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MM I > Extra-articular Hip > Flashcards

Extra-articular Hip Flashcards

1
Q

Identify 6 likely causes of Extra-articular hip pn/sxs

A
  1. Greater trochanteric pain syndrome (GTPS)
  2. Piriformis Syndrome
  3. Snapping hip
  4. Hip stress fracture
  5. Femoroacetabular impingement syndrome
  6. Sports hernia
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2
Q

If a pt has a suspected hip condition, what do you want first RULE OUT?

A

Other regions that can refer to Hip (differential dx)

  1. Pelvic ring (incl sacroiliac jts)
  2. Lower thoracic (T7-12) and Lumbar spine
  3. Thigh and Knee
  4. Ankle & foot (potential referral from hip)

(can use a scanning exam to rule out potential contributors from adjacent regions)

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3
Q

T or F: Orthopedic injuries to the hip tend to be “age” specific

A

True

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4
Q

What are 3 “age” specific orthopedic injuries to the hip for

Age 0-3

A
  1. Congenital dislocations
  2. Septic arthritis
  3. Transient synovitis
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5
Q

What is 1 “age” specific orthopedic injury to the hip for

Age 4-8

A

Legg-Perthes Disease

= insufficient blood flow to femoral head –> bone death

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6
Q

What are 3 “age” specific orthopedic injuries to the hip for

Age 8-15

A
  1. Slipped Capital Femoral Epiphysis
  2. Apophysitis
  3. Osteochondritis Dissecans (OCD)
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7
Q

What are 4 “age” specific orthopedic injuries to the hip for

Age 15-30

A
  1. OCD
  2. Overuse injuries
  3. Strains
  4. FAI
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8
Q

What is 1 “age” specific orthopedic injuries to the hip for

Age 8-72

A

Labral tear

(labral tears have a better prognosis if managed between 17-35)

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9
Q

What are 3 “age” specific orthopedic injuries to the hip for

Age 30-50

A
  1. RA
  2. AVN (avascular necrosis - death of femoral head due to lack of blood supply)
  3. GTPS
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10
Q

What are 3 “age” specific orthopedic injuries to the hip for

Age 50+

A
  1. GTPS
  2. OA
  3. Hip fx
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11
Q

What is GTPS?

A

Pn & reproducible tenderness in region of greater troch, buttock, or lateral thigh

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12
Q

T or F: the most common pathology in GTPS is not bursitis, but tendinosis

A

True.

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13
Q

What are 7 risk factors for GTPS?

A
  1. > 40
  2. Female
  3. Obesity
  4. Knee or Hip OA
  5. RA
  6. Lumbopelvic back pn
  7. Core motor control impairment, gluteal mm weakness
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14
Q

What are 3 MOI for GTPS?

A
  1. Direct trauma to lat hip
  2. Cumulative microtrauma
  3. Intrinsic degenerative tendinosis of hip abd
    • most common finding on MRI! Rarely is true trochanteric bursitis identified
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15
Q

How does a pt with GTPS present clinically?

-onset of pn
-region of pn
-radiating pn?
-what is the pn exacerbated by?

A
  1. Onset: acute OR insidious
  2. Location: lateral thigh region
  3. May radiate (occasionally down to calf)
  4. Pain exacerbated by:
    • Lying on affected hip
    • Repetitive hip flex-ext activities
      (walking, running, climbing stairs)
    • Prolonged standing or single limb
      activities
    • Repetitive hip int/ext rot
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16
Q

What should you include in your exam of a pt with suspected GTPS?

A
  1. Palpation (posterolateral area of GT)
  2. Ober’s test
  3. Hip AROM, AROM + resistance
  4. SLS for 30 sec
  5. Trendelenburg test/ obs amb
  6. Resisted external de-rotation test
  7. Tests to rule out lumbar spine radiculopathy
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17
Q

What are common exam findings for a pt with GTPS?

A
  1. Point tenderness in posterolateral area of GT (typically regional to glute med tendon insertion)
  2. Pn reproduced w/:
    • Stretching of lat/ext hip mm
      (ITB/TFL) (Ober’s test)
    • Active resistance to hip abd & ext
      rot (occasional int rot)
    • SLS for 30 sec (100% SEN, 97.3%
      SPEC)
    • (maybe) ecc contraction hip
      rotators
  3. Rarely pain reproduced with hip ext
    • trendelenburg test/sign
      or coxalgic gait (pelvis level but trunk lean to affected side)
  5. Resisted external de-rotation test
    SN 88%; SP 97%; +LR 32.6; -LR 0.12
    (for gluteal tendinopathy)
18
Q

Describe the etiology of Piriformis Syndrome

A
  1. Causes = multivariate
    • Compression of sciatic n
    • Muscle imbalances
    • Trauma
    • Strain
    • Overuse
  2. May start as buttock pn, can progress to post thigh & calf pn
  3. May be aggravated by walking, extended sitting, external rotation of hip
19
Q

What would you include in your exam of a pt with suspected piriformis syndrome?

A
  1. obs gait/posture
  2. hip AROM (esp. ER)
  3. hip MMT (esp ER)
  4. SLR
  5. Palpation
  6. FAIR test (piriformis test)
20
Q

What are common exam findings for PIRIFORMIS SYNDROME?

