5 - Extra-Articular Hip Conditions

Question 1

Name 4 extra-articular diagnoses

Answer 1

1. Greater Trochanteric Pain Syndrome (GTPS)
2. Piriformis Syndrome
3. Snapping Hip
4. Stress Fracture

Question 2

Name 6 intra-articular hip diagnoses

Answer 2

1. Acetabular Labral Lesions
2. Femoral Acetabular Impingement (FAI)
3. Osteonecrosis
4. Fracture
5. Osteoarthritis (OA)
6. THA

Question 3

When examining a patient with a suspected hip condition, you MUST

Answer 3

rule out other regions that can refer to Hip (differential dx).

Question 4

What 3 other areas can refer to the hip?

Answer 4

1. Sacroilliac joint
2. Lumbar Spine
3. Knee/Foot and Ankle

Question 5

What can be used to rule out potential contributors from adjacent areas?

Answer 5

Scanning Examination

Question 6

What orthopaedic injuires to the hip occur at age 0-3? (3)

Answer 6

1. Congenital dislocations
2. Septic Arthritis
3. Transient Synovitis

Question 7

What orthopaedic injuires to the hip occur at age 4-8? (1)

Answer 7

1. Legg-Perthes Disease

Question 8

What orthopaedic injuires to the hip occur at age 9-15?

Answer 8

1. Slipped Capital Femoral Epiphysis
2. Apophysitis
3. Osteochondritis Dissecans (OCD)

Question 9

What orthopaedic injuires to the hip occur at age 14-25?

Answer 9

1. OCD
2. Overuse injuries
3. Strains
4. FAI
5. Labral Tears

Question 10

What orthopaedic injuires to the hip occur at age 30-50?

Answer 10

1. Rheumatoid Arthritis
2. AVN
3. GTPS

Question 11

What orthopaedic injuires to the hip occur at age 50+?

Answer 11

1. GTPS
2. OA
3. Hip Fractures

Question 12

GTPS: What percentage of people will develop lateral hip pain in their life?

Answer 12

10-25%

Question 13

GTPS: What areas does lateral hip include? (3)

Answer 13

Pain and reproducible tenderness in region of:

1. greater trochanter
2. buttock
3. lateral thigh

Question 14

What 3 injuries are related to GTPS?

Answer 14

1. Trocanteric Bursitis
2. Glut Med/Min/Piriformis Tendinopathy/Tears
3. ITB Friction Syndrome/Snapping Hip

Question 15

What are the risk factors for GTPS? (7)

Answer 15

1. Age older than 40
2. Female
3. Obesity
4. Knee or Hip OA
5. RA
6. Lumbrosacral back pain
7. Core instability, including glute med weakness

Question 16

What are the mechanisms of injury for GTPS

Answer 16

1. Direct trauma to the lateral hip
2. Eccentric hyperadduction
3. Cumulative microtrauma
4. Illiotibial tract impingement
5. Intrinsic degenerative tendinosis of the hip abductors

Question 17

What can direct trauma to the lateral hip result in?

Answer 17

myotendinous injury or trochanteric bursitis.

Question 18

What does cumulative microtrauma occur as a result of?

Answer 18

Combination of overuse and faulty mechanics.

Question 19

What is the most common finding on an MRI?

Answer 19

Intrinsic degenerative tendinosis of hip abductors

Question 20

T/F: Trochanteric bursitis is commonly identified on an MRI.

Answer 20

False: very rarely

Question 21

What is the clinical presentation of GTPS?

Answer 21

Acute or insidious onset of pain in the lateral thigh region that may radiate - occasionally down to the calf.

Question 22

What is GTPS exaccerbated by? (4)

Answer 22

1. Lying on the affect hip
2. Repetitive hip flexion-extension activities (walking/running/climbing stairs)
3. Prolonged standing or single limb activities
4. Reptitive hip internal or external rotation movements

Question 23

During an examination for GTPS, point tenderness is in the

Answer 23

posterolateral area of GT, tyically on either side of gluteus medius tendon insertion

Question 24

How is pain reproduced for GTPS? (4)

Answer 24

1. Strething of IT Band (Ober’s test)
2. Active resistance to hip abduction and external rotation, occasionally internal rotation
3. Pain with straight leg standing for 30 seconds

Question 25

T/F: Pain is rarely produced with hip extension.

Answer 25

True

Question 26

What two tests can be performed during examination of GTPS?

Answer 26

1. Positive Trendeleburg Test

2. Resisted external derotation test

Question 27

What must be ruled out for GTPS?

Answer 27

Lumbar spine radiculopathy.

Question 28

In what percentage of the population will the sciatic nerve pass through piriformis?

Answer 28

15% of the population

Question 29

What is Piriformis Syndrome?

Answer 29

Spasm/hypertrophy of piriformis compresses “sciatic” nerve

Question 30

In addition to pain, what might also occur with piriformis syndrome?

Answer 30

Abnormal neurological findings in affected nerved.

Question 31

What is the Etiology of Piriformis Syndrome.

Answer 31

Causes are multivariate, may result from compression of sciatic nerve, muscle imbalances, trauma, strain or overuse.

Question 32

Piriformis Syndrome may start as ___ and can progress to ___.

Answer 32

May start as buttock pain, can progress to posterior thigh and calf pain.

Question 33

What might aggrivate Piriformis Syndrome?

Answer 33

walking, extended sitting, external rotation of the hip

Question 34

What will be found during examination of Piriformis Syndrome?

Answer 34

1. May have antalgic gait
2. May stand with ER leg
3. AROM hip ER may cause pain
4. Positive SLR especially with IR/Add
5. MMT pain and/or weak hip ER
6. Palpable tenderness and TP in piriformis

Question 35

Describe how to perform a piriformis test?

Answer 35

1. Patient posititioned in side-lying on uninvolved side with leg on involved side placed in 60 degrees of hip flexion.
2. Stabilize pelvis, apply an adduction force to knee on involved side
3. Posiitive test- if movement reproduced patient’s pain in buttock or leg

Question 36

What is snapping hip syndrome also known as?

Answer 36

Coxa Saltans
Coxa = hip
Sultans = jumping/dancing

Question 37

Is snapping hip syndrome more common in males or females?

Answer 37

Females

Question 38

What do patients normally complain of with snapping hip syndrome?

Answer 38

Patients can complain of “noise” but can also be painful (usually the snapping is more of a nuisance