Hip Flashcards
If pain with palpation more proximal to ischial tuberosity- what does this tell you about hamstring strain?
the closer to the ischial tuberosity- the longer the rehab period
Presentation of SCFE
-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
what are the best xray views for SCFE?
-AP,
-frog leg,
-true lateral radiographs are the ideal images for diagnosing a suspected SCFE.
What is cross table lateral xray view best for?
OA, osteophytes, cysts and fractures, and AVN.
How should all SCFE;s be managed?
Stable or unstable
ALL SCFE’s should be treated with with screw fixation in situ using a single cannulated screw.
Risk factors for SCFE
obesity #1
femoral or acetabular RETROVERSION
What is a risk factor for Adductor strain?
-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
Hamstring strains
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
The femoral triangle is bounded by
(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.
Sports Hernia/athletic pubalgia Presentation:
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.
Describe Legg-Calves-Perthes
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
Describe Hip Transient Synovitis
in children
-pain ,
-refusal to bear weight
-may present with hip in ABD, ER and flexed for more comfort
-may have fever
What is the most common hip labral tear?
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.
Hip Labral Tear symptoms:
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
4 types of hip labral tears
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.
Describe Meralgia Paresthetica
-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
The most commonly sited mechanism of injury to the labrum of the hip is
rotation in a weight-bearing position
A hip pointer is
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
of hip pointer can be abdominal wall or iliac crest
Risks for HS injury (needs more research)
-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.
HS strain prevention:
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
In what time fram are you most likely to reinjure after a hamstring strain?
Within first 2 weeks
What 3 factors cause a longer to RTS time frame after Hamstring strain?
(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
Discuss Phase 1 Hamstring Strain rehab
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.
Explain Phase 2 Hamstring strain rehab
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.
Explain Phase 3 Hamstring strain rehab
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
Return to sport criteria after HS strain
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
Risk for HS injury
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.
Suggested modifiable risk factors for HS injury
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
What is used for HS strain imaging?
US and MRI if initial or superficial- for subsequent injuries or deep mm need MRI
the length and cross-sectional area
Signs and Sx’s of Athletica Pubalgia
-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.
Athletica Pubalgia Examination includes
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.
athletes with athletica Pubalgia typically have weakness in which mm groups?
deficits greater than 20% for ADDUCTOR
ABDOMINALS
have been frequently documented in athletes with
adductor- and pubic-related pain
Which CA’s metastasize to hip/groin?
Breast CA, Prostate and reproductive organ CA
Signs of Developmental Hip Dysplasia
a distinct waddling gait, one hip lower than the other, a limp, and walking on tipto
Possible cause of athletica pubalgia
shearing forces caused by rapid cutting and twisting contributes to the development of a sports hernia.
presence of a cam deformity
Describe presentation of femoral anteversion
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.
A femoral fracture across epiphysis has highest incidence of
AVN
Hip Dislocation
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
Signs of SCFE
Groin pain,
limitations in abd, flexion and IR,
walk with limp
Sometimes see ER of foot or appearance of shorter limb
What strength ratio of adductors/abductors is a predictor of future groin strains?
80%
