COMMON INJURIES OF HIP, GROIN & THIGH Flashcards
SOURCES OF HIP PAIN
Schema
HIP CONDITIONS: ant, lat, post, common, less common & not to be missed
Tableau
HIP: 3 ≠ common condition
Femoroacetabular impingement
Hip labral tear
Hip osteoarthritis
FAI: def, ≠ types, diagnostic, assessment
D: = morphological abnormality develops on femoral head, acetabulum or both
- Abnormal contact between proximal femur & acetabulum
T: - CAM = type lesion where bump or bony formation found on femoral head surface
- Pincer = type lesion where lesion appears on acetabulum
D: - Morphological changes present in absence of pain
- Need to have symptoms, clinical signs & radiological findings to be positive for FAI
A: Tests always compared to unaffected limb in which negative result should be found
Unfortunately lot of clinical tests do not have high sensitivity & specificity, so we need to combine with history patient
Hip ROM => painful & decreased hip flexion & IR FADDIR => pain
FABER => pain
SCOUR => pain
Thomas => pain in flexed dip & decreased ROM in extended hip
HIP LABRAL TEAR: def, ≠ types, assessments
D: Frequent presentation in athletic population (22% of people with groin pain will have a labral tear)
Common in people with FAI, but can occur with and without FAI
T: Type I- detachment of the labrum from the acetabular rim
Type II- separation within the labrum alone
A: Tests always compared to unaffected limb in which negative result should be found
Unfortunately lot of clinical tests do not have high sensitivity & specificity, so we need to combine with history patient
Painful clicking => positive findings present ( high sensitivity & specificity)
FADIR => pain
FABER => pain
Hip dial test => increased ER on affected side, loss of elasticity in hip Scour => pain
Thomas => pain in flexed hip
HIP OA: def, assessment & symptoms
D: = Degenerative condition normally diagnosed in females > males over 40 years old
- Non-traumatic
A: Stairs, STS, walking and/or squatting => painful
Hip ROM => painful and/or decreased passive hip ROM (mainly IR’
Active hip extension => pain
Active hip flexion => pain
Scour => pain
FABER + FADDIR => pain
S: - Pain surrounding lateral hip (C-sign) or anterior hip
- Stiffness (eases in less than 30 mins)
- Worse at end of day if patient has been standing or walking for long periods
GROIN PAIN: acute groin injuries & classification of chronic
ACUTE GROIN INJURIES
- Musculotendinous structures
- Explosive MOI: kicking, change of direction, reaching with leg - Most commonly adductors
CLASSIFICATION OF LONG STANDING (CHRONIC) GROIN INJURIES
- Defined clinical entities
• Adductor related
• Iliopsoas related • Inguinal related • Pubic related
- Hip-related groin pain
- Other conditions (neurological, gastrointestinal, urological …)
ADDUCTOR TEAR: description & clinical tests
D: Common during football, ice hockey & rugby
- Normally occurs during lunge and/or change of direction with excessive stretch of adductor group - Sudden onset injury
CT: - Palpation (muscle, pubic bone & pubic symphysis)
- Positive adductor squeeze test
- Decreased resisted hip adduction (pain)
PUBIC BONE OVERLOAD = osteitis pubis: description & clinical tests
D: - Overuse injury of pubic
- Symphysis & surrounding tissue
- Normally chronic injury developing from abnormal loading of adductor tendons
CT: - Sometimes pain on palpation (pubic bone & pubic symphysis)
- Sometimes pain with adductor squeeze test
- Sometimes pain with resisted hip adduction
- Sometimes positive hop test
THIGH PAIN: common condition
Hamstring tears
Proximal hamstring tendinopathy
Greater trochanter pain syndrome (gluteal tendinopathy)
HAMSTRING TEARS: description, ≠ types, risk factors, assessment & prognosis
D: = physical disruption of muscle fibre/s
- Patients report sudden onset of posterior thigh pain
T: Type I- running type injuries - Terminal swing
- Sprinting
- Biceps femoris
Type II- dancing injuries - End range
- Over-stretched
- Semimembranosus
RF: - Short muscle fiber fascicles
- Decreased strength
- Previous hamstring injury
A: Tests always compared to unaffected limb in which negative result should be found
Hamstring palpation => pain locally over muscle belly
SLR (with no reproduction of neural symptoms => pain through post thigh
Resisted isometric knee flexion => pain & reduced strength Single leg bridge => pain & reduced strength
Slump test => negative for neural symptoms 90/90 test => pain and/or decreased ROM
P: Pain with normal walking => 4x more, > 3 weeks rehabilitation
Pain free jogging within 1-2 days => <2 weeks for return to sport
Pain free jogging within 3-5 days => >2 weeks for return to sport
Pain free jogging > 5 days => >4 weeks until return to play
PROXIMAL HAMSTRING TENDINOPATHY: description & assessment
D: - Pain around gluteal fold or buttock region
- Need to rule out lumbar spine & hamstring tears before considering hamstring tendinopathy
- Common in distance runners & jumpers
- Normally evolves from compressive forces surrounding proximal hamstring tendon combined with abnormal loading/biomechanics - Overuse injury
A: Tests always compared to unaffected limb in which negative result should be found
Ischial tuberosity palpation => pain locally over tendon/bone junction
Heavy isometric knee flexion => pain & reduced strength 90/90 test => pain and/or decreased ROM
Modified single leg bridge => pain over ischial tuberosity
GREATER TROCHANTER PAIN SYNDROME: description & assessment
D: - Pain over lateral hip region
- Previously referred to as ‘greater trochanteric bursitis’ or ‘greater trochanter pain syndrome’
- Common in distance runners & woman >40 years old (up to 20% suffer the condition)
- Normally caused by increased compressive tensile load of gluteal tendons on greater trochanter
A: Tests always compared to unaffected limb in which negative result should be found
Stair climbing / crossing legs => pain lateral hip
FABER => pain through anterolateral / lateral hip
Trendelenburg => contralateral pelvic drop
Derotation test => pain lateral hip
Ober’s test => pain lateral hip
Side-lying => pain when affected hip upwards
