Hip Flashcards
Piriformis OINA
Origin: S2-4
Insertion: greater trochanter
Nerve: ventral rami S1-2
Action: hip ER, hip abd+flex.
Piriformis Syndrome: MOI & pathophysiology
-Compression of Sciatic N d/t piriformis either shortened or lengthened.
-Lengthened piriformis happens when glut max/med are weak, piriformis overworked.
-Shortened piriformis can be from overuse (runners, prolonged sitting) or secondary to other issue (e.g., LBP).
Piriformis Syndrome: key sxs
-Glute P! that may radiate to Sciatic distribution.
-Agg by active ER & passive IR.
Piriformis Syndrome: special tests & objective findings
(+) FADIR
(-) SLR usually
Weak/painful hip abd
Weak/painful hip ext
Piriformis Syndrome: treatment
-Stretching, STM.
-Strengthen glut max + med.
-Movement re-ed (address excessive IR + add).
GTPS: common pathologies included
-Glut med tendinopathy
-Glut min tendinopathy
-Trochanteric bursitis
-ITB issues
GTPS: pathophysiology & risk factors
Repeated flex/ext = friction of ITB over greater troch = microtrauma to tendons inserting on GT (gluts).
Risks:
-Knee OA
-ITB syndrome
-LBP, lumbar DDD or OA
GTPS: key sxs
P! over greater troch.
Aggs:
-Lying on affected side.
-Prolonged standing.
-Sitting cross-legged.
GTPS: special tests & objective findings
(+) FABER
(+) External Derotation
-P! with passive add.
-Weak/painful abd.
-Weak/painful IR.
-Weak/painful single leg stance.
-Trendelenburg.
GTPS: treatments
-Glute strengthening (isometrics good).
-Lumbopelvic stability.
External Derotation Test: procedure, purpose, (+)
GTPS.
Supine or long-sit.
Passive hip flex + ER.
Resisted IR.
(+) P!
ITB Syndrome: key sxs & special tests
-P! over lateral thigh & knee.
-P! with knee ext/flex.
-Snapping sensation over GT.
-TTP at lateral knee &/or GT.
(+) Noble Compression.
Noble Compression Test: procedure, purpose, (+)
ITB syndrome.
Sidelying w/ affected side up.
Passively flex & ext knee while palpating lateral knee for crepitus.
(+) = palpable crepitus or P! with pressure, usually ~30deg flex.
Athletic Pubalgia: pathophysiology & MOI/risks
-Muscle imbalances = lumbopelvic instability = abnormal motor control.
-Common in soccer.
-Repeated twisting, turning.
Athletic Pubalgia: key sxs
-P! in low abdomen or groin.
-Agg by valsalva, resisted situp, kicking, sprinting.
Athletic Pubalgia: special tests & objective findings
(+) Adductor Squeeze Test
-Limited ROM: abd, IR, ER.
-Weak/painful add.
-Weak/painful crunch or situp.
Adductor Squeeze Test: procedure, purpose, (+)
Athletic Pubalgia.
Squeeze legs together against resistance.
Repeat at 0, 45, and 90 hip flexion.
(+) = P! at groin, likely worst at 45 flex.
FAI types
- CAM: femoral neck bony overgrowth anteriorly.
- Pincer: acetabular rim bony overgrowth anteriorly & superiorly.
- Mixed: both at the same time.
Labrum tear MOI & risk factors
Risks:
-FAI
-Capsular laxity, hypermobility
-Developmental Hip Dysplasia
-Degeneration (OA)
MOI:
-Hip hyperabd traumatic injury
-Dislocation
-Repetitive ER or ext (golf, ballet, hockey, soccer).
Labrum tear special tests
-Scour
-FABER
-FADIR
-Squat
-Third
-Fitzgerald’s
-McCarthy
Labrum tear key sxs
-C Sign
-Anterior hip P!
-Groin P!
-Clicking, catching, locking.
-Aggs: descending stairs, prolonged sitting or standing, pivoting.
Labrum tear gait characteristics
-Prolonged foot flattening.
-Decreased knee flex (early stance).
-Excessive knee/hip ext.
-Excessive hip ER.
