Term
| Hip joint's resting position. |
|
Definition
ABd = 30
Flex = 30
slight ext rotation |
|
|
Term
| when is the resting position used during treatment? |
|
Definition
| during the initial mobilization to assess the hip joint |
|
|
Term
| what is the orientation of the acetabulum? |
|
Definition
| acetabulum faces laterally, anteriorly, and inferiorly |
|
|
Term
| What portion of the acetabulum is non-articular? |
|
Definition
|
|
Term
| what is the periphery of the acetabulum lined by? |
|
Definition
| horse-shoe shaped articular cartilage |
|
|
Term
| Where is the effective WB surface of the acetabulum? |
|
Definition
| the posterosuperior aspect of the femoral head |
|
|
Term
| the acetabulum is deepened by the ____ |
|
Definition
| fibrocartilaginous labrum |
|
|
Term
| can you dislocate the hip w/out tearing the labrum? |
|
Definition
|
|
Term
Double limb stance:
body weight
muscle activity
joint reaction force |
|
Definition
Double limb stance:
body weight distributed equally & balanced
little/no muscle activity req secondary to stability provided by capsular ligaments
joint reaction force at ea. femoral head = 1/3 of body weight |
|
|
Term
Single limb stance:
joint reaction force in diff. activities |
|
Definition
Single limb stance:
dramatic force change on the WB hip
joint reaction force at ea. hip changes to 2.5 X BW
climbing stairs = 3x BW
running = 4.5x BW
femoral head can resist fracture up to 12-15x BW |
|
|
Term
Angles of inclination
anatomic plane and normal values |
|
Definition
in the frontal plane, angle formed by neck and shaft of femur
adults = 125
children = 150
increased angle is coxa valga
decreased angle is coxa vara |
|
|
Term
Angle of torsion
plane
values |
|
Definition
formed by angle between femoral condyles and femoral neck in the transverse plane; how the femoral head is angled into acetabulum (must look straight down)
Normal = 15
Anteversion= 30; lack EROT; toe-in gait
Retroversion= 5; lack IROT; toe-out gait |
|
|
Term
| Capsule of the hip joint is _____ and ____ over the ____ and ____ portion of the joint. |
|
Definition
| The hip capsule is strong and thick over the upper and anterior portion of the joint. |
|
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Term
| The hip joint capsule is ___ and ___ over the ___ and ____ joint area. |
|
Definition
| Hip joint capsule is weaker and thinner over the lower and posterior joint area. (why we dislocate posteriorly most often.) |
|
|
Term
|
Definition
"Y ligament of Bigelow"
strongest in the body, rarely ruptures
checks IROT and Ext.
"resting on your ligaments" |
|
|
Term
|
Definition
lies anterior - pubis to just ant to lesser trochanter
checks ABd and slight IROT |
|
|
Term
|
Definition
lies posterior (direction of dislocation)
weakest of the three
checks IROT and Ext. |
|
|
Term
| Which ligaments limit extension? |
|
Definition
| All three - iliofemoral, pubofemoral, and ischiofemoral |
|
|
Term
When are the ligaments on slack?
When are they tight? |
|
Definition
ligaments are on slack in flexion
ligaments are tight when hip is "wound up" from extension - results in passive stabilization |
|
|
Term
What are the mechanisms of hip dislocation?
what are the associated risks? |
|
Definition
1. compressing trauma - blunt force to bent knee when the hip is flexed - fall)
2. rotational trauma - severe IROT of thigh with hip partial flexed (skiing)
3. most common is post disclocation often with rim fracture
4. Assoc risks - sciatic N. dmage and compromised blood supply |
|
|
Term
| When do hip dislocations occur? |
|
Definition
When the capsule and ligaments are lax
* this is opposite of all other joints!
