan is good to see: | stress fracture (through isotopes), necrosis |
| what is a DXA scan used for? | osteoporosis= bone density= GOLD STANDARD! |
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