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118 Cards in this Set
- Front
- Back
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Average neck/shaft angle of hip?
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130 degrees
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proximal femur anteversion?
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15 degrees relative to the bicondylar axis
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Anterior capsule formed by:?
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Iliofemoral ligament - "ligament of Bigelow", strongest of 3 pelvifemoral legaments
Pubofemoral legament - inferior and relatively weak |
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Posterior capsule of the hip formed by...?
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Ischiofemoral ligament
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Hip capsule position of tautness?
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extension
external rotation |
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Hip capsule position of laxity?
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flexion
internal rotation |
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Consequence of breach of integrity of labral function w hip stability?
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...leads to decreased femoral stability during extreme ROM
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Lumbar innervation of hip joint?
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L3
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Femoral n,a,v and inguinal ligament and iliopsoas?
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Femoral n,a,v pass superficial to iliopsoas and under the inguinal ligament
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Lateral fem cut nerve location?
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exits under the inguinal ligament near ASIS
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majority blood supply femoral head?
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lateral ascending branch of medial circumflex a
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secondary blood supply femoral head?
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-descending branch of inferior gluteal
-medullary artery of femur -ligamentum teres -posterior division of obturator |
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hip average ROM?
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flexion 115
extension 30 abduction 50 adduction 30 IR 45 ER 45 |
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force non-weightbearing ambulation places on ipsilateral hip?
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1.5 x BW
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Athletic pubalgia?
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** will be on test. look up!
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Major bursae about hip?
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1) trochanteric
2) ischial 3) iliopectineal 4) iliopsoas |
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types of snapping hip?
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1) external
2) internal 3) intra-articular |
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external snapping hip cause?
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ITB or gluteus maximus sliding over trochanter
inflammation of trochanter bursa |
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Internal snapping hip cause?
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iliopsoas tendon snaps over iliopectineal eminence or femoral head, ass'd w ballet
*elicited by moving from AB, ER, Flex to AD, IR, and extended position |
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external snapping hip cause?
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thickened ant gluteus max fascia or post iliotibial band
examine by palpate GT as pt flexes and extends hip **positive Ober test |
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OBER test?
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lateral decubitus position
affected leg up abduct, extend hip, and flex knee += pt cannot extend beyond midline |
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surgical treatment for internal snapping hip?
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fractional iliopsoas lengthening
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arth Rx internal snapping hip?
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iliopsoas release
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open treatment external snapping hip?
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z-plasty of IT band
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arthroscopic treatment external snapping hip?
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trochanteric bursectomy vs IT band release
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when advise applying heat for contusions?
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wait 48 hours for bleeding to stop before PT,massage, Heat.
start NSAIDs after 24 hours |
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when return hip pointer to play?
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when full motion and strength
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how immobilize quad contusion?
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immobilize in FLEXION to maintain ROM and decrease bleeding
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Intra-articular snapping hip causes?
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-loose bodies
-labral pathology -chondral lesions -synovial chondromatosis |
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surgery timing for myositis ossificans?
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delay 9=12 months
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where and how do muscle/ligament tears occur?
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-at myotendinous junction
-usually partial tears -violent eccentric force |
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most common adductor strain?
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Adductor longus
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which quad muscle crosses two joints?
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rectus femorus
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Gaenslan's test?
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hyperflex hip on unaffected side
lock pelvis hyperextend hip on affected side |
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order of rehab for strains?
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ROM, then strength, flexibility, and endurance
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athletic pubalgia?
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tear of adductor longus or rectus abdominus attachnent
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Hx athletic pubalgia?
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hyperextension injury
disabling abdominal pain at extremes of exertion resolves w cessation of activity soccer or hockey specific |
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PE athletic pubalgia?
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tender to palpate peripubic area, symphisis pubis, or adductor area
no palpable hernia pain w resisted adduction or situps tight hamstrings or limitedhip motion normal neuro exam |
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Rx athletic pubalgia?
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surgery: pelvic floor repair and adductor release
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position to immobilize knee w quad contusion?
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120 degrees flexion
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description of athleetic pubalogia?
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syndrome of lower abdominal and adductor pain
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16yo female lacrosse player w hip pain and popping when running. PE->mild hip pain with resisted hip flexion. "Click" with hip adduction with knee in flexion. Location of pathology?
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Between IT band and Greater Trochanter.
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19yo ballet dancer w internal snapping hip syndrome by U/S. Recommended treatment?
