LE 1

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  1. Location of Pain and Symptoms back pain
    • Lumbar spine
    • Sacroilitis
  2. Lumbar Spine
    • 80% prevalence rate in the adult population
    • Mechanical pain with or without radiating leg pain
    • Treatment-based classification system (Fritz 2007 JOSPT)
    • ----Mobilization/manipulation (Likely had recent injury)
    • ----Stabilization (General laxity)
    • ----Specific exercise (directional preference)
    • ----Traction
    • --------Distal referral of pain
    • --------Numbness or weakness
    • --------Mixed results
    • Impairment-based treatment
    • ----1st tx impairments then tx using above method
  3. Sacroilitis
    • Forten sign: point to SI as painful spot
    • Clinical Prediction Rule:
    • ----Thigh thrust/POSH test
    • ----Compression
    • ----Distraction
    • ----Sacral thrust
    • ----Gaenslan
    • 3 out of 5 is positive
    • Sn: 91 Sp: 87
    • Look at pelvic rotation is not accurate
  4. SI dysfunction common in
    • Pregnant: laxity
    • Erlors Danlos
    • Marfans
    • Fall (shearing)
    • Otherwise it is a very stable jt compared to L/S and hip
  5. Neuromuscular Causes of Hip Pain
    • 1. Slipped Capital Femoral Epiphysis
    • 2. Hernia
    • 3.Athletic pubalgia
    • 4. Legg-Calve-Perthes disease
    • 5. Osteitis pubis
    • 6. Meralgia Paresthetica
    • 7. Scaiatica
    • 8. Hip OA
    • 9. Lumbar spine, SI joint, knee
    • 10. Bursistis/Tendinosis
    • 11. Femoral acetabular impingement
    • 12. Fracture
  6. Hip OA
    • Altman’s Criteria for Hip OA à The American College of Rheumatology
    • ----Hip pain
    • ----IR < 15
    • ----Morning stiffness up to 60 minutes
    • ----Age > 50 (just like CA)
    • Sn: 86, Sp: 75
  7. Femoral acetabular impingement
    • CAM vs Pincer will show either a pos FABER or FADDIR
    • Active individual
    • Hurt when sit bc getting impinged but usually active
  8. Hernia
    • Inguinal
    • ----Through inguinal ring
    • Femoral
    • ----Fossa ovale
    • ----Less common but more common after delivery
    • Portion of abdomen/ hip already weak
    • Content extruded from structure
  9. What can cause hernia
    • Lifting
    • Valsalva : bowel (if constipation)
    • After delivery
  10. Athletic pubalgia (sportsman hernia)
    • Not true hernia
    • Rectus abdomins tearing from pubic bone
    • In highly athletic individuals
    • Dx of exclusion
    • ----Usually sent with adductor/hip flexor strain and those tests will be pos
    • ----But if true adductor strain then they should not have pain with hip flexion
    • Will have pain if ask to crunch but planking better bc really getting lower abs
    • Tx
    • ----Rest or surgery depending on severity
  11. Osteitis pubis
    • Inflammation of pubic symphysis
    • In highly athletic or If have had Suprapubic surgery
    • Multiple muscles pos bc of the torque being applied on the pubis
    • How to differentiate btwn oscietis pubis and athletic pubalgia
    • Imaging
    • From PT standpoint: our tx isn’t going to change: strength, ROM, mobility,
  12. Fracture
    • 1. Insufficiency: normal stresses on abnormal bone
    • ----Osteoporotic bone
    • ----Bone insufficient to handle normal daily stresses of life
    • 2. Fatigue: abnormal stresses on normal bone
    • ----Excessive running
    • 3. Pathologic: generally refers to focal region of metastases
    • ----Bone has started to metastasize
  13. Meralgia Paresthetica
    • Compression over the lateral femoral cutaneous nerve
    • No weakness or motor impairment
    • Non traumatic pops
    • ----Athletic field: hit of field, bruised on field
    • ----Nerve is being compressed by a heavy belt (construction or law enforcement)
    • ----Pt has to modify
    • Traumatic
    • ----Have to wait for it to get better
  14. Legg-Calve-Perthes disease
    • Idiopathic avascular necrosis of the hip
    • Most common in boys ages 4-8 (ages vary depending on sources)
    • ROM limitations into extension, abduction, and IR
    • Painful limp to bear weight
    • When blood supply returns they will start to see return
    • Return dependent on how long they were without blood
    • Loss ROM non-capsular
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ID
320944
Card Set
LE 1
Description
LE 1
Updated
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