Hip Lecture - PT528 Rehabilitation of Hip Nonsurgical...

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5/2/2016 PT528 – Rehabilitation of Hip Nonsurgical Musculoskeletal Disorders Quinnipiac University Physical Therapy PART A: IMPAIRMENT/ FUNCTION-BASED DIAGNOSIS I. Structural Considerations A. Acetabular labrum & alignment (Neumann, pg 473-474) 1. Acetabular labrum a. Fibrocartilaginous rim; enhances stability by deepening the acetabular socket b. Acts as a seal to maintain negative intra-articular pressure c. Poor vascularization (limited ability to heal) but well supplied by afferent nerves (injury is painful) 2. Acetabular alignment a. Deviations from optimal may be at risk for hip joint pain (e.g. labral tears, osteoarthritis) b. Measurements used to describe extent to which acetabulum covers femoral head 1) Center-edge angle: frontal plane (Gosvig, J Bone Joint Surg Am, 2010) • Measures extent to which acetabulum covers the top of the femoral head. • Intersection of a vertical, fixed reference line with the acetabular reference line that connects the upper lateral edge of acetabulum with center of femoral head; ≈25-35 0 • Decreased C-E angle (<25 0 ): decreased coverage is consistent with structural instability & increased risk of dislocation; also, reduces contact area thereby increasing joint pressure (force/area). • Increased C-E angle (>35 0 ): excessive coverage; pincer impingement 2) Acetabular anteversion angle: transverse plane • Measures extent to which acetabulum covers the front of the femoral head. • Intersection of a vertical, fixed anterior-posterior reference line with the acetabular reference line that connects the anterior and posterior rim of the acetabulum; ≈20 0 • Excessive acetabular anteversion (>20 0 ) exposes the femoral head anteriorly making hip more prone to anterior labral tears and/or dislocation, especially at extremes of external rotation. • Decreased acetabular anteversion (aka retroversion) (<20 0 ) results in excessive coverage; pincer impingement. B. Femoral neck diameter (alpha angle) & alignment 1. Femoral neck diameter: alpha angle (Notzli, J Bone Joint Surg Br, 2002) a. Angle created by: 1) A line between the anterior point, where the distance from center of the head exceeds the radius of the subchondral surface of the femoral head, 2) A line from the center of the head through the narrowest part of the femoral neck; b. Angle of 60 0 or greater is consistent with cam femoroacetabular impingement (FAI) 2. Femoral version (torsion): transverse plane QUPT 1 Rehabilitation of Patient with Nonsurgical Hip Disorder Primary References (in Addition to Kisner & Colby) Part A: Impairment / Function-Based Diagnosis I. Structural Considerations II. Hip Joint Pain III. Contractile Tissue Injuries Grimaldi, 2015; Dutton, 2012 IV. Bursitis Dutton, 2012 V. Piriformis Syndrome Tonley JC, 2010 Part B: Examination I. Pathoanatomic & Movement System Diagnoses Cyriax (Ombregt, 1995); Sahrmann, 2002 II. Differential Diagnosis Dutton, 2012 III. Symptoms & Self-Report Enseki K, 2014; Cibulka M, 2009 IV. Postural Assessment Sahrmann SA, 2002 V. Examination Enseki K, 2014 VI. Functional Performance Testing Martin RL, APTA Independent Study Course 24.2.1 (2014) VII. Interpretation Enseki K, 2014; Cibulka M, 2009 Lab Handouts
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  • Spring '14
  • DeniseCameron
  • Muscles of the hip

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