4 The Hip Flashcards
What’s close-packed position for the hip joint? (think about how ligs are coiled)
- ext (15°)
- medial rotation (40°)
- abduction (50°)
What’s loose-packed position of hip joint?
flexion, abduction, external rotation
What’s the normal end feel for hip movements?
capsular (though hip flexion can illicit a soft tissue approximation end feel)
What’s a capsular pattern?
When certain soft-tissue pathologies are present, many joints have a characteristic pattern of limited movement. Each pattern of movement limitation is unique to a particular joint. This movement restriction is caused by dysfunction in the joint capsule. Consequently, it’s called the joint’s capsular pattern.
What’s the capsular pattern of the hip joint?
flexion, abduction, medial rotation (order may vary)
What’s nutation and what’s its aka?
- sacral base moves anteriorly while apex moves posteriorly relative to innominate bone, which rotates posteriorly
- aka sacral flexion
- (counternutation is opposite)
What’s arthrogenous weakness?
inhibition of mm activity secondary to joint dysfunction or swelling
What are symptoms with a labrum tear?
- pain in front of hip (most often in groin area) accompanied by clicking, locking, or catching of the hip
- pain may radiate to the buttocks, along side of hip or down to knee
- jt stiffness and a feeling of instability where the hip and leg seem to give away are also common
What are relevant tests for labrum impingement? What would be positive for each?
- McCarthy Test:
- Px supine. Px flx both hips then extends affected hip. If px feels a catch, labral tear likely
- FABER’s: pain in hip jt could indicate labrum injury
- Ant Impingement test: same as scouring test – pain, grinding, clicking are positives
- Posterior impingement test: prone, therapist takes hip into hyperextension, abduction, ext rotation. Positive is hip pain.
Does the labrum have a blood supply?
Yes (so some tears are capable of healing)
What are common presentations (symptoms) of hip OA?
- jt pain is often described as ‘groin pain’
- pain can also refer into ant. and med. thigh
- rigid posture comes with disuse and antalgic (pain-avoiding) posture/gait
- pain/stiffness is relieved with either/or/both rest or activity, but too much of either increases symptoms
What are tx considerations for labrum tears?
Lifestyle mods:
- increase level of low-moderate physical activity (to avoid further damage)
- focus on proper posture, avoid activities that take hip through full ROM or reproduce pain
- Therex: strengthen to stabilize hip, optimize biomechanics to prevent pinching of labrum; postural correction
Mx:
- to help correct underlying postural dysfunction
- diminish inflamm and spasm pain
- jt play to diminish pain and promote jt health
Surgery may be necessary.
What are tx considerations for hip OA?
- progressively and realistically normalize jt ROM (all tools except jt mobes if osteophytes present)
- manage pain
- improve jt stabiility by improving muscular strength
- address causative factors
- symptom management is often required
- referral to Arthritis Society, nutritional consultation and/or weight loss
What are possible indications of Snapping Hip Syndrome?
- pain/snapping internally when hip is at about 45° flx and moving from flx to ext. It is often caused by slipping of psoas tendon over ridge of lesser trochanter or iliofemoral lig riding over fem head
- pain/snapping externally (lateral to hip) could be tight ITB or Glute max tendon riding over greater trochanter. Typically felt with flx or ext and often exacerbated if hip is med rotated. Can cause trochanteric bursitis
- articular snapping may be labral tear or Femoral Acetabular Impingement (FAI)
What are S/S of inguinal hernia?
- pain in groin and/or scrotum in males
- consider “sports hernia” (internal disruption of inguinal canal) in athlete with unresolved groin pain
- symptoms exacerbated by coughing, sneezing or resisted sit-up
- tenderness in area of inguinal canal
