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Resting position (Loose-packed) for iliofemoral jt - 3
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Hip ROM
- Flexion - 120
- Extension - 30
- ABD - 45
- ADD - 30
- ER/IR - 45
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Closed-packed position for iliofemoral jt - 3
-
Capsular pattern @ iliofemoral jt
- Flexion > ABD > IR
- Sometimes IR is the most limited
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Hip blood supply - arteries for proximal femur; femoral head; acetabulum
- Proximal femur - Medial/lateral femoral circumflex
- Femoral head - obturator
- Acetabulum - superior/inferior gluteal
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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
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Pain in sciatic distribution - Ischiogluteal; from sitting on hard surface
RA - illiopsoas + trochanteric
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Iliofemoral ligament - another name; restrict
- "Y" or ligament of Bigelow
- 2 bands - Inferior (medial) + superior (lateral)
- Overall resists - extension
- Lateral band resist ADD
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Pubofemoral ligament resists what motions? - 2
- ABD
- Extension
-
Ischiofemoral ligament resists what motion?
- IR
-
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
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Coxa valga vs coxa vara & knee position
- Coxa valga = genu varum (bow-leggedness)
- Coxa vara = genu valgum (knock-knees)
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Angle of inclination - relationship to height of person
- Taller person - larger angle
- Shorter person - smaller angle
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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
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Anteversion - Positions lower limb how in WB - 3
- Femoral IR
- In-toeing
- Squinting patellae
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Retroversion - Positions lower limb how in WB - 2
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Hip flexion - Prime movers - 3
- Iliopsoas
- Rectus femoris
- Sartorius
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Hip extension - Prime movers - 5
- Gluteus maximus
- Semitendinosus
- Semimembranosus
- Biceps Femoris (Long head)
- ADD magnus (posterior fibers)
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Hip ABD - Prime movers - 2
- Gluteus medius
- Gluteus minimus
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Hip ADD - Prime movers - 4
- ADD Magnus (anterior fibers)
- ADD Longus
- ADD Brevis
- Gracilis
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Hip ABD - Prime movers - 3
- Gluteus medius
- Gluteus minimus
- TFL
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Hip ER - Prime movers - 4
- Glute Max
- Obturatus internus
- Gemelli
- Quadratus femoris
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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
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Sign of Buttock - causes - 9
- Infection
- Fx of sacrum/pelvis
- Osteomyelitis
- Sacroilitiis
- Septic bursitis
- Rheumatic bursitis
- Gluteal hematoma
- Ischiorectal access
- Tumor
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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
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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
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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
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Ischiogluteal bursitis - symptoms INC by - 3
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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
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Avulsion fx - History - 2; When is surgery done
- Sudden, violent mm contraction
- May hear or feel a “pop”
- Surgery >2 cm displacement
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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)
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Pelvis fx - pubic rami & acetabulum; how
- Pubic rami - anterior compression of pelvis
- Acetabulum - lateral compression of pelvis (falls from roof landing on feet)
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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
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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
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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
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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
-
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
-
Congenital hip dislocation/Dysplasia - S/S - 4
- ER & Shortened leg
- Weak hip ABD
- DEC ABD ROM
- Balance/gait difficulties - Trendelenburg gait
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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
-
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)
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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
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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
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Hip Posterior (dorsal) glide INC what? - 2
- Flexion (especially near anatomical limit)
- IR
-
Hip anterior glide INC what? - 2
-
THA - score test name; poor score
-
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
-
THA - phases time period
- Phase I - 0-2 wks
- Phase II - 3-8 wks
- Phase III - 9-16 wks
-
THA - precautions - general; anterolateral; posterolateral; Complication
- General - Hip flex & 90 + ADD past 0
- Anterolateral - ER
- Posterolateral - IR
- Complication - Hip dislocation
-
THA limited activities - 6
- sitting
- reaching
- twisting
- IR beyond neutral
- Soft chairs
- Crossing involved leg over
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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
-
THR (posterolateral) - bed-to-WC transfer to what side?
Stand-pivot to sound side - no ADD to neutral
-
Test for hamstring length - 3
- Straight leg raise
- 90-90 straight leg raise
- Tripod test
-
Test for TFL & ITB
Ober test
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Test for illipsoas
Thomas test
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Test for rectus femoris
Ely’s test
-
Name 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
-
Name 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
-
Name 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
-
Name 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
-
Name 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
-
Name test; tests what; (+)
- Tripod Tests
- Hamstrings
- Short sitting - PT passively extends knee
- (+) INC trunk extension; >10 deg knee flexion
-
Name 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
-
Name 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
-
Name 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
-
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
-
Name 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
-
Name 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
-
Difference between Barlow & Ortolani tests
- Barlow is done to dislocate hip
- Ortolani is for relocation
- Both tests are for DVN
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Pain at MIDRANGE of hip flexion/ABD/ER implies what? As opposed to END Range
- Midrange - Hip jt pathology
- End-range - SI jt
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