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Rest, stretching, and analgesics
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25 yo hockey player w Sx x 6 weeks, no improve w PT. N xray/MRI of pelvis.C/o diffuse groin and lower abd pain which increases w heavy wt training.PE +bilat adductor tightness but no pubic or adductor tenderness. Best next step in mgmt?
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referral to general surgeon
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Injury mechanism postulated for athletic pubalgia?
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Repeititive extension and abduction
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Most common adductor groin strain?
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Adductor longus
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Most common quad tendon injured?
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rectus femoris
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type of muscle contraction is leading cause of muscle strains?
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Eccentric
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def eccentric muscle contraction?
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the force generated is nsufficient to overcome the external load on the muscle and the muscle fibers lengthen as they contract. An eccentric contraction is used as a means of decelerting a body part or abject, or lowering a load gently rather than letting it drop.
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def concentric muscle contraction?
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the force generated is sufficient to overcome the resistance, and the muscle shortens as it contracts - what most people think of as a muscle contraction
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def isometric muscle contraction?
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the muscle remains the same length. An example would be holding an object up without moving it; the muscular force precisely matches the load, and no movement results
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def isotonic contraction?
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the tension in the muscle remains constant despit a change in muscle length. This can occur only when a nuscle's maximal force of contraction exceeds the total load on the muscle
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20 yo male w refractory groin pain and inconclusive MRIl PE shows groin tenderness but no hernia. PTand NSAIDS unsuccessful. most likely Dx?
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Sportmans' (hockey) hernia
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Hip dislocation: % anterior?
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8-15%
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risk factors for femoral stress fx?
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-coxa vara
-variation in running surface -improper footwea |
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Rx medial fem neck stress fx?
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conservative. Is stable.
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Rx lateral fem neck stress fx?
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operative. Is tension side and more likely to displace
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ASIS avulsion fx is from ?
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sartorius
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AIIA avulsion fx is from ?
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rectus femoris.
occurs during straight leg kicking *obtain contralateral xray to r/o os acetabulus |
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ischial tuberosity avulsion is from ?
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hamstring max contraction when pelvis in flexion and knee in extension
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mechanism Greater Troch avulsion fx?
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forced ER leg w simultaaneous glut med/min contraction
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lesser troch avulsion ?
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sudden iliopsoas contraction
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gen Rx avulsion fx's?
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rest, NSAIDs, position to relax involved muscles.
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causes AVN hip?
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idiopathic
trauma alcohol steroids decompression sickness |
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Ficat 0 AVN?
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no Sx, no xray changes
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Ficat I AVN?
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mild/early clinical features, no xray changes
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Ficat II AVN?
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mild/early clinical features
diffuse sclerosis, porosis, and cysts on Xray |
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Ficat III AVN?
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moderate clinical findings
xray broken contour of femoral head, bone sequestrum, and normal joint space |
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Ficat IV AVN?
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severe clinical symptoms
xray flattened contour, decreased joint space, collapse of head |
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% primary musculoskeletal tumors in pelvis/hip?
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10-15%
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most common direction of hip dislocation?
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posterior
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principle complication of hip dislocation w/o fx and w stable reduction?
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AVN
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32yo marathon runnerw +MRI medial femoral neck stress fx - best management?
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NWB x 6 weeks
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13yo w SCFE, wt gain, fatigue, loss of interest in school, and patchy hair loss. Most likely underlying medical disorder?
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hypothyroidism
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PE finding to differentiate apophyseal avulsion fx from apophysitis?
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bruising and ecchymosis
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Serious complication associated w avulsion of greater trochanter hip is?
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osteonecrosis of the femoral head
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risk factors for AVN fem head?
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-Caisson Dz
-Sickle cell anemia -Gaucher disease -pancreatitis |
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least common comnplication of isolated posterior dislocation of femoral head w no associated fx?
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recurrent dislocation
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13yo w apophyseal avulsion of ischial tuberosity: advice to mother about treatment options?
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non-operative treatment is likely to produce return of normal function
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Injuries resulting from acute posterior subluxation of the hip:?
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-posterior labral tearing
-chondral shear of femoral head -anterior labral tearing (w reduction) |
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Obturator nerve entrapment syndrome?
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Entrapped as enters thigh
medial thigh pain, worse w activity, adductor weakness |
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Rx obturator nerve entrapment syndrome?
