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hip limitations get compensated for by what body part?
lumbar spine
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how does the femoral head run?
sup, med, ant
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how does acetabulum run?
inf, lat, ant
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articular cartilage covers all but __ of the femur's head and neck. Why?
the fovea - this gap allows the ligamentum teres to get to the head
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hip's capsule - runs from where to where?
it's a cylindrical sleeve, running from iliac bone to upper end of the femur
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4 kinds of fibers in hip's joint capsule?
- longitudinal: run the length of the capsule
- oblique: diagonally spirallying around capsule
- arcuate: look like the sign Mom made for my shag rug
- circular: run around the periphery
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frenula capusle
it's a pleat, extra fabric in the medial aspect of the capsule - it lets you do a split w abduction
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which lig attaches to he obturator eternus?
ishiofemoral
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rel of fem head to acetabulum when we're upright and when we're bent
- erect - the head pokes out ant.
- quadruped - fits loverly bc this is the true physiogical pos of the hip, dating back to our quad days
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hip ligaments when we're upright vs quadruped
- upright - ligs coil "clockwise" i think laterally
- quad loose
- extension winds the ligs, flex unwinds them
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what kind of motion is flexion and extension from an arthrokinematic view?
how about flex and ext in another position (so some translation is necessary)
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abd/add and ER/IR in hip is a combo of what movements in the joint?
slide and glide
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"zero starting position" for the hip
anatomical position - line btwn ASISes and ASIS to patella is 90 degres
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2 ways to treat a painful hip w yr thumbs by the greater trochanter
- pt is sidelying, leg is in resting position, pillow is between knees
- a) thumbs are behind the greater trochanter for ant/post movement
- b) thumbs are sup to greater trochanter for longitudinal movements
- in both cases, grades I and II
- note: don't push with thumbs. they're just markers, and the work is coming from the shoulder. Also, these techniques aren't direction dependant for pain relief. Thumbs can be nail to nail or pad over pad
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how to treat a painful hip with minor rotation
- hands on distal femur and proximal tibia
- pt supine, limb in resting position, pillow under knee
- do med lat ossilations - it's basically tiny IR-ER mvmnts
- grades I and II
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treatment of painful hip w pt supine, doing oscillations of the femur in the caudal/longitudinal direction
- pt supine, hip in resting pos, pillow under knee
- your hands on distal femur (don't compress the patella!)
- grades I and II
- can also do compression in this position
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tx of painful hip doing oscillations of femur in cephalal/proximal direction
- pt supine, hip in resting pos, pillow under knee
- PT's hands on distal femur and prox tibia (both hands are in the same place on med and lat side of knee, thumbs pointing towards pt's head)
- grades I and II for pain, III and IV for wt bearing
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when to use longitudinal distraction mobilization for hip?
use when pt has restricted flexion
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longitudinal distraction mobilization for hip - how to
- pt is supine, pelvis stabilized, hip flexed to 90 degrees
- yr hands by proximal hip (ulnar side of one hand in groin), or have a strap around pt's hip and PT's waist, pt's ankle on your shoulder
- shift your weight backwards (so, start in a lunge pos)
- hold stretch for 7 sec, relax, repeat 2-3x
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parameters to play w for mobilizations
- the grade
- duration and number of repetitions
- position of joint (y're starting in resting pos but you can progress to other angles)
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lateral traction hip mobilization is for what?
for restricted flex or extension
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lateral traction hip mobilization - how?
- pt supine, hip at near end range of flexion, knee at 90 degrees, pelvis stabilized
- put your hands around prox med thigh or use a strap
- shift your wt back in lateral direction w pt's knee on yr shoulder
- (be sure the femur moves as a unit)
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dorsal glide mobilization for hip is for what?
for restricted hip flexion
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dorsal glide mobilization - how? (aka posterior)
- pt is supine, hip in near end range of flexion, pelvis stabilized
- hold pt's leg against yr body, put yr hands over the knee/distal femur (not patella), push longitudinally along femur shaft in post dir
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internal rotation mobilization -- how?
- pt is prone w knee flxed
- stabilize contralat hip and grasp prox to ankle
- "flap" the foot against yr body doing grade III and IV mobs (position your body so you can't push beyond this/overstep bounds of anatomical limit)
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internal rotation mobilization - for what?
- pain relief at end of a session
- to improve IR flexibility
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Sign of the Buttock 3 symptoms, and what you should do
- limited SLR
- limited hip flexion w knee flexed
- non capsular pattern at hip
send pt to doctor!
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Sign of the Buttock (limited SLR, limited hip flexion w knee flexed, and non-capsular pattern at hip) can be caused by...?
- osteomyelitis of upper femur
- septic sacroiliac arthritis
- ischiorectal abscess
- septic bursitis
- rheumatic fever w bursitis
- neoplasm of the upper femur
- iliac neoplasm
- fracture of the sacrum
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referred pain in hip likely comes from what nerve root?
- L3
- "pain referred fromgroin, down ant thigh to knee. Referred to ant leg above ankle. may be only felt at knee. occassionaly developed from L4, and mimics sciatica"
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2 things that often get confused w sciatica
L5 gluteal or rachateric bursitis pain
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congenital conditions that'll present w capsular pattern
- perthes
- TB of the hip
- slipped capitl epiphysis
- synovitis
- coxa vara
- hemophilia
- congenital dislocation
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thins adults get that present w capsular pattern
- osteoarthritis
- loose body in the hip joint
- rheumtoid arthritis
- ankylosing pondylitis
- osteitis deformans
- acetabular protrusion
- synovitis
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