This document provides an overview of a physical therapy course on total hip rehabilitation. The course objectives are to understand hip surgery and exercises, describe hip biomechanics, and effectively progress patients through rehabilitation. The schedule covers topics like evidence-based practice, anatomy, exercises, and outcome measures. Recent advances in hip rehabilitation include smaller incisions, reduced hospital stays, and early mobilization leading to better short-term outcomes. Assessment tools for hip function include the Lower Extremity Function Scale and Harris Hip Score.
Ankle-foot orthoses (AFOs) are external devices that attach to the lower leg and foot to improve function by controlling motion and providing support. The main components are a calf band, medial and lateral bars that articulate with ankle joints, and a stirrup that anchors to the shoe. There are 5 types of artificial ankle joints prescribed according to muscle strength: free ankle, dorsiflexion stop, plantarflexion stop, fixed dorsiflexion stop, and fixed hinge. AFOs are used to treat drop foot and other conditions involving muscle weakness, deformities, or instability by maintaining proper foot and ankle positioning during gait.
This document provides information on various arthrodesis procedures. Arthrodesis is a surgical technique used to fuse a dysfunctional joint to relieve pain. It summarizes techniques for fusing specific joints like the shoulder, elbow, wrist, fingers, hip, and knee. For each joint, it describes common indications, positions, surgical approaches, fixation methods, and post-operative care. Complications are also reviewed. The document is a comprehensive reference for orthopedic surgeons on the principles and techniques of different arthrodesis procedures.
Spinal stabilization involves surgical procedures to treat acute spinal injuries and conditions by restoring vertebral alignment and removing bone fragments. The degree of stabilization depends on the severity of the problem. Surgery involves inserting instruments like screws and plates in the back to stabilize the spine and facilitate fusion after decompression. Minimally invasive procedures perform stabilization through small incisions without damaging muscles. Recovery takes around six months with limited activity and physical therapy starting in the first week.
Physiotherapy for CONGENITAL TALIPES EQUINOVARUS Sreeraj S R
The document discusses congenital club foot (CCF), also known as congenital talipes equinovarus (CTEV). CCF is a deformity occurring in the ankle, subtaloid, and mid-tarsal joints. There are several theories for its causes, and its severity depends on the degree of displacement, while resistance to treatment depends on soft tissue rigidity. The deformity can be categorized into four components: cavus, adductus, varus, and equinus (CAVE). Treatment aims to fully correct the deformity early on through non-operative methods like serial casting or the Ponseti method, which involves weekly manipulation and casting. Education of parents on care and follow-up is
Scapular dyskinesis refers to abnormal static positioning or dynamic motion of the scapula during arm elevation and is associated with shoulder injury. It has multiple potential causes including muscle weakness or imbalance. The document discusses the muscular attachments of the scapula, types of scapular dyskinesis, its effects on dynamic stability and shoulder strength, assessment methods, and rehabilitation treatments focusing on strengthening the lower trapezius and serratus anterior muscles to achieve optimal scapular positioning.
The document discusses knee osteoarthritis (OA), including its causes, symptoms, diagnosis, and physiotherapy treatment approaches. It notes that OA is the most common joint disorder worldwide, usually resulting from wear and tear of cartilage over time. Common symptoms include knee pain that worsens with use, stiffness, and swelling. Physiotherapy is an important part of OA management and focuses on exercises to strengthen the knee, education on lifestyle changes like weight loss, manual therapy, and electrotherapy modalities to reduce pain and improve function.
Osteotomy is a surgical procedure that cuts or divides bone to improve the function of a limb or provide stability to a joint. It involves three stages - dividing the bone, immobilizing it to allow correction and realignment, and physiotherapy to restore full function. Different types of osteotomies like closing wedge, opening wedge, and oblique cuts are used to correct various bone deformities and dysfunctions. Post-surgery physiotherapy focuses on reducing pain and swelling, maintaining stability, and gradually improving range of motion and strength. Complications can include under or overcorrection of deformity, nerve damage, compartment syndrome, and non-union of bone.
Upper Limb Prosthetics - Dr Om Prakashmrinal joshi
This document provides information on upper limb prostheses. It discusses the history of prosthetics, levels of amputation, types of prosthetic systems (passive, body-powered, externally powered, hybrid), components (socket, suspension, control mechanisms, terminal devices), and considerations for prosthetic selection and use. The key points are that upper limb loss can be devastating, prosthetics can replace some hand functions but not sensation, and the appropriate prosthesis depends on the amputation level, expected use, and individual factors.
