MSK_Hip_ALL

  1. Resting position (Loose-packed) for iliofemoral jt - 3
    • 30 flex
    • 30 ABD
    • Slight ER
  2. Hip ROM
    • Flexion - 120
    • Extension - 30
    • ABD - 45
    • ADD - 30
    • ER/IR - 45
  3. Closed-packed position for iliofemoral jt - 3
    • Full extension
    • IR
  4. Capsular pattern @ iliofemoral jt
    • Flexion > ABD > IR
    • Sometimes IR is the most limited
  5. Hip blood supply - arteries for proximal femur; femoral head; acetabulum
    • Proximal femur - Medial/lateral femoral circumflex 
    • Femoral head - obturator 
    • Acetabulum - superior/inferior gluteal
  6. Hip Bursas - Illiopsoas; trochanteric (superficial + deep); Ischiogluteal - Location; Which bursa has pain in sciatic distribution + from what; Which bursas are inflamed w/RA?
    • Illiopsoas - deep to illiopsoas tendon @ lesser trochanter
    • Trochanteric Superficial - over greater trochanter
    • Trochanteric Deep - bet Glute max & posterior lateral greater trochanter
    • Ischiogluteal - bet ischial tuberosity & glute max
  7. Pain in sciatic distribution - Ischiogluteal; from sitting on hard surface
    RA - illiopsoas + trochanteric
  8. Iliofemoral ligament - another name; restrict
    • "Y" or ligament of Bigelow
    • 2 bands - Inferior (medial) + superior (lateral)
    • Overall resists - extension
    • Lateral band resist ADD
    • Image Upload 1
  9. Pubofemoral ligament resists what motions? - 2
    • ABD
    • Extension
    • Image Upload 2
  10. Ischiofemoral ligament resists what motion?
    • IR
    • Image Upload 3
  11. Angle of inclination - Describe; Normal angle + abnormal; Each pathology results from what?
    • Femoral alignment in frontal plane bet femoral shaft & neck
    • Normal - 125°-130°
    • INC = Coxa valga 
    • DEC = Coxa vara 
    • Coxa vara - fx of neck of femur; SCIFE; defect in ossi­fication of head of femur
    • Coxa valga - congenital dislocation of hip
    • Image Upload 4
  12. Coxa valga vs coxa vara & knee position
    • Coxa valga = genu varum (bow-leggedness)
    • Coxa vara = genu valgum (knock-knees)
    • Image Upload 5  Image Upload 6
  13. Angle of inclination - relationship to height of person
    • Taller person - larger angle
    • Shorter person - smaller angle
  14. Torsion angle - Describe; Normal + 2 abnormal
    • Relative rotation between shaft & neck of femur in transverse plane
    • Normal range - 12-15°
    • Anteversion >25°-30° 
    • Retroversion <10° - femoral ER + toeing-out
  15. Anteversion - Positions lower limb how in WB - 3
    • Femoral IR
    • In-toeing
    • Squinting patellae
  16. Retroversion - Positions lower limb how in WB - 2
    • Ffemoral ER
    • Toeing-out
  17. Hip flexion - Prime movers - 3
    • Iliopsoas
    • Rectus femoris
    • Sartorius
  18. Hip extension - Prime movers - 5
    • Gluteus maximus