Labrum tear posture
Swayback:
-Hip & knee hyperext.
-Kyphosis.
-Posterior pelvic tilt.
Lower Crossed:
-Hip flex.
-Lordosis.
-Anterior pelvic tilt.
Labrum tear ROM & strength deficits
Limited ROM: all directions.
Painful ROM: end range flex & IR.
Weak: flex & add.
Scour Test: procedure, purpose, (+)
Labrum, OA.
90/90 position.
Axial load thru knee, passive ER/IR.
Repeat in slight hip add & slight abd.
(+) = pain, crepitus.
FABER Test: procedure, purpose, (+)
Labrum, FAI, OA.
(+) anterior P! = labrum.
(+) posterior P! = SIJ.
FADIR Test: procedure, purpose, (+)
Labrum, FAI, OA, Piriformis.
(+) P!
Squat Test: procedure, purpose, (+)
FAI.
(+) pain with squatting into max range.
Third Test: procedure, purpose, (+)
Labrum.
90/90 position, slightly adducted.
1. Axial load thru knee & passive IR.
2. Then distract & IR.
(+) = P! with compression, relief with distraction.
Fitzgerald’s Test: procedure, purpose, (+)
FABER > EADIR: anterior labrum tear.
FADIR > EABER: posterior labrum tear.
(+) P!
McCarthy Test: procedure, purpose, (+)
Labrum.
Supine, hip flexed to end range.
ER while moving back into ext.
Repeat with IR.
(+) P!, popping, catching.
Labrum tear treatments
Strengthen flex, ext, & abductors.
Avoid excessive hyperext.
Avoid excessive rotation (crossed-leg sitting, pivoting).
Avascular Necrosis key sxs & common presentation
-Age 30-50
-Male > Female
-Often bilateral
-P! in lateral/posterior hip
-Agg by activity
-ROM limited in capsular pattern (FABIR).
Hip OA key sxs & common presentation
-Age 50+
-Female > Male
-P! in anterior/medial hip
-Morning stiffness
-ROM limited (mostly IR).
Developmental Dysplasia: risk factors
Firstborn
Female
Family hx
Breech
Developmental Dysplasia: special tests
Barlow: posterior force applied thru femur while in 90/90 position & slightly adducting hip. (+) = hip dislocates out of socket.
Ortolani: abduct & apply upward force thru GT while in 90/90 position. (+) = clunk, indicates reduction.
Developmental Dysplasia: intervention
Pavlik Harness
Hip Spica Cast
Surgery if still displaced at age 2-3.
Legg-Calve-Perthes: definition
Femoral head necrosis.
Epiphysis sclerosis, then fragments, then re-ossifies.
Legg-Calve-Perthes: presentation
-Age 4-8
-Males > Females
-Leg length discrepancy
-P! with WB
Legg-Calve-Perthes: treatment
A-Frame Cast or orthosis.
Osteotomy.
Surgery if necessary to address leg length discrepancy.
Slipped Capital Femoral Epiphysis: definition
Epiphysis stays in place but femur has moved out of place.
May interrupt blood vessels (risk of AVN).
Slipped Capital Femoral Epiphysis: presentation & MOI
-Age 8-16
-Males > Females
-MOI may be traumatic/mechanical or hormonal/genetic.
-P! with WB
-ROM limited: abd & ER.
Slipped Capital Femoral Epiphysis: treatment
Pin to prevent further slip.
Correct alignment via surgery.
Hip Anterior Glide: procedure & promotes what?
ER & ext.
Prone, over edge of table, knee flexed, push downward.
Good for anterior impingement.
Hip Posterior Glide: procedure & promotes what?
IR & flex.
Supine, over edge of table, push downward.
Good for stretching posterior capsule, piriformis syndrome.
Hip Inferior Glide: procedure & promotes what?
Flex & rotation.
90/90 position, leg over your shoulder, pull inferiorly.
Hip Distraction: procedure & promotes what?
Flex & abd; pain relief.
Hip slight flex, knee ext.
Pull ankle.
Good for OA.
Hip Lateral Glide: procedure & promotes what?
Rotation, pain relief.
90/90 position, pull laterally.
