5 - Extra-Articular Hip Conditions Flashcards
Name 4 extra-articular diagnoses
- Greater Trochanteric Pain Syndrome (GTPS)
- Piriformis Syndrome
- Snapping Hip
- Stress Fracture
Name 6 intra-articular hip diagnoses
- Acetabular Labral Lesions
- Femoral Acetabular Impingement (FAI)
- Osteonecrosis
- Fracture
- Osteoarthritis (OA)
- THA
When examining a patient with a suspected hip condition, you MUST
rule out other regions that can refer to Hip (differential dx).
What 3 other areas can refer to the hip?
- Sacroilliac joint
- Lumbar Spine
- Knee/Foot and Ankle
What can be used to rule out potential contributors from adjacent areas?
Scanning Examination
What orthopaedic injuires to the hip occur at age 0-3? (3)
- Congenital dislocations
- Septic Arthritis
- Transient Synovitis
What orthopaedic injuires to the hip occur at age 4-8? (1)
- Legg-Perthes Disease
What orthopaedic injuires to the hip occur at age 9-15?
- Slipped Capital Femoral Epiphysis
- Apophysitis
- Osteochondritis Dissecans (OCD)
What orthopaedic injuires to the hip occur at age 14-25?
- OCD
- Overuse injuries
- Strains
- FAI
- Labral Tears
What orthopaedic injuires to the hip occur at age 30-50?
- Rheumatoid Arthritis
- AVN
- GTPS
What orthopaedic injuires to the hip occur at age 50+?
- GTPS
- OA
- Hip Fractures
GTPS: What percentage of people will develop lateral hip pain in their life?
10-25%
GTPS: What areas does lateral hip include? (3)
Pain and reproducible tenderness in region of:
- greater trochanter
- buttock
- lateral thigh
What 3 injuries are related to GTPS?
- Trocanteric Bursitis
- Glut Med/Min/Piriformis Tendinopathy/Tears
- ITB Friction Syndrome/Snapping Hip
What are the risk factors for GTPS? (7)
- Age older than 40
- Female
- Obesity
- Knee or Hip OA
- RA
- Lumbrosacral back pain
- Core instability, including glute med weakness
What are the mechanisms of injury for GTPS
- Direct trauma to the lateral hip
- Eccentric hyperadduction
- Cumulative microtrauma
- Illiotibial tract impingement
- Intrinsic degenerative tendinosis of the hip abductors
What can direct trauma to the lateral hip result in?
myotendinous injury or trochanteric bursitis.
What does cumulative microtrauma occur as a result of?
Combination of overuse and faulty mechanics.
What is the most common finding on an MRI?
Intrinsic degenerative tendinosis of hip abductors
T/F: Trochanteric bursitis is commonly identified on an MRI.
False: very rarely
What is the clinical presentation of GTPS?
Acute or insidious onset of pain in the lateral thigh region that may radiate - occasionally down to the calf.
What is GTPS exaccerbated by? (4)
- Lying on the affect hip
- Repetitive hip flexion-extension activities (walking/running/climbing stairs)
- Prolonged standing or single limb activities
- Reptitive hip internal or external rotation movements
During an examination for GTPS, point tenderness is in the
posterolateral area of GT, tyically on either side of gluteus medius tendon insertion
How is pain reproduced for GTPS? (4)
- Strething of IT Band (Ober’s test)
- Active resistance to hip abduction and external rotation, occasionally internal rotation
- Pain with straight leg standing for 30 seconds
T/F: Pain is rarely produced with hip extension.
True
What two tests can be performed during examination of GTPS?
- Positive Trendeleburg Test
2. Resisted external derotation test
What must be ruled out for GTPS?
Lumbar spine radiculopathy.
In what percentage of the population will the sciatic nerve pass through piriformis?
15% of the population
What is Piriformis Syndrome?
Spasm/hypertrophy of piriformis compresses “sciatic” nerve
In addition to pain, what might also occur with piriformis syndrome?
Abnormal neurological findings in affected nerved.
What is the Etiology of Piriformis Syndrome.
Causes are multivariate, may result from compression of sciatic nerve, muscle imbalances, trauma, strain or overuse.
Piriformis Syndrome may start as ___ and can progress to ___.
May start as buttock pain, can progress to posterior thigh and calf pain.
What might aggrivate Piriformis Syndrome?
walking, extended sitting, external rotation of the hip
What will be found during examination of Piriformis Syndrome?
- May have antalgic gait
- May stand with ER leg
- AROM hip ER may cause pain
- Positive SLR especially with IR/Add
- MMT pain and/or weak hip ER
- Palpable tenderness and TP in piriformis
Describe how to perform a piriformis test?
- Patient posititioned in side-lying on uninvolved side with leg on involved side placed in 60 degrees of hip flexion.
- Stabilize pelvis, apply an adduction force to knee on involved side
- Posiitive test- if movement reproduced patient’s pain in buttock or leg
What is snapping hip syndrome also known as?
Coxa Saltans
Coxa = hip
Sultans = jumping/dancing
Is snapping hip syndrome more common in males or females?
Females
What do patients normally complain of with snapping hip syndrome?
Patients can complain of “noise” but can also be painful (usually the snapping is more of a nuisance