when the joint surfaces and bony axes are out of congruence |
|
|
Term
| The hip is most prone to dislocate when: |
|
Definition
- hip is flexed (ligaments are lax)
- hip is ABd and IROT (non-congruent)
- posterior F. thru femur (dashboard) |
|
|
Term
| What is the PT 1st impression of a hip dislocation? |
|
Definition
Pt. lying supine or on injured side
the damaged hip is partially flexed, IROT and ADd across the opposite thigh |
|
|
Term
| What are S/S of a hip dislocation? |
|
Definition
- extreme guarding
- hip "locked" into place
- any mvmt = extreme pain
- partial loss of motor fuction (drop foot) and sensation |
|
|
Term
| Where does the Iliopectineal (psoas) bursa lie? |
|
Definition
lies under the iliopsoas ant. to the joint
communicates with the joint. |
|
|
Term
| Where does the trochanteric bursa lie? |
|
Definition
| Between the greater trochanter and IT band |
|
|
Term
T/F
The trochanteric bursa is the most common site for bursitis in the hip |
|
Definition
|
|
Term
| What are the mechanisms of injury for trochanteric bursitis? |
|
Definition
Repetitive flexion and EROT
IT band tightness (often seen in long distance runners)
leg length discrepancy (long leg is predisposed)
trauma |
|
|
Term
| What are the S/S of trochanteric bursitis? |
|
Definition
painful ADd
lateral hip pain
pain with standing, walking, sitting, stairs - esp. SLS bc ADd tighten
Point tenderness |
|
|
Term
| What is the treatment for trochanteric bursitis? |
|
Definition
Ice
stretch IT band
inject with corticosteroids |
|
|
Term
| Where does an Intracapsular femoral fx occur? |
|
Definition
It occurs at the femoral neck, proximal to the trochanteric line within the joint capsule
*rare in children
*worse prognosis |
|
|
Term
| What are the mechanisms of injury for an intracapsular femoral fx? |
|
Definition
High-energy trauma
low-energy trauma secondary to osteoporosis |
|
|
Term
| What complications can occur with an intracapsular femoral fracture? |
|
Definition
high rate of non-union & avascular necrosis
fracture site bathed in synovial fluid which retards healing by dissolving the fibrum clot so a proper capillary cascade cant happen)
risk of thromboembolic ds. port-op if pt. not mobilized w/in 24h |
|
|
Term
| What are the WB restrictions post-op of intracapsular femoral fx? |
|
Definition
WB varies w/ stability of reduction and surgical approach
stable fx = WBAT (non-displaced of impacted femoral head)
unstable fx = NWB (req. reduction/manipulation) |
|
|
Term
| Where does an Extracapsular femoral fx occur? |
|
Definition
In the area of the trochanters - b/w greater and lesser
Along the intertrochanteric line
outside of the joint capsule |
|
|
Term
| What are the mechnisms of injury for extracapsular femoral fx? |
|
Definition
falls in geriatric pop (esp on knee)
high energy trauma in younger pts (may accompany a femoral shaft fx) |
|
|
Term
Extracapsular femoral fx post-injury
(union rate, vascular supply, etc) |
|
Definition
rich vascular supply (no synovial fluid)
high union rate
extensive fx hematome (allow for healing)
must check for concomitant (accompanying) fractures |
|
|
Term
| What is the most common ds affecting the hip? |
|
Definition
| Degenerative joint ds (osteoarthritis) |
|
|
Term
| what is the difference bw primary and secondary OA? |
|
Definition
primary OA - idiopathic dev middle age
secondary OA - response to known injury/ds (macro or micro trauma) |
|
|
Term
|
Definition
60 yrs and older:
25% females
15% males
have symptoms of OA |
|
|
Term
|
Definition
pain in the groin extending anteriorly to knee (or medially); an aching sensation esp with WB
range limited in the capsular pattern
trendelenberg gait
pain in terminal stance (b/c the peak force is closer to area of peak force in midstance on femoral head)
muscle atrophy: ABd and glut max |
|
|
Term
| What is the treatment for OA? |
|
Definition
early stages of tx should involved joint mobilization (gain extension)
hemiarthroplasty
total arthroplasty (THR) |
|
|
Term
| What are the considerations for Total Hip Replacements? |
|
Definition
cemented v non-cemented (controversy about best type)
non-cemented favored for younger pts.
non-cemented is easier to revise
cemented allows for immediate WB
non-cemented has WB restrictions |
|
|
Term
| Posterolateral approach for THR: |
|
Definition
access hip bw glut max and medius
joint capsule and EROT released
hip dislocated postteriorly
allows for quicker normalization of gait |
|
|
Term
| What muscles are affected w/ the posterolateral approach of THR? |
|
Definition
| obturator internus, gemelli, piriformis, quadatus femoris |
|
|
Term
| What muscles are preserved with the posterolateral approach to THR? |
|
Definition
Gluteus medius, minimus, vastus lateralis
translates to regaining normal gait sooner |
|
|
Term
| When do you have elective THR v non-elective THR? |
|
Definition
Elective THR: OA, RA, AVN
Non-elective THR: fracture where ORIF isn't appropriate (intracapsular) |
|
|
Term
| Anterolateral approach to THR |
|
Definition
access hip bw glut medius and TFL
decreased risk of posteror dislocation
hip precautions are less crucial
longer surgical time and less blood loss |
|
|
Term
| What muscles are affected by the anterolateral approach to THR? |
|
Definition
| gluteus medius, minimus, TFL, vastus lateralis, and iliopsoas |
|
|
Term
| What are the precautions of posterolateral THR? |
|
Definition
flexion > 90
IROT
ADd past midline |
|
|
Term
| What are the precautions for anterolateral THR? |
|
Definition
flexion > 90
ADd past midline
IROT
EROT with flexion
*these are followed 6-8 wks min and gen 6 months |
|
|
Term
| What are the 3 types of Snapping Hip Syndrome? |
|
Definition
Internal Snapping
External Snapping
Intra-articular Snapping |
|
|
Term
| Internal Snapping Hip Syndrome |
|
Definition
internal snapping from 45 flex to ext.
