Name the 3 hip ROM tests the in order in which they are performed - PowerPoint PPT Presentation

Name the 3 hip ROM tests the in order in which they are performed here: Image Challenge: Hip, Foot and Ankle UCSF Primary Care Sports Medicine Conference 2018 Carlin Senter, MD Anthony Luke, MD, MPH Associate Professor Professor UCSF Primary Care Sports Medicine 12/13/2018 Hip passive range of motion The 3 hip ROM tests in order are: A. Extension, flexion, adduction B. Extension, flexion, abduction 71% C. Flexion, abduction, adduction D. Flexion, adduction, abduction E. Flexion, external rotation, internal rotation 19% F. Flexion, internal rotation, external rotation Flexion External Internal 6% 3% 1% 0% normal rotation rotation 120° normal 40-60° normal 30- . . . . . . . . . . . . . . . c . c . u u , . n , u u d d n o d d d b o i d b a a t i a t a a , , a 40° n n t t , , o n n o o o r o o i i r t t l l i i c c a a x x e e u u n n r l l d d r f f e e b d t , , a a x t n n n o o e , , i i i n n s s , , o o n n n n o o x i x i e e i i t t e e x x x x l l e e E E F F F l F l http://www.youtube.com/watch?v=5LNYdJIrWYo 1

Hip passive range of motion: 21 y/o soccer player has groin pain with this internal and external rotation maneuver. What is the most likely diagnosis? What is the most likely diagnosis? FADIR  Flexion A. Trochanteric bursitis 82%  Adduction B. Iliotibial band tendinitis C. Hip flexor tendinitis  Internal D. Femoroacetabular impingement  Rotation E. Sacroiliac joint dysfunction 9% 4% 2% 2% s s s n i i i . t t t . o i i . s n i n p i t r i d i m c u d n n b n i e u e r f c t a s i t l r r u y e d o d b t n x n a a t e n a b t l e i h f o l p c c a a j o i i b H o c r a T i r t o i o l m o i i l r I e c F a http://www.aafp.org/afp/2009/1215/p1429.html S 2

Please focus on L hip. What x-ray findings What x-ray findings of the L hip are seen? do you NOT see? 87% A. Joint space narrowing B. Subchondral sclerosis C. Subchondral cysts D. Osteophytes E. Femoral neck fracture 7% 6% 0% 0% s g s s e i e n s t r i o s t u w y y r h t c c o e p a l l r c a o r r r f a s e d k n l n t a s c r O e e o d h n c a n c o l p b a r s h u c o t S n b m i u o S e F J 4 radiographic hallmarks of osteoarthritis Which muscle is weak in this runner? 1. Joint space narrowing 2. Subchondral sclerosis 3. Subchondral cysts 4. Osteophytes 3

Which Muscle is weak in this runner? Case: What will this patient have difficulty doing ? 78% A. Gluteus Minimus B. Gluteus Medius C. Piriformis D. Quadratus Lumborum E. Hamstring 8% 6% F. Rectus abdominis 4% 4% 1% g s s s s u u i m n i m n m i u i d r i r r t m i e o o s n M i f b m o M i r m d s i a b P H s u u a u e L e t s s u t u u l u t G t c l G a e r R d a u Q What will this patient have difficulty doing? PT Dysfunction Presentation Wearing running shoes A. Swimming  Usually women > 40 y.o. B. Going on her toes  Weakness with inversion C. Curling her toes D.  “ Too many toes sign ” 77% Taking her shoes off E.  Unable to plantarflex – Single limb heel rise test Feeling her little toe F. 15% 4% 3% 0% 0% g s s s f e e n e e o f o o i o o t m t s h t e s m r r e l e e o t g i h h t n w h i s l i S n g r n o n r e n i e h u g l h n r g r u g g i C n n o i n G k i l i e r a e a T F e W 4

Looseness on this Exam is Consistent with Injury to ? Ankle Ligaments High tibial fibular ligament A. Lateral Collateral Complex Anterior Talofibular ligament B.  Anterior talofibular lig. Calcaneal Fibular ligament C.  Calcaneofibular lig. Posterior Talofibular ligament  Posterior talofibular lig. D. Medial Ligament Complex Spring Ligament E. 80%  Deltoid ligament  Superficial and deep ligaments 11% 7% 2% 1% t n t n t n e . e . m . m . . e a . g m a a g g l i a g i r g i l l i a l r L i r a r u l a l a g l u u l b n u b i b b f i f i i o p r f i o F l a S a l a l l T a b i T e r n o t i o r i a r h r i c e g e l t a s H i t C o n A P What is the difference between these two R The difference between the 2 radiographs: knee x-rays taken days apart on the same patient? A. Non weight-bearing versus weight-bearing 1. 2. B. Extended versus flexed C. AP versus lateral D. AP versus sunrise view 0% 0% 0% 0% d l w a . e r . x e s e i r e t v e l a v f e l s s s g u u i n s r s n i r r u a r e e v s e v s b d P u - e t A s h d r n e g i e v e t P w x A E n o N 10 5

Weight-bearing radiographs increase What is the diagnosis? sensitivity for joint space narrowing 3 views for knee pain  66 y/o woman  Presented to urgent care with sudden severe R shoulder pain - Weight bearing that developed a few days after doing extensive yard work flexed PA (aka notch  ROM limited to 10 degrees forward flexion, 10 degrees view) abduction. FW - Lateral of affected  Unable to tolerate strength testing of shoulder due to B side excruciting pain XR - Sunrise or merchant view Calcific tendinitis of the shoulder What is the diagnosis? Glenohumeral joint osteoarthritis A. Frozen shoulder B.  Calcium deposit in rotator cuff tendon, most commonly supraspinatus at its insertion on greater tuberosity of Calcific tendinitis C. humerus Gout D.  Can cause severe shoulder pain, causing patient to go to Polymyalgia rheumatic E. emergency room Fibromyalgia F.  Can be asymptomatic, incidentally found on radiographs  Diagnosed by radiograph or ultrasound  Tx (not a lot of evidence for any of following) Rest, ice, NSAIDs, Physical therapy - Subacromial corticosteroid injection  can dissolve calcium - deposition Extracorporeal shock-wave therapy (Bannuru RR et al. Annals - 0% 0% 0% 0% 0% 0% Internal Medicine, 2014) Frozen shoulder Calcific tendinitis Polymyalgia rheumatic Fibromyalgia Glenohumeral joint oste... Gout Arthroscopic debridement if above does not resolve symptoms - 10 6

Case: What nerve is involved here? What nerve is involved here? A. Superficial branch of the radial nerve B. Axillary nerve C. Suprascapular nerve D. Long thoracic nerve E. Musculocutaneous nerve F. Ulnar nerve 0% 0% 0% 0% 0% 0% e e e e e . v v v v v . r r . r r r e e e e e e n n h n n n t y r f r c s a r a i u o a c n u l o h l a l i l p r e U c x a o n n A h a a c s t t r u b a g r c n l p o a o u u l i L c S c i f s r u e M p u S 10 Winged scapula  Long thoracic nerve = pure motor nerve  Injury  paralysis of serratus anterior muscle  winged scapula most obvious on a wall pushup  Causes - Brachial neuritis (Parsonage turner) - Trauma or compression - Stretch or traction Have a great evening!  Usually resolves over 1-3 years See you tomorrow  Physical therapy to maintain range of motion, strengthen around the injury UpToDate “Overview of upper extremity peripheral nerve syndromes” accessed 7/15/17. 29 7