    • Semitendinosus
    • Semimembranosus
    • Biceps Femoris (Long head)
    • ADD magnus (posterior fibers)
  19. Hip ABD - Prime movers - 2
    • Gluteus medius
    • Gluteus minimus
  20. Hip ADD - Prime movers - 4
    • ADD Magnus (anterior fibers)
    • ADD Longus
    • ADD Brevis
    • Gracilis
  21. Hip ABD - Prime movers - 3
    • Gluteus medius
    • Gluteus minimus
    • TFL
  22. Hip ER - Prime movers - 4
    • Glute Max
    • Obturatus internus
    • Gemelli
    • Quadratus femoris
  23. Pain in buttock - location & nn root - upper medial; lower medial; upper lateral
    • Upper lateral buttock - L1
    • Upper medial buttock - L2/3
    • Lower medial buttock - S1/2
  24. Sign of Buttock - causes - 9
    • Infection
    • Fx of sacrum/pelvis
    • Osteomyelitis
    • Sacroilitiis
    • Septic bursitis
    • Rheumatic bursitis
    • Gluteal hematoma
    • Ischiorectal access
    • Tumor
  25. Sign of Buttock - S/S - 7
    • Limited SLR
    • Limited hip flexion
    • Limited trunk flexion
    • Non capsular pattern of hip restriction
    • Gluteal swelling
    • Hip flexion - empty end-feel
    • Hip extension - painful and weak
  26. Trochanteric bursitis - chief complaint - 6 + seen w/what pathology
    • Pain over lateral aspect of greater trochanter
    • Pain w/AROM hip ADD & IR/ER
    • Pain w/resisted ABD
    • Lying on involved side
    • Pain during transitions from standing to lying down to standing
    • Tight ITB
    • Seen w/RA
  27. Iliopsoas bursitis - S/S - 4 + diff diag
    • Pain and snapping in medial groin or thigh
    • Pain INC w/active/passive hip flex/extension 
    • Pain INC w/ABD in flexion
    • Pain INC w/resisted hip flexion
    • Diff Diag - Avulsion fracture
  28. Ischiogluteal bursitis - symptoms INC by - 3
    • Walking
    • Climbing
    • Sitting
  29. Iliotibial Band Syndrome - Pain location; Mechanism of injury; Seen w/what athletes?; Diff diagnosis
    • Pain at lateral hip, thigh or knee
    • Snapping as ITB passes over greater trochanter - repetitive flexion + extension of knee
    • Seen w/long-distance runners
    • Results in inflammation of trochanteric bursa
    • Diff diag - Trochanteric bursitis
  30. Avulsion fx - History - 2; When is surgery done
    • Sudden, violent mm contraction
    • May hear or feel a “pop”
    • Surgery >2 cm displacement
  31. Femoral neck stress fx - 5; Inferior vs superior fx - PT
    • Persistent groin discomfort INC w/activity
    • Female athlete triad - Hx of endurance exercise
    • ROM may be painful
    • Pain on palpation of greater trochanter
    • Inferior fx - Non-WB 2-4 wks
    • Superior fx - ORIF; non-WB 1-2 weeks (w/crutches or walker)
  32. Pelvis fx - pubic rami & acetabulum; how
    • Pubic rami - anterior compression of pelvis
    • Acetabulum - lateral compression of pelvis (falls from roof landing on feet)
