Week 1: Hips Don't Lie

Spooky Scary Skeleton

100

This structure is formed by 3 bones: ilium (2/5), ischium (2/5), and pubis (1/5)

Acetabulum

200

How many degrees of freedom does the hip joint have?

3 (flexion/extension, abduction/adduction, internal/external rotation)

300

What comprises the intracapsular structures of the hip joint?

Femoral Head and Neck

400

What is the function of the labrum?

Deepens Acetabulum

500

In what position is the hip joint maximally congruent?

Flexion, Abduction, and slight ER (more movement is available in this position --> discuss what the closed packed position is)

600

This angulation of the femur is measured in the frontal place and has a normal value of 125 degrees

Angle of Inclination

coxa vara = more stable

coxa valga = more mobile

700

What ligaments assist at the hip joint?

Iliofemoral: Y-shaped with origin on AIIS and insertion on Greater Trochanter --> limits hip extension

Ischiofemoral: posterior ligament with origin on acetabular labrum and insertion on anterior Greater Trochanter --> limits hip extension)

Pubofemoral: anterior ligament with origin on superior rami and insertion on trochanteric fossa --> limits hip abduction)

800

What are the normal values for the femoral angle of torsion?

8 - 15 degrees

Glutes Gone Wild

100

This structure is considered the "key" to the gluteal region because structures are either found above or below it

Piriformis

200

What muscle groups belong in each of the three compartments of the thigh?

Anterior: quads (and sartorius)

Posterior: hamstrings

Medial: adductors

300

What is the function of the quadratus femoris?

Hip External Rotation

400

What muscle(s) of the hip and posterior thigh have dual innervation?

Biceps Femoris (tibial nerve and peroneal nerve)

500

Identify this muscle

Superior Gemellus

600

True or False: All of the gluteus muscles perform a common action of hip external rotation

False

Glute max: hip extension + hip ER

Glute med: hip abd + hip IR + hip ER

Glute min: hip abd + hip IR

700

Name the short external rotator muscles (6)

Piriformis

Obturator Internus

Obturator Externus

Superior Gemelli

Inferior Gemelli

Quadratus Femoris

800

If the innervation of the superior gemellus were interrupted, what other specific muscle would be effected?

Obturator Internus

(superior gemellus + obturator internus = innervated by 'nerve to superior gemellus and obturator internus)

Same goes for inferior gemellus and quadratus femoris

Vibe Check

100

Name the muscle length tests that can be conducted in a hip exam (Name at least 2)

Ely Test

Thomas Test

90/90 Test

Ober's Test

Piriformis Length Test

200

Which examination tests concern the TFL and ITB?

Ober's Test

Noble's Compression Test

(Technically also Thomas Test)

300

What is the beginning position for the FADDIR test?

Flexion, Abduction, Lateral/External Rotation (then you scoop into adduction and internal rotation)

400

Your friend is an aspiring supermodel and shows you her best supermodel runway walk, as you observe you notice that her R hip drops compared to her L hip during R LE swing phase. What does she have?

Positive L Trendelenberg

500

What are the tests for intra-articular joint pathology?

Scour Tests

FABER/Patrick's Test

600

OMG! Your patient has a Craig's Test result of 25 degrees on their right leg, what does that mean?

Anteversion of the R Hip

700

Apparent/Functional Leg Length is measured from what two landmarks?

Umbilicus and Medial Malleolus

800

Which two pairs of tests have the same starting position?

Anteroposterior impingement test and Anterior Labral Test (flexion + abduction + lateral rotation)

Scour and Posterior Labral Test (flexion + adduction + medial rotation)

"Why does this hurt?"

100

What is included in the category "Contractile Tissue"?

Muscles and Tendons

200

A patient arrives complaining of pain with shoulder flexion as well as shoulder extension, what other Selective Tissue Test might elicit pain?

Resisted Isometric Contractions

300

A patient arrives to the clinic complaining of pain with a hamstring stretch as well as pain with knee flexion and hip extension, what tissue type are you most concerned about?

Non-Contractile Tissue

400

Name at least 2 structures that are included with non-contractile tissues?

Joint Capsules, Ligaments, Cartilage, Nerves, Bursae

500

In a Passive Movement Exam, if you encounter pain before the motion barrier; is the injury considered acute/subacute/chronic?

Acute

600

If a Resisted Isometric Contraction is painful or weak, what tissue type is involved?

Contractile Tissue

700

A patient arrives in the clinic 2 months post knee injury; during the exam, the symptoms are reproduced with active knee extension and during the Thomas Test. You are able to passively move the patient up to their motion barrier but not through it due to pain.

Is this Contractile/Non-Contractile Tissue Injury AND is it acute/subacute/chronic?

