CKC and Hip Exam

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CKC and Hip Exam
2014-01-31 23:09:08
CKC Hip Exam

Parts of KC and PP notes
Show Answers:

  1. CKC characteristics
    • interdependence of joint motion
    • motion will occur proximal and distal to a join in a predicatable fashion
    • predominance of ecc and cocontraction/stability
    • increased compression
    • decreased shearing
    • enhances proprioception
  2. Congential hip dislocation (dysplasia) etio
    • shallow acetabulum
    • possibly caused by increased hormones during pregnancy
  3. dysplasia common in
    • 80% female
    • usually found in infants
  4. dysplasia can lead to
  5. if not hip will continue to deteriorate with this disorder
    dysplasia (congenital hip dislocation)
  6. Legg-Calve-Perthes (coxa plana)
    femoral head blood supply interuption
  7. Coxa plana most common in
    males 4-10 y/os
  8. within several months this disorder has blood supply return and rebuild bone over 2-4 years
    coxa plana
  9. SnS coxa plana
    • knee pain
    • limited hip ROM
    • limp
  10. angle of torsion
    15-25 degrees forward from shaft of femur
  11. Coxa valga
  12. Coxa vara
  13. Coxa valga presents with
    • longer limb
    • pelvis adducted during WB
  14. Coxa vara presents with
    • shorter limb
    • and pelvis drop on with WB on affected side
  15. Hip pointer etio
    • at pelvis not hip
    • severe bruise due to direct trauma to iliace crest with bleeding into abdominals
  16. hip pointer sns
    • pain with:
    • walking
    • laughing
    • coughing
    • deep breathing
  17. THA indications
    • severe hip pain with motions and WB with limited motion
    • non-union fx
    • instability/deformed hip
    • bone tumors
    • failure of conservative management or previous reconstruction
  18. THA contras
    • active joint infection
    • sepsis
    • chronic osteomyelitis
    • inefficient or significant bone loss that prevents sufficient fixation
    • neuropathic joint
    • severe paralysis of muscles surrounding joint
  19. cemented THA info
    • allows early post op wb
    • shortened period of rehab
    • common for osteopor, elderly, and poor bone stock
  20. cement-less tha info
    • months of restricted wb and mob limits
    • common for under 60 year olds who are physically active
  21. THA post op complications
    • dislocation
    • LLD
    • mechanical loosening
    • heterotrophic ossification
  22. THA goals and interventions
    • regain strg/endurance
    • increase cardio pulmonary endurance
    • decrease contractures
    • increase postural stability, balance, and gait
    • prepare for full lv of functional activites
  23. how soon do you see a THA post op
    day after surgery
  24. SnS of THA in out patient
    • decreased ROM
    • pain
    • joint stiffness
  25. general components of short term THA rehab
    • 4-6 weeks
    • walking with min to no aid
    • giving up major pain killers
  26. general components of long term THA rehab
    • ~6mo
    • complete healing of surgical wound and soft tissue
    • returning to ADLs and work
  27. intracapsular fx
    • fx site proximal to attach of hip joint capsule
    • potential for direct cause of avascular necrosis
  28. extracapsular fx
    • distal to capsule
    • doesn't directly disrupt blood supply to femoral capsule
  29. T/F avascular necrosis can be related to extracapsular
    • True
    • May not primarily cause it but fixation failure of an extracapsular fx can be a potential hazard
  30. ORIF indications
    • (non)displaced intra-capsular femoral neck fx
    • fx dislocation of femoral head
    • (un)stable intertrochanteric fx
    • sub-trochanteric fx
  31. Hip fx post op goals and interventions
    • prevent vascular and pulmonary complications
    • increase strg
    • prevent post op reflex inhibition of hip and knee musculature
    • increase flexibility
    • restore active mobility and dynamic control of involved hip and adjacent joints
  32. T/F hip pointer occurs at hip
    • occurs at pelvis
  33. Trochanteric bursa etio
    • acute trauma
    • overuse
    • spontaneous
  34. trochanteric bursa sns
    • pain in hip region with walking
    • tenderness over upper part of femur
    • intolerance to side lying on affected side
  35. movements of pronation at each joint
    • pelvis anterior tilt
    • hip flex, add, and IR
    • knee flex
    • ankle DF, eversion, abduction
  36. CKC precautions
    • pain
    • joint effusion
    • limitations on joint compression
    • acute fx
    • osteoporosis
  37. tight and stretched muscles with lordotic curve
    • tight: ilio, TFL, ITB, ES
    • stretched: piriformis, glute medius, max, HS, rectus abdom
  38. flat posture tight and stretched muscles
    • tight: HS, g. med, g. max, rect abdom
    • stretched: ilio, ES
  39. DJD SnS
    • groin pain
    • stiffness with immob
    • pain with weight bearing
    • progressively limited function
  40. DJD findings
    • limited IR>ER
    • limited limited abd>flex
    • muscle imbalances
    • balance/posture
  41. THR acute tx
    • maintain slight abd
    • neutral rotation
    • gait training
    • breathing/coughing
    • ankle pumps
    • contralat ex
    • muscle sets
    • retrograde msg
    • protected ROM
  42. THR subacute tx
    • progressive ROM per Dr. usually ~90 flex, neutral rotation and adduction
    • try to avoid hip flexion contracture
    • WB depends on surgical procedure and may be restricted for up to 12 weeks
    • AAROM/AROM light resistance
    • OKC and CKC activities
  43. THR chronic tx
    • slowly increase ROM (flex, add, rotation) to submax levels
    • progress WB and assistive device use
    • progress resisted ex, generally high rep low weight
    • progress CKC especially but avoid impact activites
  44. Patrick/Fabere Test
    • Ipsilater hip patho or contralateral SI patho
    • Supine 1L straight
    • Other knee flexed with ankle on other knee
    • Stabilize pelvis and push knee down
  45. Sciatic Nerve palpation
    • Sidelying with back to therapist
    • Palp in the "groove" between ischial tube and greater trochant
  46. Anteversion/retroversion (Craig's Test)
    • Prone knee bent on farther side of therapist
    • Rotate leg until find greatest protrusion of greater trochanter
    • Slight IR is normal, more external= retroversion
  47. Leg Length
    Try in various positions. Have patient move around and therapist pulls on legs to try and remove and postural assymetries
  48. Trendelenburg
    • Patient stands and lifts one leg.
    • If on left leg and pelvis drops to the right, means left glute med/min weakness; +Left trendelenburg
  49. Ober
    • Patient side lying
    • Stabilize hip
    • Flex/bring under leg forward
    • Pull upper leg slightly into extension 
    • Let leg drop behind patient
    • If leg fails to drop behind patient positive for ITB/TFL tightness