Common Hip Soft Tissue injuries

Question 1

Trochanteric Bursitis: mechanism of injury

Answer 1

• insidious
• repeated hip flexion/extension
• IR/ER
• compression

Question 2

trochanteric bursitis

Answer 2

• also called trochanteric pain syndrome
• bursa is found over GT and under IT band
• Could also be a gluteus medius tear

Question 3

Signs and symptoms of trochanteric bursitis

Answer 3

• deep ache (local)
• no active limitations
• pain ascending stairs
• resisted EXT/ER
• may disturbe sleep
• AVN can minmic this
• IT band tightness

Question 4

Interventions for trochanteric bursitis

Answer 4

• avoidance of aggravating activity
• Ice, gentle stretch, iontophoresis
• restore gluteal and tensor strength/flexability balance
• trochanteric osteotomy

Question 5

hip pointer: mechanism and what it is

Answer 5

• direct trauma
• pain associated with trauma to anterior hip

Question 6

Hip pointer

signs and symptoms

Answer 6

• tender to palpation
• aggravated by running, coughing, sneeze, trunk movements

Question 7

Interventions for hip pointer

Answer 7

• rest
• ice
• gentle stretching
• protective padding

Question 8

How is a muscule injuried

Answer 8

• strong contraction
• blunt trauma
• overstretched
• overuse

Question 9

Signs and symptoms of a muscule strain

Answer 9

• Grade 1: mild symptoms & RI strong and painful
• Grade 2: moderate symptoms & RI are weak and painful
• Grade 3: weak and painless (torn)

Question 10

Interventions for muscule strains

Answer 10

• initially: PRICE
• Strengthen: isometric
• Stretch: to return to resting length not over stretching

Question 11

Common hip muscle strains

Answer 11

• adductor strain
• iliopsoas strain
• Hip flexor
• hmastring
• gluteus medius

Question 12

When are the adductors active during gait

Answer 12

• loading reposne into initial swing

Question 13

When is iliopsoas active during gait

Answer 13

intial swing = concentrically
mid stance into preswing = eccentrically

Question 14

When are the hamstrings active during gait

and how can you differiate which hamstring

Answer 14

• mid swing to initial contact = eccentrically
• intiail contact to loading response: counter hip flexor moment
• differentiate by toes in = semis and toes out = biceps femoris

Question 15

Gluteus medius

activity in gait cycle

Answer 15

• will see + trendelemberg
• works throughout stance esp. SLS

Question 16

Athletic pubalgia aka sports hernia

Answer 16

• strain: abdominal muscules or adductrs muscles
• weak abs can set you up for overstressing adductors and vice versa

Question 17

Mechanism of injury for athletic pubalgia

Answer 17

• vigorous trunk twisting with foot planted

Question 18

exam: athletic pubalgia

Answer 18

• resisted trunk flexion
• resisted hip adduction
• no bulge
• MRI, bone scan

Question 19

Interventions for athletic pubalgia

Answer 19

• rest
• flexibility
• strengthening
• surgery: repair tear or inguinal neurctomy (if inguinal nerve is irritated)

Question 20

Prognosis

athletic pubalgia

Answer 20

• return to activity 6-12 weeks
• may progress to inguinal hernia with content bulge

Question 21

Signs and symptoms of acetabular labral tears

Answer 21

• anterior hip/groin pain
• posterior hip pain less frequent
• greater in women with history of dysplasia
• catching/clicking
• diagnosis of exclusion (rule out soft tissue, DJD, back etc)

Question 22

Provocation tests

acetabular labrum tears

Answer 22

• anterior flex, ER, abdu –> ext, IR, add
• posterior: ext, ER, abd –> flexion IR and add
• Compression (axial)
• painful SLR (rectus femoris attahces to superior labrum
• (+) FABERS
• confirm with MRI with arthrography

Question 23

Acetabular labrum tears intervention

Answer 23

• avoid knee hyperextnesion
• surgery: repair and debride, cartilage regeneration procedures