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surgical release is successful with return to play in as little as a month.
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Pudendal nerve entrapement?
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numbness shaft of penis and perineum
cycling and hip arthroscopy or fx table |
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femoral nerve entrapment syndrome?
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anomalous slip of iliacus
quad weakness, loss knee jerk, sens loss anteromedial thigh conservative usually ok, surgery rarely needed. |
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"hamstring syndrome?
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sciatic n entrapment between semitendinosus and biceps femoris (fibrous connection)
described in track athletes pain from ischial tuberosity rediating to popliteal fossa imitating sciatic nerve pain |
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what nerve does NOT exit the greater sciatic notch distal to the piriformis:
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the obturator nerve.
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Which two nerves enter th pelvis through the lesser sciatic foramen?
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the nerve to the obturator internus and the pudendal nerve
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What separtes the greater and lesser sciatic foramen?
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the Sacrospinous ligament
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**What nerve is associated with hip pain referred to the knee?
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anterior branch of the obturator nerve
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27yo power-lifter complains of dysesthesias at the anterolateral aspecc of his left thigh. remainder exam normal. Appropriate next clinical step?
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adjustment of the fit of his weight belt
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What is the most common etiology of the ilioinguinal nerve entrapement?
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abdominal muscle hypertophy
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in-line force required to distract the hip for artrhroscopy 8mm?
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50 lbs.
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max time for hip arthroscopy?
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2 hours
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padding needs for hip arthroscopy?
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well padded perineal post along medial thigh. Improves lateral distraction and decreases pudendal nerve palsey
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mini-open interval for ant hip scope?
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3-4 cm incesion over AIIS
Sartorius and iliopsoas interval |
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anterolateral hip scope portal position and at-risk structures?
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2cm anterio to greater troch at level of tip
superior gluteal nerve 4.4cm cephalad |
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anterior hip scope portal position and at-risk structure?
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Intersection of sagittal lie from ASIS to sup greater trochanter
Direct 45deg cephalad and 30deg to midline -femoral NV bundle is 3-4cm from portal -lateral femoral cutaneous nerve (incise skin and spread to fascia) |
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Posterolateral hip scope portal placement and at-risk structures?
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2cm post to GT at level of tip
follow femoral neck -generally in safe zone -sciatic n at risk in internal rotation. Neutral rot = 3 cm to entry point |
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anterior portal hip scope direct nerve injury?
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femoral artery and nerve, lateral circumflex artery
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hip scope complication rate?
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1.3%
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anterolateral portal direct nerve injury?
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superior gluteal nerve
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Posterolateral hip portal direct nerve injury
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sciatic and superior gluteal nerve
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traction and compression nerve injuries in hip scope?
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femoral, sciatic, lateral femoral cutaneous, pudendal nerves
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hip TFC function?
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resists lateral motion
enhance joint stability preserve joint congruity proprioception |
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most common location for labral tears?
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10:00 to 2:00 position
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impingement sign for hip labral tears?
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-pain w maximally flexed and internally rotated hip
-post/sup labrum -82% sensitivity |
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MR arthrogram sens/spec for labral tears?
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74% sensitivity
83% specificity recent reports >90% sensitivity |
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Femoroacetabular Impingement?
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Impingement of lateral edge of acetabulum on Ant/Sup femoral nect
-groin pain w flexion and IR -labral and cart injury can occur -arthritis is endpoint of disease |
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Cam impingement?
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femur-based.
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Pincer impingement?
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acetabulum-based
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Pincer impingement pathoanatomy?
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deep or retroverted socket. fem neck produces high stresses directly on large portion of acetabular rim
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Cam impingement pathoanatomy?
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asphericity of head or insufficient offest at head-neck junction.
continuous loading of anterior cartilage and labrum greatest stress at acetabular rim |
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alpha angle and FAI?
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N=42-45
abN= >55 degrees bisecting line from head center ot femoral head asphericity point (see p 470) |
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two structures at risk w anterior portal?
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lateral femoral cutaneous nerve and femoral vessels
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two structures at risk with the anterolateral portal?
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superior gluteal nerve and lateral femoral cutaneous nerve
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best indication for hip arthroscopy?
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management of intra-articular loose bodies
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contraindication question for hip arthroscopy?
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passive hip flexion limited to 90 degrees attributed to joint contracture
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**In FAI, what is the usual location of the corresponding labral injury?
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AnteroSuperior
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