Hip

Question 1

What is the criteria to classify a patient in the hip pain category, hip pain with mobility deficits?

What level of evidence was given to this criteria based classification in the Hip Pain mobility deficits osteoarthritis CPG?

Answer 1

-moderate anterior or lateral hip pain during weight bearing activity
-morning stiffness less than 1 hour in duration after wakening
-hip IR ROM less than 24 degrees or IR and hip flexion 15 degrees less than contralateral side
-hip pain associated with passive IR

‘A’ level evidence

Question 2

What are the best outcome measures to use when trying to assess pain levels as it relates to the hip?

Answer 2

WOMAC pain subscale
Brief Pain Inventory (BPI)
Pressure pain threshold (PPT)
pain visual analog scale (VAS)

Question 3

What are the best outcome measures to use when assessing activity limitations and participation restrictions for hip pain patients?

Answer 3

WOMAC physical function subscale
HOOS
LEFS
Harris Hip Score (HHS)

Question 4

What should be measured in patient with hip osteoarthritis to predict the risk of falls?

Answer 4

A level evidence supports the use of having balance as a measurement to predict fall risk by using the Berg scale, 4-square step test, and time SLS test to measure

Question 5

What is Patrick’s Test?

Answer 5

FABER test for the hip

Question 6

What level of evidence is given to patient education in the hip pain mobility deficits osteoarthritis CPG?

What should this education consist of?

Answer 6

B level evidence as long as it is paired with exercise and manual therapy

education should include teaching activity modification, exercise, supporting weight reduction when overweight, and methods of unloading arthritic joints

Question 7

Should Manual Therapy be considered for hip OA patients? Who or why not?

Answer 7

Yes, it can be thrust, non-thrust, or STM to improve mobility and ROM

As ROM improves use exercise to maintain new ROM

Question 8

Should exercise be considered for hip OA patients?

Should modalities? If so which one?

Should bracing be considered?

Answer 8

Yes, A level evidence supports this

Yes, ultrasound is given a B level evidence for hip OA (10 treatments over 2 weeks)

No, bracing should not be standalone or a first line of treatment, but can be used if exercise and manual therapy proves to have too little information

Question 9

How should clinicians determine return to play time line for patients who suffered a hamstring strain injury?

Answer 9

B level evidence supports using the patient’s history of hamstring injury as it is a risk factor for future re-injury as well as being cautious allowing return to play prior to completing a full progressive functional exercise program

clinicians should use hamstring strength, pain level at the time of injury, numbers of days from injury to pain free walking, and area of tenderness measured on initial eval to estimate time to Return to play

Question 10

What should clinicians make a diagnosis of hamstring strain injury?

Answer 10

-patient presents with a sudden onset of posterior thigh pain during activity
-pain reproduced when the hamstring is stretched and/or activated
-hamstring TTP
-loss of function as it relate to hamstring

Question 11

How should clinicians quantify hamstring strength?

How should they quantify hamstring mobility?

Answer 11

A level evidence supports using a dynamometer to assess HS strength and a hamstring length test at 90 degrees hip flexion to assess muscle mobility

Question 12

What specific exercise does the CPG for hamstring injuries mention should be included in injury prevention programming?

Answer 12

Nordic hamstring-A level evidence recommendation

Question 13

What type of muscle action, in combination with stretching, strengthening, and stabilization exercises is recommended for hamstring strain injuries to reduce return to play time line?

Answer 13

Eccentrics-B level evidence

Question 14

What is considered normal anteversion of the hip?

What is it at birth?

When does it fall into the “normal” range?

Answer 14

8-15 degrees

~40 degrees at birth

around age 16

Question 15

What degree measurement is required for a hip to be considered ‘anteverted’?

Retroverted?

How might a patient with each present?

Answer 15

Anteverted hip= greater than 15 degrees of anteversion (patient will have in toeing gait pattern and excessive IR)

Retroverted hip=less than 8 degrees of anteversion (patient will toe out and have excessive ER and limited IR)

Question 16

What test is used to measure torsion in the hip?