The tibial nerve originates from the sciatic nerve and supplies muscles in the leg and foot. Tarsal tunnel syndrome occurs when the tibial nerve is compressed as it passes through the tarsal tunnel behind the inner ankle. Symptoms include pain, tingling, and numbness in the foot and ankle. Diagnosis involves nerve conduction studies to evaluate tibial nerve function. Treatment focuses on reducing inflammation and pressure on the nerve through rest, ice, braces, and in severe cases, surgery to decompress the nerve in the tarsal tunnel.
A KAFO is a leg brace that controls knee and ankle movement. It is more energy intensive than FOs or AFOs due to compensatory movements needed to swing the leg. There are three main types - conventional metal, thermoplastic shell, and thermosetting shell. The document describes the components, designs, and joints of KAFOs including indications, advantages, and disadvantages of each. The goal is to select the appropriate KAFO design based on the individual needs of the patient.
The document discusses various aspects of arthrodesis or surgical fusion of joints. It describes the indications for arthrodesis including pain, instability, and failed joint replacement. It provides details on techniques for hip, knee, ankle, and shoulder arthrodesis including positioning, surgical approaches, fixation methods, rehabilitation, and complications. Arthrodesis is described as a way to relieve pain by permanently immobilizing the joint, though it results in stiffness. Various internal and external fixation devices and grafts are discussed for fusing the bones and achieving stability during healing.
Introduction, principles of sensory re-education hypersensitivity and hyposensitivity, stages of training after nerve repair, uses and benefits, sensory reeducation in stroke - its principle. Actve and passive Sensory reeducation in stroke, orofacial sensory retraining
The Brunnstrom approach is a physical therapy technique developed by Signe Brunnstrom for patients with hemiplegia. It uses reflexes and primitive movements to facilitate voluntary movement by progressing through normal developmental stages. The approach assesses tonic reflexes, associated reactions, sensory function, and classifies motor recovery into 6 stages. Exercises aim to elicit synergies and facilitate movement using proprioceptive and exteroceptive cues.
At the end of the lecture, the students should be able to:
Discuss the theoretical basis of the neurodevelopmental approaches
Discuss the concepts and principles underlying the Bobath approach
Discuss the concepts and principles underlying the Brunnstrom approach
This document discusses different methods for managing below-knee amputations in the immediate postoperative period. It describes the plaster-pylon technique, which involves applying a rigid plaster cast extending from the amputation stump to the thigh, with a copper tube pylon added to allow early weight bearing. For patients who received the plaster-pylon treatment, average healing time was 40.4 days and rehabilitation time was 108.4 days, compared to 98.4 days for healing and 200.1 days for rehabilitation using soft bandages. The plaster-pylon technique provides advantages of rigid dressings like decreased edema and early ambulation, without requiring specialized application.
This document provides definitions and descriptions of various hip, knee, ankle, and foot orthoses. It describes a hip-knee-ankle-foot orthosis (HKAFO) as an orthosis that stabilizes or locks the hip, knee, and ankle. The typical HKAFO consists of two knee-ankle-foot orthoses linked above the hip with a pelvic band or lumbosacral orthosis. It also discusses indications, principles, components, and fabrication of HKAFOs as well as other orthoses like reciprocal gait orthoses and hip orthoses.
This document defines metatarsalgia as a painful and inflamed ball of the foot. It lists the common signs and symptoms as sharp, aching or burning pain and numbness. Potential causes include abnormal foot structure, excessive activity, poor fitting shoes, and excess weight. Treatment options mentioned are resting, changing shoes, and using orthotic devices like metatarsal bars.
SCOLIOSIS assessment, types and managementSyed Adil
Scoliosis is an abnormal curvature of the spine that can occur in childhood or adolescence. It involves lateral curvature in the coronal plane as well as spinal rotation in the axial plane. Scoliosis is classified as either structural or non-structural. Structural scoliosis is permanent and involves bony deformities, while non-structural scoliosis is temporary and only involves curvature. The most common type of scoliosis is idiopathic scoliosis, which develops in adolescence and accounts for 90% of scoliosis cases in children. Scoliosis is assessed using Cobb's angle measurement, Adam's forward bend test, and a scoliometer. Treatment may involve bracing or surgery depending on the severity
This document provides an overview of a foot and ankle session. It discusses topics like imaging the foot and ankle, common injuries like lateral ankle sprains and their treatment, and case studies involving various foot and ankle conditions like plantar fasciitis, pes planus, and Achilles tendinopathy. Clinical tests and management strategies are described for different injuries and conditions.