  33. Piriformis Syndrome - S/S - 5; D/t what?
    • Pain in buttock & posterior thigh
    • Pain on active hip ER + passive hip IR at end range
    • Pain on palpation of sciatic notch
    • Uneven sacral base
    • INC in symptoms w/squatting, prolonged sitting
    • D/t Excessive pronation of foot - leads to abnormal femoral IR
  34. Acetabular Labral Tear - S/S - 5; PT phase 1 - avoid what?
    • NO restrictions in ROM
    • Buckling; locking; instability
    • Painful clicking
    • Normal radiographs
    • Pain INC w/forced ADD + rotation
    • Pain w/active SLR
    • PT - Phase 1 (day 1-7) - AVOID SLR
  35. Hip Muscle Strains - Hamstrings - S/S - 5; PT - concentrics done when; PT - eccentrics done when; PT - stretching done when; PT - isometrics done when
    • Ecchymosis (frequently)
    • Limited/painful knee extension/SLR
    • Pain w/resisted hip extension/knee flexion
    • (+) tripod sign
    • Symptoms INC w/running
    • PT - CONCENTRIC - phase 2 (day 3-3 wks) 
    • PT - submax isometrics - phase 2
    • PT - Stretching - phase 3 (3-6 wks)
    • PT - Eccentric - phase 3
  36. Hip Muscle Strains - ADD strains - S/S - 4
    • Stabbing pain in groin w/quick start/stop
    • Edema/ecchymosis several days post injury
    • Pain w/passive ABD or manual resistance to hip ADD
    • Associated w/running, jumping, twisting especially when ER of leg is added
  37. Hip OA - S/S - 6 + 1 advanced
    • ROM restriction in capsular pattern
    • Pain in groin, anterior thigh, knee
    • Painful hip extension/IR/ABD
    • Pain INC after prolonged activity/prolonged rest/WB
    • Stiffness
    • Antalgic limp
    • Advanced - loose bodies
  38. Congenital hip dislocation/Dysplasia - S/S - 4
    • ER & Shortened leg
    • Weak hip ABD
    • DEC ABD ROM
    • Balance/gait difficulties - Trendelenburg gait
  39. Avascular Necrosis of Femoral Head (AVN) - 5
    • Hip ROM DEC in capsular pattern - Flexion/IR/ABD
    • Dull ache or throbbing pain in groin/lateral hip/buttock
    • Hx of prolonged steroid use
    • Prior hip fx &/or SCEF
    • Corticosteroids - contraindicated
    • PT - Protected WB; Exercises to max soft tissue function (strength & support); THR
  40. Legg-Calve-Perthes Disease - 4
    • Onset Insidious (gradual)
    • Age - 3-12 (Male:female = 4:1)
    • Antalgic limp - 1-3 months 
    • Aching pain @ groin & anterior thigh
    • Disuse atrophy of hip/thigh mms 
    • Painful limitation - ABD/IR
    • Short limb
    • Special test - (+) bony crescent sign (collapse of subchondral bone at femoral neck/ head)
  41. Slipped Capital Femoral Epiphysis (SCFE) - 9
    • Fracture through growth plate which results in slippage of overlying end of femur
    • Onset - sudden
    • Males: 10-17 (ave 13)
    • Females: 8-15 (ave 11)
    • Pain - VAGUE @ hip/anterior thigh 
    • Pain worsens w/WB
    • Limited & painful IR
    • Weak hip ABD - Trendelenburg gait (glute med gait)
    • PT - non WB + closed chain partial WB (in therapy test)
    • Tx - Surgical pinning - URGENT
  42. Main differences bet Legg-Calve-Perthes & Slipped Capital Femoral Epiphysis (SCIFE) - AGE WILL BE KEY WORD
    • Legg starts younger at 3 BUT SCIFE starts 8-10
    • Onset - Legg insidious (gradual) BUT sudden w/SCIFE
    • Both have limited ABD/IR + glute med gait
  43. Hip Posterior (dorsal) glide INC what? - 2
    • Flexion (especially near anatomical limit)
