Hypermobility

Etiology for hypermobility

traumatic-fx, ligamentous or labral tear, total hip arthroplasty

atraumatic-repetitive/extreme motions in sports, labral tear w/ FAIS/IPI, connective tissue disorder

Cam type FAI w/ fulcruming etiology

shallow acetabulum

inferior insufficiency

excessive femoral torsion/version

femoral torsion what is it/plane/types

angle b/w femoral condyles & femoral head/neck

transverse plane

excessive anteversion (toe in)

excessive retroversion (toe out)

femoral version what is it/plane/types

angle b/w shaft & neck

frontal plane

coxa valga (leads to genu vara, large angle of inclination)

coxa vara (leads to genu valga, small angle of inclination)

prevalence of hyper

5-35% of those w/ hip jt p!

risk factors for hyper

genetics

injury

nature of pt's activates (run, ballet, golf, hockey, soccer, excessive ROT, flx, hyper ext)

symptoms of hyper

like impingement due to hyper +

groin + lat hip p!

popping, locking, snapping

feeling instability especially when squatting

ROM for hyper

pot excessive ext, IR, abd (ligamentous close packed position)

specifically hip IR>30 degrees at 90 degrees flx

combo: inconsistent block poss

Special tests for hyper

hip apprehension

ligamentum teres

specific ligament

abnormal femoral version or torsion

regional interdependence innervation

L4-S1 Z jts, is the L4 dorsal rami,

discs-L4 & L5, --> L1,L2 dorsal root ganglia & L4, L5 sinuvertebral nn.

iliolumbar ligaments at L5, S1 innervated by

L1-4 spinal nn.

So if L4-S1 jts are persistently dysfunctional??

L1-4 nerves are likely sensitized/ excessively recruit some hip flx

What hip flx are commonly affected by regional interdependence

iliopsoas (L1-4)

iliocapsularis (l2-4)

rectus femoris (L2-4)

dysfunction/sanitization to nerves lead to

excessive recruitment of mm. -->attached to capsule -->tugging on labrum away from jt=excessive traction on 3/9 o'clock portion of labrum

what m. are inhibited b/c of the imbalance of m. (regional interdependence)

hip ext/abd

iliopsoas importance in regional interdependence

excessively recruitment of this m. can add to ant shearing with lumbar hyper/instability

(keeps lordosis in standing)

etiology of iliopsoas impingement (IPI)

excessive iliopsoas recruitment (LBP, THA, hip hyper)

symptoms of iliopsoas impingement

consistent w/ other types of impingement

LB or other hip condition symptoms present

signs of iliopsoas impingement

consistent w/ other types of impingement

TTP over 3(R) or 9(l) o'clock position

LB or other hip condition signs if present

PT Rx iliopsoas impingement

culprit Rx-LB condition likely hyper/instable

victim Rx-like FAIS Rx