Extra-Articular Disorders of the Hip

Question 1

When examining a patient with hip condition : must rule out the following 3 things?

Answer 1

Sacroiliac Joint
Lumbar Spine
Knee/Foot/Ankle

Question 2

Greater Trochanteric Pain Syndrome, which percent of population will get this?

Answer 2

10-25% will develop lateral hip pain

Question 3

What is present in GTPS and where is it located?

Answer 3

Pain and reproducible tenderness in region of : greater trochanter, buttock, and lateral thigh.

Question 4

What 3 contributing conditions can lead to GTPS?

Answer 4

Trochanteric Bursitis
Glut Med/Min/Piriformis Tendinopathy/Tears
ITB friction Syndrome/Snapping hip

Question 5

Risk factors for GTPS?

Answer 5

Older than 40
Female
Obese
Knee/Hip OA
RA
Core instability
Lumbosacral back pain

Question 6

Mechanisms of Injury GTPS?

Answer 6

Direct trauma to hip
Eccentric Hyperadduction
Cumulative Microtrauma
IT impingement
Intrinsic degenerative tendinosis of hip abductors

Question 7

What is the most common finding on an MRI for people with GTPS? What is rarely found?

Answer 7

Intrinsic degenerative tendinosis of hip abductors.

Rarely is trochanteric bursitis identified.

Question 8

Clinical presentation of GTPS?

What exacerbates the pain?

Answer 8

Acute onset of pain lateral thigh, radiates down to calf on occasion.

Lying on the affected hip.
Repetitive hip flexion-extension activites
Prolonged standing or single limb activity
Repetitive hip internal or external movements

Question 9

Examination of GTPS signs?

What reproduces the pain?

Need to rule out what?

Answer 9

Tenderness in the posterolateral area of GT; on either side of the glute med tendon

Pain reproduced with : Stretching of IT band (Ober’s Test)
-Active resistance of hip abduction and external rotation. Occasionally internal rotation.
Pain rarely reproduced with hip extension**

Pain with Straight Leg Standing for 30 seconds. 100% sensitivity.

• Positive trendelenberg
• Resisted external derotation test 97% SP

Need to rule out lumbar spine radiculopathy!

Question 10

Piriformis Syndrome?

What percent of population affected

What presents?

Etiology?

Answer 10

Sciatic nerve passes through piriformis in 15% population.

Spasm/Hypertrophy of pirfiromis compresses the sciatic.

Presents with abnormal neuro findings in affected nerves

Etiology: multivariate . Compression of nerve, muscle imbalance, trauma, strain or overuse

Question 11

Piriformis syndrome may start as what, and progress where?

Aggravated by?

Answer 11

Buttock pain and progress to posterior thigh and calf pain

Aggravated by walking , extended sitting, external rotation of hip

Question 12

Examination for pirformis syndome?

Answer 12

Antalgic Gait
May stand with ER leg
AROM hip ER may cause pain
Positive SLR with IR/ADD
Weak hip ER and MMT pain
Palpable tenderness in piriformis

Question 13

Positive piriformis test

Answer 13

Patient in side-lying on uninvolved side with involved side place 60 degrees of hip flexion

Stabilize pelvis apply adduction force to opposite side.

Positive test- if movement reproduces patient’s pain in buttock leg

Question 14

Snapping Hip Syndrome?

Which gender gets it more?

Answer 14

Females.

Patient complains of snapping noise, occasional pain.

3 classifications: External, Internal, Intra-Articular

Question 15

Snapping hip syndrome: External

Answer 15

Tight ITB or glute Max over the greater trochanter

Question 16

Snapping hip syndrome: Internal

Answer 16

Iliopsoas tendon over anterior acetabulum OR iliofemoral ligament over femoral head

Snapping common during hip flexion of 45 deg

Question 17

Snapping hip: intra-articular

Answer 17

Loose body in joint from a Labral Tear

Question 18

Examination: what to do? Snapping hip

Answer 18

Rule out intra-articular cause of snapping hip.
Snapping hip Sign
Palpate!

Question 19

How to rule out intra-articular causes of snapping hip?

Answer 19

FADIR and Thomas Test

Question 20

What is snapping hip sign?

Answer 20

Patient abducts and ER leg, moving into flexion and then extension.

Reproduces snapping around 45 deg.

Question 21

Femoral Stress Fractures are most common where? And what percent of people will get them?

What is the most common place for a stress fracture in the femur?

Answer 21

Tibia and Metatarsals
7-10% in the femur
Most common in the shaft

Question 22

Risk factors for stress fractures: Extrinsic

Answer 22

Frequency, duration, intensity, surface, footwear

Question 23

Risk factors for stress fracture: Intrinsic

Answer 23

Poor muscular endurance/decreased muscle mass

Question 24

What is the female triad?

Answer 24

Disordered eating, Amenorrhea, osteoporosis

Question 25

Femoral Neck stress fractures are at higher risk for displacement on which side? How is it treated?

What about the other side?

Answer 25

Tension side (superior aspect of femoral neck) Treated with an ORIF

Compression side is treated conservatively

Question 26

Femoral Shaft stress fractures occur mostly where?

Answer 26

Medial proximal third and treated conservatively

Question 27

Diagnosis of femoral stress fractures?

Answer 27

Radiograph, Bone Scan, MRI

Question 28

Examination of stress fractures?

Answer 28

Subjective
Patient complains of localized pain insidious onset in groin, thigh or knee.

Pain at end of a run that may progress.

Usually related to a change in activity level.

Hard to illicit pain with palpation

Question 29

Which test can be used with high sensitivity for stress fracture femur?

Answer 29

Patella-pubic percussion test at 95%

Or fulcrum test

Question 30

Fulcrum Test?

Answer 30

Possible proximal 1/3 femoral stress fracture

Patient’s femur is leveraged over examiner’s forearm and positive when pain is reproduced.