This document summarizes research on the treatment of femoroacetabular impingement (FAI) with manual therapy. It discusses the anatomy and causes of FAI, as well as diagnosis using imaging and clinical exams. While evidence directly comparing manual therapy to exercise for FAI is limited, manual therapy techniques used successfully for hip osteoarthritis may also benefit FAI by increasing range of motion and reducing pain. Case reports show positive outcomes with manual therapy including traction, mobilization, and soft tissue techniques for FAI patients. More research is still needed on rehabilitation approaches for FAI.
Hip Arthroscopy in 2013: Inova Annual Sports Medicine Programwashingtonortho
This document discusses hip arthroscopy techniques and considerations in 2013. It begins with an overview of the goals of hip arthroscopy which are to relieve pain, improve function, and improve longevity by restoring hip anatomy. It then discusses various pathologies that may be addressed such as CAM lesions, pincer lesions, torn labrums, and cartilage defects. Approaches can be open or arthroscopic. The document emphasizes making the correct diagnosis and understanding concomitant issues. It provides guidance on evaluating patients through history, physical exam including various special tests, and diagnostic injections. Femoroacetabular impingement is discussed as a common cause of labral tears. Techniques for addressing pincer impingement including bony resection are outlined
Femoroacetabular impingement (FAI) is a hip condition caused by a mechanical mismatch between the femoral head and acetabulum. There are three types of FAI - cam, pincer, and mixed - which describe deformities of the femoral head or acetabulum that can cause pain and restricted movement. FAI is typically diagnosed based on symptoms like groin pain worsened by activity, and imaging tests may confirm deformities. Treatment starts with rest, modifications to activity, and physical therapy, while surgery can reshape bone structures for severe cases or when other options provide no relief.
The Achilles tendon evolved approximately 2 million years ago to allow humans to run faster. It is prone to injury due to its limited blood supply. A rupture typically occurs when a load is applied while the tendon is stretched, often due to pre-existing tendonitis. Treatment options include operative repair through open surgery or minimally invasive surgery, or non-operative casting and rehabilitation. Rehabilitation programs focus on regaining range of motion and strength over 4-6 months. Future research could investigate genetic risk factors, standardized strength testing for different treatment options, and outcomes of surgery for primary versus recurrent ruptures.
16001107 01 X Stop Surgeon To Patient FinalWilliamYoungMD
This document summarizes lumbar spinal stenosis, including its symptoms, treatment options, and a new minimally invasive treatment called the X-STOP spacer. Lumbar spinal stenosis causes back and leg pain due to narrowing of the spinal canal. Treatment options discussed include non-operative care, laminectomy, and the X-STOP procedure, which separates the spinous processes with an implanted spacer to relieve pressure on nerves. The X-STOP procedure provides relief of symptoms with less risks and recovery time compared to laminectomy.
The MRI scans show a ruptured ACL and possible MCL rupture in the knee of an 18-year-old football player who heard a pop while changing directions. Non-operative management is an option if the patient is willing to modify activities, but given his young age and activity level, ACL reconstruction is recommended, likely using a bone-patellar tendon-bone graft. Post-op rehabilitation would include a knee brace and protected range of motion exercises initially before a gradual return to sports over 9-12 months.
The x-rays of a 26-year-old man with longstanding joint pain show diffuse osteopenia, joint space narrowing, and erosions in the hips, knees, and hands.
This document contains a series of questions and answers related to adult reconstructive surgery of the hip and knee. It includes radiographs, diagrams, and descriptions of clinical scenarios. For one scenario, it describes radiographs of an 82-year old man with loosening of the tibial component of a total knee arthroplasty. The preferred treatment is listed as revision of the tibial component with porous metal augmentation.
The document discusses the anatomy of the knee joint and common conditions that can lead to total knee replacement (TKR) such as osteoarthritis and rheumatoid arthritis. It details the evolution of TKR from early resection techniques to modern prosthetics with three components. The procedure of performing a TKR is described along with postoperative rehabilitation and goals of restoring function. Data from the author's hospital on 8 TKR cases is presented.