    • IR
  44. Hip anterior glide INC what? - 2
    • Extension
    • ER
  45. THA - score test name; poor score
    • Harris hip score
    • < 70
  46. THA - cemented vs non—cemented for what populations + what can cemented do right away
    • Cemented - dementia; significant debilitation; fragile bones
    • Non-cemented - younger, more active individuals
    • Cemented can tolerate full WB immediately after surgery
  47. THA - phases time period
    • Phase I - 0-2 wks
    • Phase II - 3-8 wks
    • Phase III - 9-16 wks
  48. THA - precautions - general; anterolateral; posterolateral; Complication
    • General - Hip flex & 90 + ADD past 0
    • Anterolateral - ER
    • Posterolateral - IR
    • Complication - Hip dislocation
  49. THA limited activities - 6
    • sitting
    • reaching
    • twisting
    • IR beyond neutral
    • Soft chairs
    • Crossing involved leg over
  50. THA - PT - Isometrics; Partial WB; Stair training; MM to strengthen for efficient gait
    • Isometrics - Immediately post as tolerated 
    • Partial WB - 2nd post-op
    • Stair training - subacute - Up stairs w/control
    • Gait - hip extensors + ABD
  51. THR (posterolateral) - bed-to-WC transfer to what side?
    Stand-pivot to sound side - no ADD to neutral
  52. Test for hamstring length - 3
    • Straight leg raise
    • 90-90 straight leg raise
    • Tripod test
  53. Test for TFL & ITB
    Ober test
  54. Test for illipsoas
    Thomas test
  55. Test for rectus femoris
    Ely’s test
  56. Image Upload 7Name test; tests what; (+)
    • Thomas Test
    • Iliopsoas + Rectus femoris
    • (+) Thigh is raised off table
    • Iliopsoas is short - Overpressure into hip extension leads to INC in ER of thigh
    • Rectus femoris is short - Overpressure into knee flexion leads to INC in hip flexion
  57. Image Upload 8Name test; tests what; (+)
    • Ely’s Test
    • Rectus femoris
    • Pt prone, knee is passively flexed by PT
    • (+) Hip flexion on same side + Pelvis anteriorly rotates early in knee flexion
  58. Image Upload 9Name test; tests what; (+)
    • Ober Test
    • ITB + TFL
    • Side-lying, lower leg flexed at hip & knee
    • Testing leg in hip extension & ABD
    • (+) When leg is released it fails to lower
  59. Image Upload 10Name test; tests what; (+)
    • Straight Leg Raise Test
    • Hamstrings + neural tension (sciatic)
    • Supine; PT raises leg while palpating opposite ASIS
    • to diff bet hamstring lesion & sciatic nn lesion + DF
    • (+) <80 deg
    • 90-90 Straight Leg Raise Test (+) >10 deg knee flexion
  60. Image Upload 11Name test; tests what; (+)
    • Piriformis Test = FAIR - flexion, ADD, IR
    • Supine, leg placed near opposite knee
    • Holding pt’s knee, PT brings leg into hip flexion, ADD, IR
    • (+) Pain in glute; Radicular pain down sciatic nn; If tested knee cannot go over opposite knee
  61. Image Upload 12Name test; tests what; (+)
    • Tripod Tests
    • Hamstrings
    • Short sitting - PT passively extends knee
    • (+) INC trunk extension; >10 deg knee flexion
  62. Image Upload 13Name test; tests what; (+)
    • Craig’s Test
    • Femoral antetorsion
    • Prone, knee flexed to 90 deg
    • PT IR/ER hip while palpating greater trochanter - finding where it is most prominent laterally
    • PT measures that angle
    • (+) Measurement >15 deg
  63. Image Upload 14Name test; tests what; (+)
    • FABER test = Patrick’s test
    • Differentiation for Hip, lumbar or SI pathology
    • Supine, hip flexion, ABD, ER (foot of test limb rests on opposite knee)
    • PT presses test limb toward table while stabilizing opposite ilium
    • (+) SI - Pain in posterior
    • (+) Hip - Pain in anterior
  64. Image Upload 15Name test; tests what; (+)
    • Quadrant (Scour) Test
    • Non-specific joint pathology )non muscular/tendonous) - DJD
    • Typically labral/OA
    • Supine
    • PT passively flexes hip to 90 deg, knee flexed
    • PT moves hip into quadrants while applying longitudinal compression force
    • (+) Clicking; Crepitus; Pain
  65. Trendelenburg Sign - tests what; (+)
    • Gluteus Medius during U/L WB
    • Pt stand on 1 limb for 30 sec
    • PT notes whether pelvis is level w/o compensations
    • (+) Pelvis drops towards the unsupported limb
  66. Image Upload 16Name test; tests what; (+)
    • Barlow’s Test = Anterior hip dislocation
    • Hip is reduced - Test will dislocate hip
    • Supine; Hips/Knees @ 90 flexion
    • PT moves hip into ADD, pushing posteriorly through knees
    • (+) Click or clunk
  67. Image Upload 17Name test; tests what; (+)
    • Ortolani’s Test = Posterior hip dislocation
    • Hip is dislocated - Test will reduce hip
    • Supine; Hips/Knees @ 90 flexion
    • PT moves hip into ABD, while pushing thigh anteriorly at greater trochanter
    • (+) Click or clunk
  68. Difference between Barlow & Ortolani tests
    • Barlow is done to dislocate hip
    • Ortolani is for relocation
    • Both tests are for DVN
  69. Pain at MIDRANGE of hip flexion/ABD/ER implies what? As opposed to END Range
    • Midrange - Hip jt pathology
    • End-range - SI jt
Author
Tanuisha
ID
324124
Card Set
MSK_Hip_ALL
Description
MSK_Hip_ALL
Updated