Answer 16

Craig’s test

Question 17

What mechanical cause is there for developmental dysplasia?

physiological cause?

Environmental?

Answer 17

mechanical=malposition in the womb

physiological= estrogen and relaxin in utero

Environment= cultural positioning of infants

Question 18

How will a patient with developmental dysplasia typically present in clinic?

Answer 18

-limited or asymmetrical abduction
-asymmetric thigh folds
-telescoping
-(+) galeazzi sign
-(+) ortolani sign

Question 19

What interventions are appropriate for developmental dysplasia?

Answer 19

double diaper or pavlik harness if patient is younger than 9 months

abduction orthosis or surgical intervention needed if over 9 months

Question 20

What is Septic Arthritis?

What are it’s clinical features?

What should treatment be?

Answer 20

an acute and rapidly progressing infection typically seen in patients under 2 years old due to pyrogenic bacteria

clinical features
-irritability
-hip held in open pack position
-fever, sweating, chills, and tachycardia
-loss of appetite

IV antibiotics and aspiration

Question 21

What is Legg-Calve-Perthes Disease?

How does it typically present?

What does treatment look like?

Answer 21

avascular necrosis of the femoral head

-hip/knee pain, especially at night
-ROM in abduction and ER decreased-flexion contractures are common
-Abnormal growth patterns-forearms and hands are short
-antalgic gait, mostly at night
-patient is often very active

treatment is to reduce hip irritability
-restore hip mobility
-regain spherical femoral head
-prevent ball from extruding or collapsing

Question 22

What is a Slipped Capital Femoral Epiphysis (SCFE)?

How does it typically present?

What does treatment consist of?

Answer 22

-a posterior and inferior displacement of femoral head which mostly affects girls (2:1) around age 10-16 and is 50/50 bilateral to unilateral

Clinical Features include
-gradual hip pain and limp
-medial sided knee pain
-hip extension and IR are limited
-passive flexion present with abduction/ER
-3 to 12 months before diagnosis do symptoms start

Question 23

What is the diagnostic cluster for hip OA?

Does this cluster help rule in or rule out OA?

Answer 23

-hip pain
-IR greater than 15deg
-pain with IR
-morning stiffness less than 60mins
-50 years old or older

Good for ruling out OA not in

Question 24

Is the FABER test more specific or sensitive for intra-articular hip pathology?

Answer 24

Sensitive (~88%)

Question 25

What exam findings would suggest a patient may have an acetabular tear?

Answer 25

(+) FABER AND FADIR
pain with resisted SLR

MRI best tool for diagnosis

Question 26

What subjective exam findings may suggest a patient has an iliopsoas bursitis?

What objective findings might you find?

Answer 26

-anterior hip pain that gets worse with hip extension
-overuse injury so history of heavy use may indicate
-patient may complaint of snapping in their hip

Objective
-pain with PROM into hip extension and resisted hip flexion
-TTP at bursa
-(+) snapping hip maneuver-feel for a click at inguinal line while passive flex/ext of the hip
-(+) supine heel raise

Question 27

What exam findings are typical for a femoral neck stress fracture?

Answer 27

-pain at the extreme ROM
-pain with FWB
-(+) hop test and heel tap
-(+) fulcrum test
-(+) FABER

x-rays may not see fracture for 3-4 weeks

Question 28

What subjective findings suggest a patient may have osteitis pubis?

What objective findings are typical?

Answer 28

reports of gradual onset of pain in pubic region which refers to the groin, medial thigh, and lower abdomen
-possibly has a history of bladder or prostate surgery
-also common to happen in endurance athletes

Objective
-TTP in pubis
-PROM hip adduction limited with pain
-Hip Adduction MMT weak due to pain

Question 29

how does Obturator Nerve entrapment present?

What objective findings are common with this condition?

Answer 29

presents as medial thigh pain with exercise and pain continues with exercise and subsides with rest

-paresthesia in medial thigh
-adduction weakness without pain
-pain reproduced with FWB on hip

Diagnosed with EMG