This document provides a literature review on differential diagnosis of hip pain. It begins with an overview of hip structure and function. Common causes of hip pain are then discussed, including arthritis, traumatic injuries, vascular disorders, developmental issues, and other soft tissue injuries around the hip joint. For each condition, the document describes definitions, causes, clinical features, diagnosis methods where relevant. Case studies on osteoarthritis, rheumatoid arthritis, and developmental dysplasia of the hip are also summarized. The review provides a comprehensive guide to differential diagnosis of hip pain covering multiple pathologies.
This document summarizes a study on using proximal fibular osteotomy (PFO) to treat medial compartment osteoarthritis of the knee. PFO is presented as a simpler, less expensive alternative to procedures like high tibial osteotomy (HTO). The study included one patient who underwent PFO and was followed for 6 months, showing decreased pain scores and improved knee joint space. While PFO provided good short-term outcomes, more research is needed to establish its role compared to procedures like HTO and unicompartmental knee arthroplasty. PFO may be particularly suitable for resource-limited settings due to its low cost and technical simplicity.
The document presents five case reports that required referral from a physical therapist to a physician or specialist due to abnormal screening test results during differential diagnosis of hip versus lumbar spine pathology. Each case resulted in a new diagnosis beyond the scope of physical therapy, such as fracture or osteonecrosis of the hip. Cyriax's concepts of capsular and noncapsular patterns of joint restriction and the "Sign of the Buttock" were useful in differentiating hip from lumbar spine pathology in each patient. The clinical experience suggests these screening tests may effectively identify hip pathology, but further research is needed.
This document discusses the importance of detecting and properly reporting vertebral fractures seen on imaging studies. It notes that vertebral fractures are common but often go unreported, and early detection can help prevent future fractures and morbidity. The document describes audits conducted at Bradford Royal Infirmary that found low rates of vertebral fracture reporting and recommendations for osteoporosis screening. Actions taken include providing spine reconstructions for CTs, educating radiologists, and allowing direct referrals for bone density tests. A follow-up audit showed improvements in detection and reporting but also continued room for progress.
This document discusses the use of osteotomy procedures, specifically high tibial osteotomy (HTO), for treating osteoarthritis (OA) in younger patients with malalignment. It provides details on the purpose and techniques of HTO, including closed-wedge and open-wedge approaches. Ideal candidates for HTO are identified as those under age 60 with isolated medial compartment OA and varus malalignment of under 15 degrees. Complications of HTO procedures are outlined. Studies have found obesity, inadequate correction, and age over 50 to be negative prognostic factors, while joint line preservation is key to success.
This study evaluated the intermediate and long-term results of femoral neck lengthening (Morscher osteotomy) in 18 patients (20 hips) with a median follow-up of 7 years. Postoperatively, the Trendelenburg test was negative in most patients and the median Harris Hip Score improved significantly. Radiographic examination found progression of osteoarthritis in 3 patients, while one operation failed and required total hip replacement after 4 years and two others required it at 10 years. The procedure successfully reduced leg length discrepancy in most patients. The study concluded that Morscher osteotomy can effectively treat patients with short femoral neck and overgrown greater trochanter with a positive Trendelenburg test and mild leg length
The document provides information on performing a differential diagnosis examination for the hip. It discusses evaluating the hip for common conditions like osteoarthritis, fractures, bursitis, labral tears, and referred pain from the low back. Physical examination tests are outlined to help determine the likely cause of hip pain, including assessing range of motion, special tests, and risk factors. The goal is to systematically examine the hip to form an evidence-based diagnosis and guide appropriate treatment.
Cervical Hybrid Arthroplasty by Pablo Pazmino MDPablo Pazmino
This video explains Cervical Arthroplasty in combination with a fusion. When people have more than one cervical disc which has degenerated or which has sustained a traumatic rupture they may need a procedure to address both levels. These herniations may begin to affect the surrounding nerves and/or spinal cord. This video highlights the history, epidemiology, and treatment options both conservative and surgical. If you or someone you know needs to be seen in regards to Cervical Herniations/ Radiculopathy at multiple levels feel free to look us up online www.beverlyspine.com or call toll free 1-8SPINECAL-1
This document provides guidance on the acute management of pelvic ring injuries. Key points include:
1. Pelvic ring injuries can cause significant hemorrhage and morbidity. Initial management focuses on airway, breathing, circulation and hemorrhage control through methods like pelvic sheeting, binding, or external fixation.
