Hip Flashcards
Most common hip conditions in young and middle aged active adults are-
FAI, acetabular dysplasia and/or hip instability, and labral/chondral or ligamentous teres tears
what is a common and overlooked cause of hip pain
myofascial pain syndrome
Trigger points and complex motor and sensory abnormalities producing local and referred pain
extra articular hip pathologies
snapping hip
muscle injuries
stress fraction
IT band restriction
tendinopathies of rectus abdominus
osteitis pubis
what could be creating the snapping in the hip
External -> IT over greater trochanter
Internal -> iliopsoas over pelvic rim
Intra-articular -> symptom of other pathologies
Muscle injuries
intra articular hip injuries
Femoral acetabular impingement
Acetabular labral tear
Chondral injuries
Synovitis
Intra articular pathologies usually radiate to anterior and medial hip due to structures being innervated by femoral and obturator nerve (Frank et al, 2010)
what could a posterior hip pain could indicate
Proximal hamstring tendinopathies and obturator internus/gemelli, sacral stress fracture, piriformis syndrome, ischiofemoral impingement, sacral neuropathies
posterior hip pain referer from
lumbar and SIJ
which type of injury could be under recognized with posterior hip pain
femoroacetabular joint disease
what could lateral hip pain could indicate
Tendinosis of glute medius and minimus, thickening of IT band, trochanteric bursitis
labral tear may refer wear
lateral hip pain
what sould be rule out with anterior hip pain
OA primary consideration with older individuals with restrictions in hip flexion and internal rotation during examination
OA is associated with which hip restricted ROM
hip flexion and internal rotation
anterior hip pain is often associated with what with younger and older individual
younger: Labral tear
older: OA
which hip pathologie could be associated with anterior hip pain
FAI, iliopsoas impingement, internal snapping hip, stress fractures, capsular laxity
physical examination of hip pain contribue to how many % in determining differential diagnosis of hip
30%
history question of hip shown to be instrumental in determining how many % of differential diagnosis of the hip
56-90%
a patient aged 3-11yrs with hip pain could have which pathologies
legg-calves-perthes disease
a patient aged 12-15yrs with hip pain could have which pathologies
slipped femoral epiphysis
Hip is so close to reproductive areas and GI tract, therefore patients with _ symptoms should be screened _
systemic, infection and cancer
what are some alarming symptom when someone is presenting with hip pain
Alarming symptoms include fever, malaise, night sweats, weight loss, history of drug abuse, past or present diagnosis of cancer, or being immunocompromised
if I have pain in back, buttock, hip, thigh, leg and foot which region is affected
lumbar pathology pain
if I have pain in buttock. thigh, groin, back, knee which region the pain come from
SIJ pathology pain regions
if I have pain in groin buttock, thigh and knee which region could create the pain
hip pain pathology region
if you have lumbar pathology pain where do you might feel the pain
Back
Buttock
Hip
Thigh
Leg
Foot
if you have SIJ pathology pain where do you might feel the pain
buttock, thigh, groin, back, knee
if you have hip pathology pain where do you might feel the pain
groin, buttock, thigh, knee
if you have trigger point that refer to posterolateral and anterolateral hip which muscle are affected
Glute group (maximus, medius, minimus), piriformis, TFL and QL muscles
if you have trigger point that refer to tigh and anteromedial hip which muscle are affected
illiopsoas and proximal adductor
Hip Subjective Screening
- clicking, catching type of pain
- AM stiffness
- pain on loading the hip after rest, squat or stair
- history of W sitting or hip dysplasia
- hip injury activity
- sleep position
- footwear
if an athlete have
Dull or sharp groin pain
½ of pt have pain radiate to the lateral hip, anterior thigh and buttock
Usually insidious but could be after traumatic even
½ of patients have catching, or painful clicking with activity
hip labral tear
a patient with hip labra tear can present with which finding
Dull or sharp groin pain
½ of pt have pain radiate to the lateral hip, anterior thigh and buttock
Usually insidious but could be after traumatic even
½ of patients have catching, or painful clicking with activity
if a patient have iliopsoas bursitis what are some finding
Anterior hip pain when extending the hip from a flexed position
Can be associated with intermittent catching, snapping, or popping of the hip
if a patient have
Anterior hip pain when extending the hip from a flexed position
Can be associated with intermittent catching, snapping, or popping of the hip
iliopsoas bursitis
if a patient have stress Fx what are the finding
Trauma or repetitive weight bearing
Usually worse with activity
Pain in extreme ROM, active SLR, log roll test or hopping
a patient that had
Trauma or repetitive weight bearing
Usually worse with activity
Pain in extreme ROM, active SLR, log roll test or hopping
stress fx
if an athlete is young and physically active, have Insidious onset pain
Worse with sitting, rising from a seat, getting in or out of car, leaning forward
Location in groin primarily
FAI
if someone have FAI what could be the finding
Insidious onset
Worse with sitting, rising from a seat, getting in or out of car, leaning forward
Location in groin primarily
if someone have OA what could be the S/S
Limited motion
Gradual onset
Constant, deep, aching and stiffness
Worse with prolonged standing and weight bearing
Decrease ROM
Extreme ROM often cause pain
if you are old and have Limited motion