Subacute Contractile Tissue Injury

800

A patient presents to PT for evaluation; during the exam, the patient has pain and limited range of motion with shoulder abduction. Noticing the limited ROM, you take the patient through passive ROM and are able to exceed the motion barrier before the patient experiences pain. When taking the patient through an MMT screen, they score a 3+/5 with shoulder abduction.

Is this a Contractile/Non-Contractile Tissue injury AND acute/subacute/chronic?

Chronic Contractile Tissue Injury

Bad Hip

100

Name at least 1 pathology that effects a largely pediatric population?

Apophysitis, Avulsion, Slipped Capital Femoral Epiphysis, Legg Calve Perthes

200

Name at least 1 pathology that effects a largely older population?

Hip OA

Greater Trochanteric Pain Syndrome

Hip Strain/Tendinopathy

Femoral Stress Fracture

300

What is the capsular pattern for Hip OA?

IR > Hip Flexion > Hip Abduction

400

This pathology refers to a type of labral tear presenting as a non-round femoral head that is unable to rotate smoothly inside the acetabulum; a bump generally forms on the edge of the femoral head that grinds the cartilage inside the acetabulum

Cam Lesion

500

Which pathologies effect Contractile Tissues? (Name 2)

Greater Trochanteric Pain Syndrome

Hip Strains/Tendinopathy

Adductor Strain

600

This pathology refers to the inflammation or occurrence of a stress injury on/around growth plates in children and adolescents

Apophysitis

700

What is the CPR for Hip OA?

Hip/Groin Pain (or Paresthesias)

Ipsilateral Anterior Thigh Pain

Passive Knee Flexion < 122 degrees

Passive Hip IR < 17 degrees

Pain with Hip Distraction

800

Which pathology (mostly present in a pediatric setting) includes the following 4 stages?

1. Necrosis (portions of bone turn into dead into dead tissue and the femoral head becomes less round)

2. Fragmentation (body 'cleaning up' dead bone and replaces it, allowing the femoral head to begin remodeling)

3. Re-Ossification (femoral head continues to remodel)

4. Remodeling (normal bone cells replace new bone cells to continue remodeling for a few years)

Legg Calve Perthes

Electric Boogie - NMES Edition

100

What currents are best for a tetanic contraction? (Name at least 1)

BSPC

Russian

IFC

MFBurstPC

200

For NMES, what frequency range would be best?

50 - 80 pps

300

Name the 3 Theories of Strength Gains?

Type 2 Fiber Activation

Overload Principle

Synchronous Firing of Motor Units

400

Concerning muscle contraction, would increasing or decreasing the current amplitude increase the force of contraction?

Increasing

500

What is the ideal on/off time for NMES?

10/50

600

Name the appropriate pulse duration range for motor level reactions

100 - 600 microseconds (or more)

700

Name the appropriate range for ramp up/down times

1 - 5 seconds

800

How long should one treatment session last for NMES?

10 - 20 minutes

Grown up Babies

100

Name at least one of the variables that influence growth

Nutrition

Hormones

Drugs

Environment

Mechanical Forces

200

This term identifies the center of bone growth that is located at the distal ends

Epiphyseal Plate

300

Is genu varum or genu valgum expected in the first year of life?

Genu Varum

400

What two forces change and mold skeletal development?

Compression (Weightbearing) and Shear (Muscle Pull Forces)

500

What does the SALTER acronym stand for and describe?

Straight Across

Above (Growth plate)

Lower/below (Growth plate)

To/Through (Growth plate)

ERasure (of Growth plate)

600

At what age range would you expect to see a NORMAL decrease in flexibility?

11 - 14 years old (due to growth spurt and muscle length needing to 'catch up')

700

What are the 4 F's of DDH (Developmental Dysplasia of the Hip)?

Female 

First Born

Feet First

Family History

800

At what age is the adult coverage of the femoral head reached?

8 years old

Babies R Walkin

100

What is most important in the development of gait?

Practice

200

What are some common chief concerns for children in gait development? (Name 2)

In-toeing/Out-toeing

Knock Knees

Flat Feet

Hip Clicks

Toe Walking

Late Walking

300

At which age is heel strike consistently seen in gait?

2 years old (24 months)

400

Name one of the three causes of in-toe gait

Persistent Femoral Anteversion

Internal Tibial Torsion

Forefoot Adductus

500

At what age range would you expect to see a narrowed BoS?

18 - 24 months

600

At what age is knee flexion in mid-stance consistent?

3 - 3.5 years old

700

At what age would a normally developing child have a fully mature gait?

6 - 7 years old

800

Name two characteristics of gait seen in a 9 month old

Wide BoS

Hip Abduction

Hip ER

Hip Flexion

Genu Varum

Everted Heel