2. Indications for transfer include hemodynamic instability, bladder/urethra injury, open pelvic fractures, or significant displacement/instability on imaging. Physical exam assesses for injuries like degloving or limb deformities.
3. Sources of hemorrhage include external wounds, chest, long bones, abdomen, and retroperitoneum. Hemodynamic instability is evaluated through
Patella in total knee arthroplasty to resurface or not is the questionBipulBorthakur
This document discusses different perspectives and techniques regarding patellar resurfacing during primary total knee arthroplasty. It notes that while resurfacing was routinely performed in North America, Asian surgeons often do not due to patient characteristics. Three main approaches are described: always resurfacing, never resurfacing, and selective resurfacing based on factors like cartilage quality and arthritis. Complications of both resurfacing and non-resurfacing are presented. Multiple studies are reviewed that compare outcomes between the two techniques, with many finding reduced reoperation rates but similar pain levels with resurfacing. The conclusion is that the best approach remains controversial, though resurfacing is often recommended for inflammatory arthritis or severe patellar deformity.
1) Limb deficiencies in children can be congenital, resulting from genetic factors or acquired through trauma or disease. Congenital deficiencies are classified based on the level and type of skeletal involvement.
2) Surgical options for managing limb deficiencies include amputation, limb lengthening, rotationplasty, and limb-sparing procedures using bone grafts or endoprosthetics. The appropriate option depends on factors like skeletal maturity and extent of involvement.
3) Physical therapy plays an important role in managing limb deficiencies from infancy through adolescence, with goals of preventing contractures, improving mobility and self-care, and training use of prosthetics tailored for growth. A multidisciplinary approach involving orthoped
This document outlines the components and purpose of a scanning examination performed in physical therapy. The scanning exam is used to ensure issues are within the scope of physical therapy and rule out serious pathology. It involves observation of gait and posture, vital signs, functional movement testing, tissue tension testing, palpation, neurological exams, and special tests. The purpose is to detect gross loss of function and movement control in order to guide further physical therapy diagnosis and treatment.
A lecture about Technology in Physical Therapy Practice. Given at the OPTA Western District Meeting on 06/30/11 by Casey Kirkes PT, DPT and Dale Boren Jr. PT, MPT, O
This new employee orientation covers the following key points in 3 sentences:
The orientation reviews PTC's core values, the employee's role and responsibilities, professional development training, who the various company partners are, documentation and billing standards, and emphasizes having fun while embracing change. Employees will complete personality and learning assessments, learn about mentoring resources, and get an overview of performance reviews, social media guidelines, and the importance of teamwork and excellent customer service. The goal is to onboard new employees effectively and get them started on a path of continued learning and professional growth as part of the PTC team.
This document provides information about fibromyalgia including its definition, symptoms, diagnosis, treatment, and prognosis. Fibromyalgia is defined as a chronic pain condition characterized by widespread muscle aches, pain and tenderness in at least 11 of 18 tender points. It predominantly affects women and has no known cause but may involve abnormalities in how the brain processes pain signals. Treatment involves lifestyle modifications like exercise, stress management and adequate sleep, along with medications to reduce pain and improve symptoms. While there is no cure for fibromyalgia, treatment can help manage symptoms and many people are able to lead active lives.
The document provides information on medical red flags and common red flags associated with various body regions. It defines red flags as signs or symptoms that may warrant referral to another provider. The document then summarizes several studies on red flag documentation and lists many common red flags for various areas including back, chest/ribs, shoulder, sacrum/pelvis, lower quadrant, and leg. Red flags listed indicate potential serious conditions needing referral such as cancer, infection, fractures, or cardiovascular issues.
This document provides a reading list and brief summaries of books recommended by Physical Therapy Central, Inc. It recommends several business and self-help books, including Michael Levine's "Broken Windows", which is described as a short, easy read; Tom Rath's "StrengthFinder 2.0", which helped change the author's thinking; and Jim Collins' "Good to Great", which helped focus the author and change how they run their business. It also lists books by Eckhart Tolle, Malcolm Gladwell, Michael Gerber, and others and provides short blurbs about each.
This document provides a reading list and brief summaries of books recommended by Physical Therapy Central, Inc. It recommends several business and self-help books, including Michael Levine's "Broken Windows", which is described as a short, easy read; Tom Rath's "StrengthFinder 2.0", which helped change the author's thinking; and Jim Collins' "Good to Great", which helped focus the author and change how they run their business. It also lists books by Eckhart Tolle, Malcolm Gladwell, Michael Gerber, and others and provides short blurbs about each.
