MS hip testing

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MS hip testing
2012-09-28 20:37:30
MS hip testing

MS hip testing
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  1. in Cyriax's 15 movement functional test for the hip, what are the first 7 movements?
    • SUPINE
    • flexion
    • er (along longitudinal axis - leg straight, stabilize other hip)
    • ir (ditto)
    • abd (w slight IR so you won't get ER)
    • add (move other leg out of the way)
    • PRONE
    • ext w knee flexed
    • ir w knee flexed
  2. if the pt performs the first 7 movements in Cyriax's hip test in AROM w/o pain, what do you do? what if there is pain or restriction?
    • apply overpressure at the end of each mvmnt
    • if pain - repeat as PROM
  3. dermatomes in the tush
    • sup med: L2 L3
    • inf med: S1 S2
    • sup lat: L1
  4. in Cyriax's mvmnt test for the hip, what are the 8 resisted movements?
    and how do you apply the resistance?
    • done in middle of range / resting position:
    • flexion
    • ext
    • add
    • abd
    • ER (w/o ab/adduction!)
    • IR
    • knee flex
    • knee ext

    the resistance is isometric - so the leg never moves really from resting pos. - brace her w your knee or a towel under her, and have her push against your hands
  5. resting pos for the hip (maximal joint laxity)
    • 30 degrees flex
    • 30 degrees abd
    • slight ER
  6. closed packed position for hip
    • max extension
    • max IR
    • max abd
  7. hip flex ROM
    110-120 degrees
  8. hip ext ROM
    10-15 degrees
  9. hip abd ROM
    30-50 degrees
  10. hip add ROM
    30 degrees
  11. hip ER ROM
    40-60 degrees
  12. hip IR ROM
    30-40  degrees
  13. mobility testing - caudal distraction for hip ... how??
    • pt is supine
    • hip is in resting pos
    • fixate pt w hands or w strap around pelvis
    • grasp femoral condyles or malleoli
    • shift yr wt backwards w lunge stance, or pull thru yr arms
    • if it's hypomobile, implies overall loss of mobility
  14. mobility testing for hip, lateral... how??
    • pt is supine
    • hip is in resting pos.
    • strap around ASIS to stabilize pt on table (or another person's hands on the ASISes)
    • yr hands: yr ulnar border in the groin, or use a strap around you and around the pt's thight
    • shift wt back to move leg laterally
    • don't let leg do abd or ER (whole femur should move in parallel) - use your hands or bring upper body forward to prevent this
    • if hypomobile, implies overall loss of movement
  15. mobility test "femur ventral glide" aka anterior glide ... how to do this w pt PRONE??
    • wedge under ant pelvis
    • ASISes on table
    • yr hands: over proximal post femur, distal to IT, primary contact is 5th metacarpal (not whole hand!) so yr hand is cupped w the other hand pressing on it to add wt
    • push down to table w extended arm for a post --> ant glide
    • implication for hypomobility: loss of extension
  16. mobility test "femur ventral glide" aka anterior glide ... how to do this w pt standing??
    • pt is prone w one leg on the floor, ASISes on the table, and you're holding the other leg
    • (this is good for a pt who can't get into 0 degrees of ext)
    • hold pt just distal to knee, and use webspace or 5th metacarpal or heel of hand to press, distal to ITs
    • (femur must move as a parallel unit! so as you push with your pushing hand, lower w your holding hand)
  17. 3 directions, 4 types of MOBILITY testing w distraction for hip
    • 1. caudal (pt is supine, PT pulls on thigh or ankle)
    • 2. lateral ( pt is supine, PT pulls lat on thigh at groin)
    • 3. ventral (pt is prone, PT pushes ant just distal to IT and a bit medial)
    • 4. ventral (pt is standing on one leg, prone on table, PT is supporting other leg and pressing down where thigh meets tush)
  18. The Continuum the 6 stages of pain and ROM
    • painful movement, limited >50%
    • pain decreased
    • pain decreased, range increased to >50%
    • pain decreased, range increased
    • pain and range same but resistance is now the limiting factor

    full range w/o pain 
  19. according to The Continuum, what do you do for a joint w painful movement that's limited >50 %?
    • consider it predominantly painful, acute
    • treat for pain, starting w Grade 1 motions to affect type I and II receptors
    • start in resting pos (least noxious) w small amplitude, pain free movements, ossilating 1-2/sec for ~15 sec

    (remember, for these to give pain relief, direction doesn't matter)
  20. according to The Continuum, what do you do for a joint w "pain decreased"
    • 1) increase repetitions
    • 2) increase amplitude (to Grade II, but not into painful range)
    • 3) increase time of tx
  21. according to The Continuum, what do you do for a joint w "pain decreased, range increased to >50%"
    • it's still considered acute and needs to be treated for pain
    • do physiologic movement (instead of just staying in joint, add movement of limb)
    • large amplitude, but short of pain
  22. in evaluation a joint, specifically w The Continuum, what does a hard end feel tell you to do?
    treat the joint or movement as painful/acute
  23. according to The Continuum, what do you do for a joint w "pain decreased, range increased"
    now ou're in the subacute phase and ready for more ROM going into painful range (only if end feel isn't hard but is capsular)
  24. according to The Continuum, what do you do for a joint w pain-same, range-same, resistance now limiting factor
    • basically it's just a stiff jiont, so you need to work on ROM
    • use Grade III and IV mobs
    • use mob procedures at limit and/or contract-relax techniques
    • these are direction dependant (the pain management techniques are not)
    • push the pathological limit to the end of the anatomical limit
  25. according to The Continuum, what do you do for a joint w "full range w/o pain"
    take it out for ice cream
  26. on the 0-6 mobility scale, which ratings get mob treatment?
    • 1 and 2 only
    • 3 is normal and doesn't need it
    • 4-6 are hypermobile
    • 0 is ankylosed