Gradual onset
Constant, deep, aching and stiffness
Worse with prolonged standing and weight bearing
Decrease ROM
Extreme ROM often cause pain
OA
what could indicate that an injury originated from the hip and not the spine
Presence of a limp, groin pain and decrease in internal rotation significantly predicted an injury originating from the hip and not spine (Reiman, 2014)
hoe munch ROM is required for gait on level surface, ascending/descending stairs, sitting in a chair, putting on socks
- 30-44 degrees of hip flexion
- 45-66 degrees of hip flexion
~112 degrees of hip flexion - 120 degrees of hip flexion, 20 abd, 20 ER
if someone have pain when putting sock which ROM could be limited
120º of hip flexion, 20º abd + ER
which test help to rule out facet joint pathology almost conclusively
seated extension and rotation test
can SLR help rule out discogenic/radiculopathy (SN 90-92)
only to a small degree
Athletes with joint changes may have complaints with a combination of
flexion, adduction and internal rotation
Pain in the deep groin area with flexion ,adduction + IR could indicate what and which movement could mimic those movement
intra articular pathology
Sitting into low chair, up stairs with involved leg, squatting etc. will mimic these movements
someone supine with external rotation with lateral of foot on table could indicate what
ant capsule laxity or hip retroversion
piriformes help with hip flexion past
60 degree internal rotation and abduction
Clinical Prediction Rule for Hip OA
- Limited active hip flexion with lateral hip pain
- Active hip extension causes pain
- Limited passive hip medial rotation (25deg or less)
- Squatting limited and painful
- Scour test with adduction causes lateral hip or groin pain
explain the patellar pubic percussion test
athlete supine with bilat leg relax. stethoscope is place on pubic tubercle on ipsilateral side of lower extremity being assed. tuning fork over patella
+ve if diminish percussion on one side
explain the stress fracture fulcrum test
athlete sitting on edge of table with bilateral feet off, clinician place one forearm under athlete’s thigh and applies downward pressure to proximal knee
FABER is testing what and how is it positive
Testing for: intraarticular hip joint pathology, SI joint, iliopsoas spasm
If the patient experiences posterior hip pain, the SI joint may be responsible. If groin pain occurs without loss of motion, the problem is most likely native to the hip (88% sensitivity in the athletic population for intra-articular pathology)
purpose of stinchfield test (resisted hip flexion test)
Designed to help distinguish between intra and extra articular hip pathologies
what is the log roll test and what does it test
patient supine, examiner passively rotates the femur medially and laterally to compare
Looks at hip mobility
Stresses capsule and femoral head in acetabulum
Positive: restriction or painful, click can indicate labral tear, and excessive lateral rotation may indicate a lax iliofemoral ligament
good test to rule out extra articular hip pathology
faber, hip scours, stinchfield
good test to rule in intra articular hip pathology
thomas test, patient clicking or locking in history
A recent systematic review and meta-analysis by Reiman et al. deemed 4 clinical tests to be both valid and reliable for the diagnosis of gluteal tendinopathy:
Trendelenburg sign
Resisted hip abduction
Resisted hip internal rotation
Hip external de-rotation tests
what is resisted hip de-rotation test
For gluteal tendinopathies
Hip flexed to 90 degrees and externally rotated
Pt to bring leg back to neutral against resistance
Positive: spontaneous reproduction of patients pain
Inequality in leg length is commonly associated with compensatory gait abnormalities and may lead to
degenerative arthritis in the lower extremity and L/S
which tissue is contracted with leg length discrepancies
hip and knee muscle contracture
T/F Average of two tape measurements appears to have acceptable validity and reliability when used as a screening tool for leg length discrepancy
T
how do you measure true leg length direct method
Set patients pelvis square- bridge up and down
Set legs 15-20cm apart and parallel to each other
Make sure the legs are comparable in amount of abduction/adduction they are in in relation to the pelvis
Measure leg length with tape measure from distal portion of ASIS to medial malleolus (or lateral)
Be aware of muscle wasting or hypertrophy
Slight difference between 1-1.5cm is considered normal
But can still cause symptoms
how measure functionnal leg length
umbilicus to medial malleolus
coxa vara angle and coxa valga angle
coxa vare decrease angle of femoral shaft and neck <105
coxa valga increased angle between femoral shaft and neck >135
what is an ante version and retroversion
Angle made by the femoral neck and femoral condyles
Degree of forward projection of the femoral neck from the coronal plane of the shaft
normal angle of anterversion and retroversion
8-15
anteversion or retroversion increase what
ant: risk for dislocation
retro: increased stability
excessive antervesion is associated with
Toeing in
Subtalar pronation
Lateral patellar subluxation
Medial tibial and femoral torsion
excessive retroversion is associated with
Excessive retroversion
Toeing out
Subtalar supination
Lateral tibial and femoral torsion
coxa valga is associated with
Pronated subtalar joint
Medial rotation of leg
Short ipsilateral leg
Anterior pelvic rotation
coxa vara is associated with
Supinated subtalar joint
Lateral rotation of leg
Long ipsilateral leg
Posterior pelvic tilt
Increased anteversion leads to
squinting patellae and toeing in
More common females
