Hip

Question 1

If pain with palpation more proximal to ischial tuberosity- what does this tell you about hamstring strain?

Answer 1

the closer to the ischial tuberosity- the longer the rehab period

Question 2

Presentation of SCFE

Answer 2

-14 YEAR OLD
-VAGUE left hip and groin PAIN that worsens with weight bearing.
– limited and painful hip INTERNALROTATION,
- ANTALGIC gait,
weak gluteus medius.

femoral head slips
-10-15 yrs males
-african American more often
-overweight
-insidious onset
–limping, pain that is poorly localized
-inability to WB
-surgical- OIRF

Question 3

what are the best xray views for SCFE?

Answer 3

-AP,
-frog leg,
-true lateral radiographs are the ideal images for diagnosing a suspected SCFE. 

Question 4

What is cross table lateral xray view best for?

Answer 4

OA, osteophytes, cysts and fractures, and AVN.

Question 5

How should all SCFE;s be managed?

Answer 5

Stable or unstable
ALL SCFE’s should be treated with with screw fixation in situ using a single cannulated screw.

Question 6

Risk factors for SCFE

Answer 6

obesity #1
femoral or acetabular RETROVERSION

Question 7

What is a risk factor for Adductor strain?

Answer 7

-adductor strength was less than 80% of his abductor strength.
In a study of ice hockey players, a player was 17 times more likely to sustain an adductor muscle strain if his

Question 8

Hamstring strains

Answer 8

injuries involving an intramuscular tendon or aponeurosis and adjacent muscle fibers (biceps femoris during high-speed running) typically require a shorter convalescent period than those involving a proximal, free tendon (semimembranosus during dance and kicking). This finding is consistent with the observation that injuries involving the free tendon require a longer rehabilitation period than those within the muscle tissues

Question 9

The femoral triangle is bounded by

Answer 9

(superiorly) the inguinal ligament, (medially) the medial border of adductor longus, (laterally) the medial border of sartorius. Its floor is formed (med to lat) by adductor longus, pectineus, and illiopsoas.

Question 10

Sports Hernia/athletic pubalgia Presentation:

Answer 10

Symptoms are insidious, progressive, and tend to be unilateral; however, in approximately 40% of the population, symptoms will progress from unilateral to bilateral.
it is thought that the shearing forces caused by rapid cutting and twisting contributes to the development of a sports hernia.

Question 11

Describe Legg-Calves-Perthes

Answer 11

AVN of proximal fem head
-4-10 yrs
-insidious onset
-intermittent limp, trendelenberg
–limited ROM- esp IR and and ABD, pain in anterior thigh, can present at medial knee
-pain worse with activity
-shorter in stature
-treatment conservative

Question 12

Describe Hip Transient Synovitis

Answer 12

in children
-pain ,
-refusal to bear weight
-may present with hip in ABD, ER and flexed for more comfort
-may have fever

Question 13

What is the most common hip labral tear?

Answer 13

Anterior and anterior-superior tears are the most common type of labral tear due to the higher overall forces experienced by this part of the labrum. The femoral head has the least amount of bony restraint anteriorly.

Question 14

Hip Labral Tear symptoms:

Answer 14

Pain in the hip or groin, often made worse by long periods of standing, sitting or walking or athletic activity
A locking, clicking or catching sensation in the hip joint
Stiffness or limited range of motion in the hip joint

Question 15

4 types of hip labral tears

Answer 15

Martin et al., (2006)  Download Martin et al., (2006) the most common types of acetabular labral tears include the following:
1) radial flap;
2) radial fibrillated;
3) longitudinal peripheral; and
4) abnormally mobile.

Question 16

Describe Meralgia Paresthetica

Answer 16

-anterior (sometimes anterior and lateral) thigh pain,
-caused by entrapment of the lateral femoral cutaneous nerve as it passes under the inguinal ligament and supplies the sensory distribution of the anterior/lateral thigh.
- burning pain, N/T, decreased sensation, need to do sensory exam

Question 17

The most commonly sited mechanism of injury to the labrum of the hip is

Answer 17

rotation in a weight-bearing position

Question 18

A hip pointer is

Answer 18

a contusion of the iliac crest and/or the greater trochanteric region of the femur following a direct impact or collision or potentionally the abdominal wall

Question 19

of hip pointer can be abdominal wall or iliac crest

Answer 19

Question 20

Risks for HS injury (needs more research)

Answer 20

-lack or asymmetry of eccentric and angle of peak strength and
-decr lumbopelvic stability may contribute
Importance of lumbopelvic stab: the iliopsoas muscle force
directly induces an increase in anterior pelvic tilt during early swing phase, necessitating, in turn, greater hamstring
stretch of the contralateral limb, which
is simultaneously in late swing phase.

Question 21

HS strain prevention:

Answer 21

NM control exercises incorporated to help prevent injury:

Examples of such movements include high knee marching, quick-support running drills, forward-falling running drills, and explosive starts, with a focus on postural control and power development.

varying trunk movements during running (eg, upright posture, forward flexed, and forward flexed and rotated

Question 22

In what time fram are you most likely to reinjure after a hamstring strain?

Answer 22

Within first 2 weeks

Question 23

What 3 factors cause a longer to RTS time frame after Hamstring strain?