4. ObjectivesCourse Objective:The course participants will be able to:Understand the surgical procedures and contraindications with specific exercises.Describe normal biomechanics for the hip joint.Implement the use of outcome measures for patient’s that have had hip surgery.Utilize the internet to access information in regards to evidence based practice.Effectively progress patients through the rehabilitation protocol.
6. Vision 2020 The first, best choice in musculoskeletal care.ResourcesAPTAJOSPTPhysiopediaEvidence in MotionAAOMPTPEDroNAIOMTLife Long LearnersPatient AccessAutonomous ExpertsTake our game to the next levelSpecialty CertificationsManual Therapy CertificationsDPT
7. Evidence Based PracticeIntegration of the best research evidence with clinical expertise and patient values.Levels of EvidenceSystematic ReviewsCase SeriesExpert Opinion
8. American Physical Therapy AssociationConsumersProfessional DevelopmentAdvocacyReimbursementLearning CenterHooked on EvidenceDatabase current researchEarn CEU’s
12. OSTEOARTHRITISIn US, 100 Billion Health Care $ by 2020Progressive loss of articular cartilage with variable subchondral bone loss.Prevalence – 10 to 25% in adults age 55 and older.43 Million people in USStandard of care is THA
13. Total Hip ArthroplastyThe most common surgical procedure for end-stage hip osteoarthritis.Primary reason for surgery is pain which interferes with ambulation.
14. American College of RheumatologyClassification Hip OACluster 1Pain in the hip< 115 hip flexion< 15 IRCluster 2Pain with IR< 60 minutes morning stiffness> 50 yrs. oldCurrent guidelines focus on pharmacological and surgical management
15. X-RayDemonstrate loss of joint space, osteophytes and sclerosis.Dysplasiatears are more common in individuals with acetabular dysplasia.
16. In US, between 1990 and 2002, THA rose from 119,000 to 193,000 annually.62% increase600,000 THA Procedures Performed Annually
17. Total Hip ArthroplastyThe first joint replacement, a total hip arthroplasty, was performed in 1936.Most widely performed orthopedic procedure performed on adults.In 2008, the average hospital and physician charge for a THA totaled $ 45,000.
21. Health Care CostsPhysical Therapy12 visitsManual Therapy and exercise$1,200THR$45,000Surgery, hospitalization and rehabilitation
22. Risks and ComplicationsMedical Risks Heart AttackStrokeVenous Thromboembolism 1%PneumoniaUTIInfection 0.2 – 1%Intra-operativeMal-positioningShort/Long 1%InstabilityLoss of ROMFracture 2-5%Nerve Damage 1%Dislocation 4-10%
23. Long Term RisksOsteolysisLoosening of the componentsCement breaks downWear debrisInflammatoryPainPolyethylene wear rate is 0.3mm yearWear debrisBody will absorb the metal
29. Subjective HistoryDJD (> 50)Usually no specific mechanism of injuryGroin pain; behind greater trochanter, anterior thigh to kneeStiffness in the morningLoss of ROM (Flexion, IR)Increased pain with WB (bony)
33. Femoroacetabular Impingement (FAI)Contact between the femoral head-neck junction and the acetabular rim.Impingement occurs with the combined movement of hip flexion, adduction, and internal rotation.
34. Precursor to early hip O-AAcetabular labral pathology secondary to femoroacetabular impingement (FAI)Acetabular labral pathology is frequently present in highly active individuals 20-40 yo.Gradual on-set with repetitive microtrauma.
35. Diagnosis of FAIScour TestFADIR – anterior-superior labrumEABDER – posterior-inferior labrumLog Roll Test
36. Scour TestThe examiner moves the patient’s hip through a range of motion from hip flexion and adduction to hip extension and abduction, while adding a compressive force through the hip joint as well as movement into hip internal and external rotation. The test is considered positive if there is a reproduction in hip pain and/or intraarticular joint clicking.
37. Log Roll TestThe examiner passively moves the patient’s lower extremity through the maximal available range of hip external (A) and internal rotation (B).Eliciting a clicking or popping sensation may indicate an acetabular labral tear, while increased total range of motion when compared to the opposite side may indicate ligament or capsular laxity
38. Impingement TestThe examiner passively moves the patient’s lower extremity into a position of hip flexion, adduction, and internal rotation. A positive test is reflected by increased hip or groin pain.