the iliopsoas over lesser trochanter and ant acetabulum (more common)
iliofemoral ligament over femoral head
*only a concern if it bothers you |
|
|
Term
| External Snapping Hip Syndrome |
|
Definition
with flexion or extension with IROT
the IT Band or glut max over the greater trochanter
*only a concern if it bothers you |
|
|
Term
| Intra-articular Snapping Hip Syndrome |
|
Definition
occurs with pivoting
labral tears or loose bodies
wear down the acetabulum
occurs with gymnasts, dancers, ballet
*problem and concern |
|
|
Term
| Piriformis Syndrome - definition |
|
Definition
| sciatica assoc w. overuse piriformis musc. |
|
|
Term
| What are the mechanisms of Piriformis Syndrome? |
|
Definition
Repetitive EROT assoc w/ running, dancing, prolonged sitting
direct trauma |
|
|
Term
| What are the S/S of Piriformis Syndrome? |
|
Definition
Unilateral pain
pain rel. to certain activites (bending, lifting) |
|
|
Term
| What is the tx of Piriformis Syndrome? |
|
Definition
stretch the piriformis
counter strain to relax the piriformis |
|
|
Term
| What are the pain patterns of the hip joint? |
|
Definition
| Midinguinal region spreading to anterior thigh/knee |
|
|
Term
| What is the pain pattern for trochanteric bursitis? |
|
Definition
| Trochanteric region spreading to lateral thigh |
|
|
Term
| What are the pain patterns for the lower spine? |
|
Definition
| Buttock region spreading to lateral and POSTERIOR thigh |
|
|
Term
| What is Developmental Dysplasia (DDH)? |
|
Definition
its a congenital dysplagia and congenital hip dislocation
*abnormal growth/development of proximal femur, capsule, and/or acetabulum; there are 3 forms recognized |
|
|
Term
|
Definition
femoral head outside the acetabulum
confirmed with the Ortolani maneuver
worst type |
|
|
Term
|
Definition
femoral head within acetabulum but easily dislocated
confirmed with Barlow maneuver
not the worst, but not best - middle of the road |
|
|
Term
|
Definition
femoral head partially displaced out to acetabular rim
least severe of the 3 types |
|
|
Term
|
Definition
femoral head partially displaced out to acetabular rim
least severe of the 3 types |
|
|
Term
| What are the etiological factors of DDH? |
|
Definition
Mechanical factors: primapara, intrauterine crowding, breech presentation
Physiologic factors: ligamentous hyperlaxity (female)
Environmental factors: carrying position of baby |
|
|
Term
| What are the presentations of DDH from 0-2 mos? |
|
Definition
- excessive hip and/or knee extension or hip hyperextension
- asymmetric thigh folds, gluteal folds, and popliteal creases
- unequal leg lengths
- + Galeazzi sign (knees unequal height)
- confirm w/ ortolani and barlow signs |
|
|
Term
| What is the clinical presentation of DDH 3-12 mos? |
|
Definition
progressive posterolateral and superior displacement of femoral head
ADd contracture
+ Galeazzi sign
*limited hip ABd - most reliable finding in child 3-12 mos |
|
|
Term
| A child with DDH often ends up with what anatomical condition? |
|
Definition
|
|
Term
| What is Legg-Calve-Perthes Ds (LCPD)? |
|
Definition
avascular necrosis of femoral head
impairment of growth plate
onset indicated by subchondral fracture
etiology unknown |
|
|
Term
| What is the clinical presentation of Perthes Ds? |
|
Definition
limp on the affected side
pain in groin, hip, and/or knee
trendelenberg type gait
may report assoc traumatic event
limited ROM: ABd, IROT (capsular pattern) |
|
|
Term
| What is the best age to have Perthes Ds? |
|
Definition
| 6 years old or younger. after 9 is really bad |
|
|
Term
| What is the tx for Perthes Ds? |
|
Definition
40% req. surgical intervention
restore full ROM
contain femoral head in acetabulum
NWB --> PWB |
|
|
Term
| What is the prognosis for Perthes Ds? |
|
Definition
females worse than males
less than 6 yrs old is best
after 9 is worst |
|
|
Term
| What is Slipped Capital Femoral Epiphysis? |
|
Definition
Femoral capital epiphysis displaces or slips on the femoral neck
occurs during period of rapid growth (puberty)
growth plate is weak and shearing stress of body weight causes slip |
|
|
Term
| What is the incidence of Slipped Capital Femoral Epiphysis? |
|
Definition
african americans
eastern US more
males more than females 2:1
age 12-17
bilateral is 23%
just L. is 60%
body weight in >90% |
|
|
Term
| What is the clinical presentation of Slipped Capital Femoral Epiphysis? |
|
Definition
hip, groin, and/or knee pain
achy or dull pain worse with activity
limited in capsular pattern (?)
resisted mvmts: strong and painless, except duing slipping stages and muscle guarding (weakness in ABd, EROT) |
|
|
Term
| What is the treatment for Slipped Capital Femoral Epiphysis? |
|
Definition
surgery to secure the slip
NWB
restore ROM with precautions:
- hip flexion to 90 only
- ADd and EROT to neutral |
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