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57 Cards in this Set
- Front
- Back
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how do you 'Establish if source of hip pain is mechanical or non-mechanical
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through screening process (look for redflags)
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how do you establish if the source of hip pain is extrinsic or intrinsic
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- Low back and SIJ typically lead to buttock/post. thigh pain
- limping, groin pain, limited hip IR point to hip pathology |
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what is the meant by extrinsic or intrinsic source of hip pain
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extrinsic = LBP or SIJ
intrinisic = hip |
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what is the next step if it has been determined that the source of hip pin is intrinsic
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establish if 1) extra-articular or 2) intra-articular
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what would suggest the hip pain is extra-articular
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- pain more superficial
- tenderness to palpation - pain in reproduction with testing of muscle function |
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what would indicate intra-articular pathology
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- groin pain with :
- FABER - scour - active SLR - impingement tests *note these do not indicate which articular pathology though* |
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what is the importance of presence/absence of groin pain during hx taking and with hip special tests
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- presence of anterior groin pain does not always mean intra-articular pathology present BUT ABSENCE RULES OUT INTRA ARTICULAR
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what his hip dysplasia
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shalolw acetabulum leding to lesser stability of the hip
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what are the possible pathologies that hip dysplasia can predispose a patient to
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1) labral tears
2) chondral lesions 3) OA |
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how would a patient with hip dysplasia present
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no S and S- simply dx with radiographs
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what is femoral acetabular impingement
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impingement b/t the neck of the femur/femoral head and the ridge of the acetabulum
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what is cam impingement
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impingement due to a larger radius of the femoral head
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what is pincer impingement
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impingement due to a deep acetabulum
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the two types of femoral acetabular impingement are ____, which is due to a larger radius of the femoral head and ____, which is due to a deep acetabulum
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Cam = larger femoral head
Pincer = deep acetabulum |
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what are the symptoms for acetabular impingement
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pinching/groin pain with sitting and hip adduction (when hip flexed)
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what are the clinical findings for acetabular impingement
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- (+) impingement test (FADIR!)
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what causes capsular laxity
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can be either traumatic or atraumatic
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what would be an atraumatic cause for capsular laxity
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connective tissue disorders or repetitive stretching
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what are the symptoms of capsular laxity
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sense of hip instability
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what are the clinical findings for capsular laxity
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1) general laxity
2) excessive hip ER with log roll test 3) loose end-feel with long axis distraction of hip |
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what is the etiology of an acetabular tear
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can be traumatic or atraumatic (repetitive stretching)
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what are the symptoms for an acetabular tear
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- anterior groin pain (but this is not specific to acetabular tear)
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what are the clinical findings for an acetabular tear
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1) clicking with log roll test
2) (+) FABER 3) (+) Scour 4) (+) Active SLR |
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what is the 1st diagnostic cluster for hip OA
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1) pain in hip
2) less than 115 deg. hip flexion 3) less than 15 degrees hip IR |
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what is the 2nd diagnostic cluster for hip OA
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1) pain with IR
2) less than 60 min AM stiffness 3) older than 50 yrs. |
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what did the 1 randomized controlled clinilcal trial show
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positive outcomes of PT intervention, including manual therapy in the treatment of OA (moderate evidence)
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what are the three things to konw before initiating treatment after a THR
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1) WB status of the pt.
2) surgical approach 3) any special instructions from surgeon |
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what are the precautions for a posterior approach for a THR
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avoid hip flexion >90, hip adduction, hip IR
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what are the precautions for an anterior approach for a THR
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avoid hip extension, hip adduction, and hip ER
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how would you differentiate capsular laxity vs. hypomobility of the capsular with long axis distraction
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capsular laxity: increased motion and feeling of apprehension
hypomobility: decreased motion, relief of pain |
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what is the etiology of an acetabular tear
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can be traumatic or atraumatic (repetitive stretching)
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what are the symptoms for an acetabular tear
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- anterior groin pain (but this is not specific to acetabular tear)
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what are the clinical findings for an acetabular tear
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1) clicking with log roll test
2) (+) FABER 3) (+) Scour 4) (+) Active SLR |
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what is the 1st diagnostic cluster for hip OA
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1) pain in hip
2) less than 115 deg. hip flexion 3) less than 15 degrees hip IR |
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what is the 2nd diagnostic cluster for hip OA
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1) pain with IR
2) less than 60 min AM stiffness 3) older than 50 yrs. |
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what did the 1 randomized controlled clinilcal trial show
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positive outcomes of PT intervention, including manual therapy in the treatment of OA (moderate evidence)
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what are the three things to konw before initiating treatment after a THR
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1) WB status of the pt.
2) surgical approach 3) any special instructions from surgeon |
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what are the precautions for a posterior approach for a THR
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avoid hip flexion >90, hip adduction, hip IR
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what are the precautions for an anterior approach for a THR
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avoid hip extension, hip adduction, and hip ER
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how would you differentiate capsular laxity vs. hypomobility of the capsular with long axis distraction
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capsular laxity: increased motion and feeling of apprehension
hypomobility: decreased motion, relief of pain |
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where are acetabular labral tears
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in the anterior/anterosuperior region
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clicking with hip IR/ER indicates
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labral tear
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snapping with flexion/extension laterally indicates
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ITB or iliopsoas
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osteoarthritis can be secondary to what 3 conditions
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1) dysplasia
2) labral tears >5 years duration 3) chondral lesions |
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what is the gold standard for determining a labral tear
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gadolinium enhanced MRA (but still not 100%(
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what is the general hip imaging done for intraarticular pathologies
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intraarticular injection of anesthetic --> proves that the pain was coming from w/in the joint (90% accurate)
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what conditions would a bone scan be indicated to dx
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fractures, arthritis, neoplasms, infections --> shows increased metabolic activity
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hip pathologies are not that common, especially _____, the problem is almost always _____
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not common espeically labral tears, but usually soft tissue related
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The study comparing manual therapy and ex in OA of hip showed what
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exercise alone is still helpful (50%) but even better results when you include manual therapy (81%)
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for the numeric pain rating scale what is the clinically meaningful change
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2- points
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what is the harris hip score
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10 item functional assessment tool (score out of 100)
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what would indicate a greater disability for the harris hip score
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lower scores
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what is the cliniclaly meaningful change with the harris hip score
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4-point change
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what were the outcomes of the study
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even with only 4-5 tx even the people with long hx or older showed significant improvements
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what were the outcomes of the test looking at the benefit of mobilization
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functional squat, FABER, hip flexion and hip scour all had decreased number or patients with a positive test post mobilization
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describe the lower extremity functional scale
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20 Q's scoring 0-4
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what determines less disability (more functional) on the LE functional scale
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higher score (out of 80) = less disability
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