39. FABER TestThe examiner passively positions the testing limb in a position of hip flexion, abduction, and external rotation. The examiner assesses the perpendicular distance from the knee on the tested lower extremity to the table. A decrease in this distance or pain, when compared to the uninvolved side, issuggestive of intra-articular hip pathology.
44. Clinical Prediction RuleChilds September 2008Loss of IR< 15 degrees Loss of Flexion< 115 degrees(+) Scour Test(+) FABER Test(+) Hip Flexion Test Twenty-one (29%) of the 72 subjects had radiographic evidence of hip OA. A clinical prediction rule consisting of 5 examination variables was identified. If at least 4 of 5 variables were present, the positive LR was equal to 24.395% confidence interval: 4.4-142.1, increasing the probability of hip OA to 91%.
45. Diagnosis Hip O-AMade with certainty on the basis of history and physical exam.X-ray is definitive CPR – Child’s et al.Hip Guidelines – CibuklaPhysiopedia
46. 1975 Management THAPhase I – immobilization. If unstable will use hip spica cast x 3 weeks. (2-5 days)Phase II – mobilization. Isometric, isotonic (AAROM, AROM). Trochanter detached and transplanted distally. 2-3 week and D/C to home. Crutches x 8 weeks. Walk day 7 - WBATROM goalsFlexion 90, ER 15, Abd 15, IR 0, Add 0
47. 2010 THA ManagementHospital 1-3 days/Out-patientAmbulate day 1 – FWBAROM day 1Isotonic week 1C-V by day 10ROM goalsFlexion 125, Add. 30, ER 50, IR 30 by week 12
51. Gluteus MaximusTFL envelops the muscles of the thighCounteracts the backward pull of the gluteus maximums of the ITB.Hip extensors are 3 times as strong as the flexors
52. PsoasIliopsoas bursa – present in 98% of adults.Lies under the psoas tendonOveruse and impingement syndromes
53. SLR ExercisesMust have excellent core strengthThis is a core exercise, If neutral pelvis is not maintained
54. Hip External RotatorsHip capsule is cut and the ER are retracted so that the joint can be exposed.THA – now most repair the capsule
56. Journal of Orthopedic Surgery Chung, et al. Smaller incisionOperating timeBlood lossNarcotic useLength of StayAssistive deviceHarris Hip Score20049.2 2049 55136 2002.2 2.644.4 5.421 2595 93
58. ResurfacingMain advantage is bone conservation for younger patientsEarly resurfacing failed because of polyethylene5 year follow-up excellent resultsComplicationFemoral neck fractureOsteonecrosis
59. High Failure Rate1970, materials available at the time had insufficient wear resistanceIncorrect patient selection1999, re-introduced Same revision rate as THA at 4 yearsWomen 2 x than men1-3%
60. DesignMetal on MetalCause release of inflammatory cytokinesMetal allergyLarge ball – decrease wear rateCementedTHA - Cementless acetabular fixation – bony in growth
61. Patient SelectionYoung and activeIsolated hip diseaseExcellent bone qualityNormal kidney functionContra-indicatedSevere acetabular dysplasiaObesity
71. ViscosupplementationInjection of artificial lubricants into the joint.Centeno et al. reported on the partial regeneration of an arthritic human hip joint using mesenchymaltem cells.
73. Hip DysplasiaDisplacement of femoral head in acetabulumLeft hip is more often involved80 % FemalesBreech birthFirst born
74. Hip DysplasiaLess degress of femoral head coverageDecreased joint surface areaNormal 30-40%Angle of inclination >125 degreesIncreased femoral anterversionAcetabular retroversionMcCarthy & Lee found 72% of patients with dysplasia had labral tears
75. Ball and Socket JointFlexion to 110-120Extension 10-15Abduction 30-50Adduction 25-30ER 30-45IR 20-35Rolls anterior glides posteriorRolls posterior glides anteriorRolls laterallyRolls mediallySpins anteriorly and laterallySpins posteriorly and medially
89. CyriaxCapsular pattern – specific and proportional loss of movementMost common cause of capsular pattern is arthritis
90. Capsular PatternCyriaxIRFlexionAbductionIf capsular pattern of restriction; joint is arthritic.If non capsular pattern; not joint.Cyriax listed in ascending orderLoss of internal rotationMore than flexionMore than abduction
101. Patient Based ScalesSite SpecificOxford Hip ScaleHealth StatusDesigned for RA20 TasksSF-12Disease-SpecificHip & Knee OAWOMACOxford12 item questionnaireTHRValidated against SF-36Short, practical and valid
102. Activity Limitation6 Minute Walk TestHow far a person can walk in 6 minutes. Can use walking aids.Treadmill is good.Stair MeasurePatients are instructed to ascend and descend 9 stairs (step height 20cm) Timed measure in seconds
122. Whitman & ClelandSeptember 2007Hip OA when treated with manual therapy (mobilization)5 PT sessionsTotal PROM increases 82 degreesHarris Hip Score 25 points
123. Case Report JOSPT Dec. 2007Vol. 37, Num. 1273 yo female with THA revision2 yrs s/p revision admitted to hospital 10/10 hip pain after lifting her foot to put on her shoeX-ray normal d/cPT – manual therapy – 4 PT visits4 year follow up
124. ProprioceptionArthritic hips lose input secondary to loss of articular cartilage.THR – no input from the hip joint. Must retrain neuromuscular system.Balance activities.