A
  1. may have antalgic gait, or stand w/
    inc ER in leg
  2. hip AROM (esp. ER): ER may = pn
  3. hip MMT (esp ER): pn and/or weak
    ER
    • SLR test
  5. Palpation: tenderness/trigger points in piriformis/lat hip
    • FAIR test (piriformis test)
21
Q

What is the FAIR test?

A

= Piriformis test

  • sidelying on unaffected side
  • affected hip flex 60 deg
  • Add + IR hip (while stabilizing pelvis)
    + test: reproduction of pain in buttock/leg
22
Q

What are the 3 classifications of Snapping Hip Syndrome?

A
  1. External
  2. Internal
  3. Intra-articular
23
Q

T or F: snapping hip syndrome is more common in females?

A

true

24
Q

Describe the 3 classifications of Snapping Hip Syndrome:

  1. External
  2. Internal
  3. Intra-articular
A
  1. External
    • tight lat hip (TFL/ITB) or glute max
      tendon over GT (ITB does not
      change length but can lose
      mobility)
  2. Internal
    • Iliopsoas tendon riding over ant
      acetabulum OR
    • iliofemoral lig riding over femoral
      head
    • Snapping common during hip
      flex ~45 deg)
  3. Intra-articular
    • Loose body in jt, assoc w/ labral
      tear or labral disruption
25
Q

What should you include in your exam for someone with suspected snapping hip syndrome but you don’t know which classification they fall into?

A
  1. Rule out intra-articular causes w/: FIRST, FADIR, and Thomas tests
  2. Snapping Hip Sign: pt abd + ext rot leg, then move from flex to ext
    + test: reproduction of
    snapping/pn usu around 45 deg
    hip flex
  3. Palpation: for snapping, point
    tenderness
26
Q

What two bones are stress fractures most common?

A
  1. Tibia
  2. Metatarsals
27
Q

7-10% of stress fxs occur in the femur. What part of the femur are stress fxs most common?

A

Neck

28
Q

What are the risk factors for femoral stress fractures, considering both extrinsic and intrinsic factors?

A

Extrinsic:
1. training/activity freq
2. duration of exercise
3. intensity of exercise
4. surface
5. footwear

Intrinsic:
1. poor mm endurance
2. dec mm mass
3. REDS (disordered eating, amenorrhea, and osteoporosis)

29
Q

Compare and contrast a tension side stress fracture and compression side (of femoral neck)

A

Tension side: superior aspect
- HIGHER risk for non-
union/displacement/AVN
- Usu treated operatively (ORIF), given
high rate of complication (30%) if
managed conservatively

Compression side: inferior aspect
- can be treated conservatively w/ activity mod & mm training

30
Q

Femoral stress fractures of the shaft most commonly occur in what region?

A

Medial proximal third

31
Q

Are femoral shaft stress fractures more commonly treated conservatively or surgically?

A

Conservatively

32
Q

How can you diagnose a stress fx with imaging?

A

Radiograph
Bone scan
MRI

33
Q

What are common exam findings for a pt with a stress fracture in the hip region?

A
  1. Localized pn: groin, thigh, or knee
  2. Insidious onset
  3. Pn that occurs at the end of a run
  4. Will progress to occur earlier and eventually impact daily amb
  5. Usu related to change in activity level
  6. Often difficult to illicit pn w/ palpation
    • Patellar-pubic percussion test
    • Fulcrum test
34
Q

What is the fulcrum test and what does it assess for?

A

Used to assess for possible prox 1/3 femoral stress fx

Pt’s femur levered over PTs forearm
+ test: reproduces pn

35
Q

What is the etiology of Femoroacetabular Impingement Syndrome (FAI)

A
  • Dysfunctional motor control –> contact btwn prox femur and acetabulum
  • Has components that are both intra & extra articular
36
Q

What are common exam findings for a pt with FAI syndrome?

A
  1. Ant/med groin pn
  2. Deep pn w/ click or “C” sign likely =
    intra-articular (labral)
  3. Pn w/ FADIR (SEN, not SPEC)
  4. Pn w/ flex, IR
  5. Limited IR
  6. Weakness in hip abd/ext, core, pelvic motor control, ecc hip flex
  7. Step down motor control deficits
  8. Dysfunction in squat (loss of
    neutral pelvic posture) - ant tilt
    often present
37
Q

What is the etiology of a sports hernia?

A
  • Primary cause = overuse
  • Condition = weakened post wall for inguinal canal
  • injury to ant fascia and mm of abdominal wall around insertion to ant pubis
  • Tear of rectus abdominus is present in 6-8% pts w/ sports hernia
  • Weakness of hip add compared to abd (add:abd strength ratio < 80% = prognostic)
38
Q

How does hip add and abd strength compare for individuals with sports hernias?

A

Hip add strength is weaker than abd

39
Q

T or F: diagnosis of a sports hernia is one of exclusion primarily

A

True

40
Q

What are 2 exam findings for a pt with a sports hernia?

A
  1. pn reproduction w/ resisted ab curl up
  2. tenderness to palpation at superior pubic ramus

MM I (9 decks)

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