Answer 23

(1) injury involving a proximal free tendon
(2) proximity of the injury to the ischial tuberosity
(3)increased length and cross-sectional area of injury

the more proximal the site of maximum pain, the greater the time needed to return to preinjury level

Question 24

Discuss Phase 1 Hamstring Strain rehab

Answer 24

Phase 1 protect: ice 2-3 times a day,
shorter strides in gait and AC;s prn,
avoid prolonged active KF
Ex: iso lumbopelvic ex, single leg balance, short stride lateral steps (ie grapevine)- avoid isolated resistance of HS mm
Progression criteria: normal gait (2) low-speed jogging without
pain, and (3) pain-free isometric contrac-
tion against submaximal (50%-70%) re-
sistance during prone knee flexion (90°)
manual strength test.

Question 25

Explain Phase 2 Hamstring strain rehab

Answer 25

Phase 1 protect: ice 2-3 times a day,
shorter strides in gait and AC;s prn,
avoid prolonged active KF
Ex: iso lumbopelvic ex, single leg balance, short stride lateral steps (ie grapevine)- avoid isolated resistance of HS mm
Progression criteria: normal gait (2) low-speed jogging without
pain, and (3) pain-free isometric contrac-
tion against submaximal (50%-70%) re-
sistance during prone knee flexion (90°)
manual strength test.

Question 26

Explain Phase 3 Hamstring strain rehab

Answer 26

Phase 3: Avoid sprinting and explosive acceleration until next criteria met
Ice prn
Exercises: Add transverse planes and asymmetric postures
w
Single bridge on bench leg 45 dgr bend
Single leg stance overhead press
“windmill” RDL with 2 DB mid range progressing to DB to floor
Agility , sport specific drills w changes of direction, acceleration etc

Question 27

Return to sport criteria after HS strain

Answer 27

Criteria to return to sport: (needs more research but: )
Normal ROM, strength: 4 reps max effort MMT in prone 90 and 15 deg positions if can test w/ isokinetic machine: no less than 5% of opp LE
Max speed and max effort agility all without pain

Question 28

Risk for HS injury

Answer 28

needs more research but lack or asymmetry of eccentric and angle of peak strength and decr lumbopelvic stability may contribute
Importance of lumbopelvic stab: the iliopsoas muscle force
directly induces an increase in anterior pelvic tilt during early swing phase, necessitating, in turn, greater hamstring
stretch of the contralateral limb, which
is simultaneously in late swing phase.

Question 29

Suggested modifiable risk factors for HS injury

Answer 29

hamstring weakness,
fatigue,
lack of flexibility,
with a strength imbalance between the hamstrings (eccentric) and quadriceps(concentric) being most supported by
evidence.
additionly, limited quadriceps flexibility and strength and coordination deficits of the pelvic and trunk
muscles

Question 30

What is used for HS strain imaging?

Answer 30

US and MRI if initial or superficial- for subsequent injuries or deep mm need MRI
the length and cross-sectional area

Question 31

Signs and Sx’s of Athletica Pubalgia

Answer 31

-pain with coughing
-radiation of pain into the groin, thigh, and testicular regions secondary to entrapment of the ilioinguinal, iliohypogastric, and
genitofemoral nerves.
-Deep anterior and lateral pain with
prolonged sitting, flexion, abduction, and torsional activities can be secondary to intra-articular hip pathology.
-Intra-articular hip
and pubalgia symptoms may coexist.

Question 32

Athletica Pubalgia Examination includes

Answer 32

Palpate: add longus, pectineus, gracilis, pubic symph, ramus and tubercle, obliques, trv abd and tendon of rectus abd
-Hip joint evaluation
-resisted adduction in flexion and extension can be performed to elicit discomfort
-A resisted sit-up or crunch with palpation
of the inferolateral edge of the distal rectus abdominus may re-create symptoms
Palpate:
The pubic tubercle and pubic symphysis
are painful in up to 22% of patients.

Question 33

athletes with athletica Pubalgia typically have weakness in which mm groups?

Answer 33

deficits greater than 20% for ADDUCTOR
ABDOMINALS
have been frequently documented in athletes with
adductor- and pubic-related pain

Question 34

Which CA’s metastasize to hip/groin?

Answer 34

Breast CA, Prostate and reproductive organ CA

Question 36

Signs of Developmental Hip Dysplasia

Answer 36

a distinct waddling gait, one hip lower than the other, a limp, and walking on tipto

Question 37

Possible cause of athletica pubalgia

Answer 37

shearing forces caused by rapid cutting and twisting contributes to the development of a sports hernia.

presence of a cam deformity

Question 38

Describe presentation of femoral anteversion

Answer 38

Patient may present with compensatory:
-lateral tibial rotation,
-lateral rotation at the knee
-lumbar rotation to the same side
Femoral anteversion is defined as a femoral neck axis that is excessively anterior to the condylar axis.
> 15 degrees = abnormal and indicates increased anteversion.

Question 39

A femoral fracture across epiphysis has highest incidence of

Answer 39

AVN

Question 40

Hip Dislocation

Answer 40

Cause: Traumatic force along femur usually with knee bent, mostly with posterior dislocation
Exam: Appearance of thigh and palpation. The thigh will appear in internal rotation, flexion, and adduction.
Palpation is tender, possible swelling, and may feel the femur posterior to acetabulum.
Treatment: Immediate medical attention for reduction, immobilization, and use of assistive device
Can lead to AVN

Question 41

Signs of SCFE

Answer 41

Groin pain,
limitations in abd, flexion and IR,
walk with limp
Sometimes see ER of foot or appearance of shorter limb

Question 42

What strength ratio of adductors/abductors is a predictor of future groin strains?

Answer 42

80%