Prac Viva

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Author:
jessiekate22
ID:
152410
Filename:
Prac Viva
Updated:
2012-05-16 19:53:45
Tags:
Hip
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Description:
Hip
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  1. COnduct a physical examination of a pt with hip pain in standing?
    • Always compare sides!
    • Observation:
    • - deformities- flex/ ext, lordosis
    • - weight bearing
    • - swelling
    • - mm spasm
    • - mm wasting
    • - leg lenght
    • Trendelenburg test- standing on one leg- shift weight
    • - weight bearing leg hip higher- no glutes
    • Balance- rhombergs
    • - if the knee is rotated the hip is- if femur rot the knee cap points out
    • - look for lordosis
    • - COG
  2. Conduct a physical examination of a pt with hip problems in walking.
    • - walk forwards/ backwards/ sideways
    • - antalgic gait (penguin)- compensation
    • - uneven
    • - swinging- leg around
    • - waddling
    • - adducted
    • - trendelenburg (weakness of abductors)- model
  3. Conduct an active movement assessment of a pt with hip problems.
    • always ask pt if a certain movement hurts
    • Overpress
    • Compare to the other side
    • Minimise the lumbar spine movements during hip testing
    • - flexion- can you bring you knees to your chest
    • - abd/adduction- supine ??? bring across/ away from midline. To OP hand on other side of hip.
    • - ER/IR- sitting is the easiest position. Can do it supine. OP in sitting stablise the femur on bed. Int rot take foot away fom midline, ext rot take foot across midline.
    • - leg length
    • thomas test
  4. Conduct some functional tests on your pt with hip problems
    Clear Lsp- full range flex/ ext, SIJ, knee- squat

    • - anything the pt says is aggravating
    • - aggravating/ injury movement
    • - stairs- depstep up/ down
    • - squat-full hip flex- feet flat
    • - rot in standing- test ext and int rotation-pt standing, test leg off the floor at 90 degrees and int/ ext rotate hip.
  5. Conduting passive movements of a pt withhip problems
    • I am going to do the movements for you!
    • Support leg
    • compare to the other side
    • - hip flexion (140 degrees)
    • - abduction (45 degrees)
    • - adduction (25 degrees)
    • - int rotation- neurtal and at 90 degrees flex (45 degrees)
    • - ext rotation- " " (60 degrees)
  6. What should you palpate on a hip problem pt?
    • Note specific palapation is to be done at theend of the examination
    • - temp/ swelling
    • - anatomy- greater trochanter
    • - abductor insertion (pubic symphysis)
    • - symphysis pubis
    • Nerve:
    • - sciatic- 1/2 between greater trochanter and ischial tuberosity
    • - femoral- 1/2 way between ASIS and pubic symphosis
    • - lateral cutaneous (medial to ASIS, below inguinal lig)
    • Bursae
    • - trochanteric- side lying
    • - psoas- in hip flexion
    • - ischial- back
  7. What are the special test you would conduct for a hip problemed pt?
    • Do no harm!
    • - Quadrants (flex/ add/ +/- IR)
    • - fabers test (flex/ abd/ ER) - testing ant hip jt and capsule.
  8. What static muscles test would you conduct on a pt with hip problems?
    • - this is a way to differentiate - working out when the pain comes on- with/ without contraction
    • - for groin tear- squeeze legs
    • - flex
    • - ext
    • - abd
    • - add
    • - IR
    • - ER
  9. What is the obers test?
    • - pt in sidelying
    • - test for tightness of ITB
    • - pull leg back in ext with knee flex
    • - once at end range straighten leg and let it drop, watch for cheat movements
    • - comapre to the other side
  10. DONT FORGET ABOUT MOVEMENT DIAGRAMS
  11. What can be conducted in sidelying when testing a hip pt?
    • - static mm- abduction
    • - accessories
    • * Ap, PA
    • * caudad glide
    • * lateral glide
    • Obers test
  12. What are the accessories for a pt with hip problems?
    • - longitudinal caudad (neutral/ 90 degrees flex) knee bent pull down
    • - longitudinal cephalad (neutral/ 90 degrees flex)- knee bent push up
    • - A/P, PA
    • - lateral glide (neutral/ 90 degrees flex)- seat belt
  13. What movements can you conduct when a pt is in prone lying for a hip?
    • active movements:
    • - ER, IR, Ext
    • Passive physiological movements
    • - ext 15 degrees
    • -IR/ER- good in prone- hip in diff position
    • Static mm tests
    • - IR/ER
    • - Ext
    • Accssories
    • -PA glide
  14. How would you trefl;eat int rotation for a hip problem pt?
    • supine: grade 1 and 2
    • Ext: supine grade 3 and 4
    • Ext: prone grade 3 and 4
    • Flex: grade 3 and 4
    • Why would you chose certain positions?
  15. WHat are the grades of mobilisation and how long would you treat a pt for?
    • grade 1- small movement- treat pain
    • grade 2- larger movement but no into restriciton- treat pain
    • garde 3- larger movmtent into restriction- treat stiffness
    • grade 4- small movement at end of range- treat stiffness

    test for 30 sec see how it goes then 3x 30 sec
  16. How would you treat ext rotation for a hip problem pt?
    • flexion supine (90 degrees hip/ knee flex)- grade 3/4
    • ext prone (90 degrees knee flex)-grade 3/4
  17. What are some passive physiological mobilisation techniques for flexion/ adduction of the hip?
    • Flexion adduction:
    • grade 4- smaller movement at end range
    • grade 3- bigger movement
    • grade 2- irritable pt easy to mid range

    This technique is not often used at end range
  18. What is a passive accessory mobilisation technique lateral movement?
    • Grades 1- 4
    • alt position- sidelying for grade 1.
    • flex and int rotation
    • if stiff bring into more flex
  19. Conduct a PAM longitudinal caudad on a pt with hip pain.
    Why chose this technique?
    • pull down/ can flex leg and sit on foot.
    • supine: neutral or flexion- grades 1-4
    • sidelying: thumbs for grade 1 and hands around lower thigh for grade 1 and 2
    • PAM- used for pain relieving when compression is an irritant.
  20. Demonstrate how you would conduct a assive hysiological technique on a pt with hip pain, in abduction. When wouldnt you use this technique?
    • Abd/ Felx
    • Abd/ ext for grade 2
    • for grades 1-4
    • Not really used with abduction sprain
  21. Passive physiological technique and ext for the hip.
    Grades 2-4
  22. Demonstrate a PA glide on a pt with hip problems? And why would you use this technique?
    • ant to post
    • - sidelying, identify greater trochanter
    • - thumbs grade 1 and 2
    • - heel of hand grade 3 and 4

    • Ensure pt comfort
    • trying to improve flex????
  23. What exercise would you give to a pt with hip problems and why?
    • stretching- of hip flexors, pulling pelvis into ant pelvic tilt
    • strenghtening- glute mucles to stabilise the pelvis
    • gai correction
    • postural correction
    • heat/ cold
    • eletrotherapy
  24. What is a passive accessory movement?
    • A movement that the pt cannot produce volumtarily
    • Always compare to the other side
    • roll, spin, glide, compress, distract
    • low accessory movements = low physiological movements
  25. WHat is a passive physiological movement?
    • a physiological movement is one a pt can do, but due to it being passive it means the therapist does the movement for the pt!
    • Muslces are not activated- non contractile, helps differentiate muscle vs inert structures as source of pain
    • End feel, ROM- normal? COmpare sides
  26. Demonstrate a thomas test for a hip pt.

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