(1) Pathologies of the Hip and Thigh Flashcards
What is involved in the subjective exam?
- PC (nature, severity, behaviour)
- HPC
- PMH
- Special Qs
- SIN
- SHx
- DHx
- Psychological and psychosocial
What is Hip Osteoarthritis?
Its a chronic (degenerative) joint disease
What happens as a result of Hip OA?
- progressive damage and loss of cartilage
- reactive bone remodeling, osteophytes
What are osteophytes?
cartilage-capped bony proliferations that most commonly develop at margins of synovial joint as a response to articular cartilage damage
What are the risk factors for hip OA?
- age & genetics
- joint incongruency
- laxity
- BMI
- heavy manual labour
What are symptoms of Hip OA?
- Pain (groin, thigh, buttock)
- Stiffness
- Agg: walking, sit to stand
- Ease: sitting
What are signs of Hip OA?
- pain / decreased ROM in IR, flexion, and abduction
- muscle weakness
- gait disturbance
What is the management for hip OA?
- local muscle strengthening
- general aerobic
- advice may cause initial pain
- education programme
- weight management
- info and support
- pharmacological
What is Femoroacetabular Impingement (FAI) syndrome?
- abnormal contact b/t the acetabulum and femoral head/neck junction
- repeated abutment of femoral neck against acetabular rim
- OA
What are the 3 types of FAI?
- CAM impingement - anterior superior fem head-neck junction
- Pincer impingement - abnormalities in shape or orientation of acetabulum
- Mixed
What are the symptoms of FAI syndrome?
- deep/anterior groin pain during activities involving repetitive hip flexion
- symphysis pubis & anterior thigh
- buttock/sacroiliac pain
- catching/clicking
What are the signs of FAI syndrome?
- no valid/reliable tests
- pain or decreased ROM passive flex & IR
- +ve FADIR or FABER
What is the treatment for FAI syndrome?
- Conservative Rx (activity modification)
- Surgery Rx (arthroscopy for acetabulum/proximal femur)
What is Greater Trochanteric Pain Syndrome (GTPS)?
It is pain overlying the lateral aspect of the hip (may refer through the thigh)
What are the types of GTPS?
- Trochanteric bursitis
- Gluteus minimus/medius tendinopathy
- Snapping hip syndrome
What are the effects of GTPS?
- sleep disturbance
- decreased PA
- decreased wellbeing
- decreased QOL
What are the symptoms of GTPS?
- Agg: ipsilateral side lying, cross legs
What are the signs of GTPS?
- pain on palpation
- pain resisted abduction & IR
- +ve Trendelenburg sign after single leg stance test
- +ve external de-rotation test
What is the treatment for GTPS?
- education
- advice: activity mod; sleep; weight loss
- soft tissue
- exercise rehab
- NSAID & corticosteroid injections
What is Acute Adductor Tendon injury?
- Strains or tears of the adductor longus tendon typically occur during acute muscle contraction
- It commonly occurs when kicking or pivoting the leg
How does an acute adductor tendon injury occur?
- strong hip abd / ER movement simultaneous with contraction of adductors
- COD, reaching, kicking, jumping
What are the symptoms of acute adductor tendon injury?
- sudden onset pain
- localised groin / medial thigh
What are the signs of acute adductor tendon injury?
- pain resisted adduction
- pain passive abduction
- local pain / tenderness
What is the rehab for an acute adductor tendon injury?
- active flexibility
- early resistance
- load progression (High load, high speed)
- running mvmts
- slow running and side steps
- running and COD
- sprinting and COD
How does a chronic adductor tendinopathy occur?
- repetitive mvmt / activity
- muscle weakness
- strength imbalance
- degenerative / genetics
- changes tendon structure & function
What are the symptoms of chronic adductor tendinopathy?
- localized groin pain
- may refer to medial thigh / abdomen
- morning stiffness
What are the signs
of chronic adductor tendinopathy?
- pain passive abduction
- pain eccentric loading
- local pain / tenderness on palpation
- +ve Add 45 degree squeeze test
How does a hamstring injury occur?
high intensity sprinting (most common injury in football)
What are the hamstring muscles?
- biceps femoris
- semitendinosus
- semimembranosus
What are the risk factors for hamstring injuries?
- decreased flexibility
- previous injury
- quads / hamstring strength imbalance
Where do hamstring injuries usually occur?
at the musculotendinous junction
What are the different grades of hamstring injury?
- Grade 1: mild damage to muscle fibres
- Grade 2: partial tear (2-3 months)
- Grade 3: complete rupture (surgery)
What are the protocols for hamstring injuries?
- PRICE
- POLICE