131. ContraindicationsHome exercises. Exercises were commenced following manual physical therapy in the clinicUpright bicycle: 10 – 20 minGluteus medius clamshell exercises: 3 sets of 12Hip abduction in sidelying: 3 sets of 12Core transverse abdominus: 2 sets of 20 in supine with hips flexed to 45°Bridge with straight leg raise: 3 sets of 10Hip flexor stretch kneeling or sidelying: 30 sec × 3Single leg balance: up to 60 secTandem stance eyes open or closed: up to 60 sec Recumbent Bike
We are in private practice, we are not owned by a hospital or any physicians. I want to try and take back our profession – when you work for yourself you have to become a better clinician. Look at the work that has come from Austrailia – Diane Lee, Maitland, McConnell, Jim MeadowsIt is my goal today to make you a better clinician, and I challenge you to use that knowledge to reclaim our profession.
The health care bill just passed. I got up the next morning and log on to APTA web site to gain more information. I also get emails from the OPTA listserve. APTA members – this is my other soap box today, if you are not a member you need to join. The APTA is fighting for our rights. You need to get active in the OPTA, the PAC. Things are changing and you can either get involved and fight for your profession or your profession may drastically change.
Research – read your journals. CE courses – Clinical Expertise – clinical skill and formulated educationWhen I graduated, we tried to selective isolate the VMO for improving patellar mechanics – the literature has proven this ineffective.
Increaseing at a rate of 10% a year.
Sensitivity was 86% and specificity was 75% with a LR+ of 3.44
This was a low friction arthroplasty. Smaller femoral head 7/8 inch which has a decreased wear rate. However, it had a poor stability. This prosetesis used cement.Stems are typically made of titanium alloys or chrome cobalt – very strong and most biocompatible. New heads are ceramic or cobalt-chromium alloy.
FDA issued a warning. Recalled ceramic hip parts.
Most patients are diagnosed with snapping hip or psoas muscle strain or bursitis
This is a non-specific test – internal hip pathology (intra-capsular).
Feel end-feel. Should be capsular, not empty or painful.
Used to assess FAI – exactally like the shoulder impingement test. Same ball and socket joint. Always test this prior to having a patient stretch the piriformis muscle
Mitchell et all reported that the presence of hip pain during the FABER test was 88% sensitive for intra-articular hip pathology.
JOSPT July 2006
College of Rheumatology has criteria – so why did Childs develop a CPR?
X-ray will show joint space narrowing, osteophytes.
Do the exercise. How to correctly stretch the psoas.
Surgical approach used is one of the main determinates to rehabilitation. The posterior lateral approach is the most common, although as new techniques of minimally invasive THA are evolving, the anterior-lateral approach is becoming more common for younger, active patients.Posterior lateral approach – cuts posterior capsule and gluteus maximus – posterior dislocation.Anterior-lateral approach involves take-down of the gluteus medius, which can limit post-op weight bearing.
Surgery done in Europe for over 17 years. Birmingham Hip Resurfacing device was approved by the FDA in May 2006
Fracture rate at about 4% compared to 1% in THA. Have preserved the bone in the femur.
2009 returned to cycling after his ban and finished 17th overall in the Tour of New Zeland.
FDA approved in 1997 – hyaluronan acid – extracellular matrix, contributes to cell proliferation.Molicular goo. Syovial fluid – increase the viscosity. Lubrication. Using in wound healing.