Hip Flashcards
T or F: a pathological hip joint may be asymptomatic
T: it may be a hip issue but they have pain somewhere else (knee, back)
arthrogenic inhibition
joints tell the muscles to stop working
(most common at knee, but at the hip you see glute weakness)
what does C sign signify?
hip joint pain
*associated with FAI and labral injury
what are a few special tests for hip joint pain?
FABER
FADIR
SLR
Scouring (hip quadrant)
when someone has hip joint pain, what will happen with SLR test?
they will have pain from about 0-30 degrees b/c that is where the most joint torque is created. then, it goes away as they get higher
what kind of strengthening helps stop arthrogenic inhibition
isometric
are muscle strains more common in one or two joint muscles
two because we put them on double the amount of stretch
3 causes of muscle strains (overall)
1 - ballistic movements
2 - eccentric contractions
3 - end range motion
what is the biggest risk factor for a hamstring injury? what are other risk factors
a prior hamstring injury
others: strength imbalance, insufficient warm-up, fatigue
your pt is a 22 y.o. male baseball player presenting with pain in the bak of the leg after lunging onto 1st base. he felt a pull and immediate pain. he has difficulty running, pain is a 5/10 and is TTP along the hamstrings. what does your pt have
hamstring strain
what is the best way to treat a hamstring strain?
don’t let it happen. strengthen them to prevent it (nordic exercise)
what are some populations hamstring tendinopathy is common in
- distance runners
- saggital plane activities (springting)
- change in direction (football, hockey)
- excessive stretching (dance)
Your pt is a 17 y.o. football player c/o pain in the back of the leg. He had no specific MOI. The pain improves once he gets through his warm-up, however, by the time he gets to the end of practice it increases again. He is TTP over the ischial tuberosity. Stretching his hamstring causes pain. What does the pt likely have? If you treat the pt and he is not improving what needs to be ruled out?
hamstring tendinopathy, avulsion needs to be ruled out if not improving
stage 1 muscle strain treatment
isometrics
stage 2 muscle strain treatment
isotonic hamstring load with minimal hip flexion
ex: bridges, prone hip extension, prone leg curls, nordic
3-4 sets every other day with isometrics in between
stage 3 muscle strain treatment
isotonic exercise with increased hip flexion
ex: hip thrusts, step-ups, walking lunges, dead lift
stage 4 muscle strain treatment
energy storage loading to prepare for return to sport
ex: bounding, split squats, a-skips, cutting, sprinter curls
what are 2 common places to get muscle contusions in the LE?
anterior thigh
iliac crest
what 2 interventions should you avoid for muscle contusions? why?
- aggressive stretching and manual therapy
- it can cause myositis ossificans
myositis ossificans
bone growth into the soft tissue
greater trochanteric bursitis encompasses what 3 disorders
1 - trochanteric bursitis
2 - snapping hip
3 - abductor tendinopathy
is greater trochanteric pain syndrome more common in men or women
women (due to pelvis shape and q angle)
what are 3 muscles are commonly weak in greater trochanteric pain syndrome
abductors, extensors, external rotators
Your pt is a 35 y.o. female with c/o R lateral hip pain. She has pain with sidebending, trendelenberg gait, and is TTP over the greater trochanter. You also note a 2cm leg length discrepancy. What does this pt likely have?
greater trochanteric pain syndrome
your pt with greater trochanteric pain syndrome c/o pain in her lateral hip when in the FADIR position. is this a positive test
no, it is only positive if it produces anterior joint pain
what are 4 differential diagnoses for greater trochanteric pain syndrome
1 - fracture
2 - hip joint pathology
3 - lumbar spine pathology
4 - lateral femoral cutaneous nerve
do corticosteroid injections, shock wave therapy, or home exercise help greater trochanteric pain syndrome more long-term?
home exercise
T or F: there was a significant difference in using dry needling vs. corticosteroid injections for greater trochanteric pain syndrome after 6 weeks
F
iliopsoas bursitis
- tendon snapping over ilipectineal eminence
- “snapping hip”
what are some causes of iliopsoas bursitis?
- growth spurt
- shortened hip flexor/weak glutes
- anterior pelvic tilt
- overuse flex/ER
what are some populations who commonly experience iliopsoas bursitis
- dances
- rowers
- resistance training
- runners
Your pt is a 21 y/o dancer experiencing pain in her anterior hip. She often hears a clicking sound. The pain bothers her most when she is dancing, specifically during kicks and splits. It improves with rest. She is TTP in the femoral triangle. What does she likely have?
iliopsoas bursitis
what is a differential diagnosis for iliopsoas bursitis
hip joint pathology
if you are treating a female who has a femoral neck stress fracture what condition should you consider?
female athlete triad
female athlete triad
eating disorder, amenorrhea, osteopenia
the femoral neck is a zone of weakness because it ha no overlying ____
trabeculae
Your pt is a 20 y.o. female who recently c/o anterior groin pain with no MOI. She is a new runner and recently increased her mileage. It hurts more when she is running and at night. On exam, you noted that IR and ER cause pain. What does this pt likely have?
femoral neck stress fracture
T or F: femoral neck stress fractures always show up on radiographs
F: they take at least 10-14 days to show up
treatment for femoral neck stress fractures depends on what 3 things
1 - radiograph
2 - location
3 - clinical presentation
if your pt with a femoral neck stress fracture has pain immediately upon standing what do they need to do
go on bed rest/offload
two types of femoral acetabular impingement
cam - femoral based
pincer - acetabular base
cam impingement is more common in _______ while pincer is more common in _______
males
females
where do people with FAI typically have pain? what motions are restricted/painful? what special test is typically positive
- groin pain
- flexion, IR
- positive FADIR
what are some typical physical impairments in people with FAI? (4)
- hip muscle weakness
- lower trunk strength
- poor single leg balance
- lower functional task performance
your pt had surgery for FAI where they went through the anterior capsule. what motions should you avoid
ER and extension
phase 1 treatment for FAI surgery 0-4/6 weeks
- normalize gait
- control edema
- restore ROM (within limits)
phase 2 treatment for FAI surgery 4-8 weeks or 6-12 weeks
-I w/ ADLs
-psoas re-ed (watch for tendinitis)
-continue glute activation, core stabilization
-consider advanced closed chain exercises
phase 3 treatment for FAI surgery
8-12 weeks or 12-20 weeks
-becoming recreationally asymptomatic
-continue building strength/endurance
-dynamic exercises, maybe plyometrics
10 rep triple for advancement/return to running
step downs, SL squats, hip abduction
T or F: you should change multiple training variables at once
F: one at a time
Your pt is a 40 y.o. female with c/o anterior groin pain for over a year. She has painful clicking and sometimes it feels like her hip “catches”. SLR, FADIR, and FABER are all painful. She also has a positive McCarthy sign. What does your pt likely have?
acetabular labral tear
T or F: snapping hip and FAI can set you up for a labral tear
T
T or F: complication rates are high with hip arthroscopies
F: only 0.5% have permanent complications
what are 3 possible complications of hip arthroscopy
1 - femoral artery/nerve
2 - lateral femoral cutaneous nerve
3 - sciatic nerve
T or F: hip arthroscopies have good return to sport rates
T
are hip fractures more common in females or males? active or sedentary? caucasion or african-american
females
sedentary
caucasian
where are intrascapular hip fractures? AKA: hip fractures?
femoral neck
subcapital
where are extracapsular hip fractures? AKA: femur fractures?
subtrochanteric
trochanteric
are intracapsular or extracapsular hip fractures more common
intracapsular
your pt is a 75 y.o. female with c/o hip pain after a fall. what should you automatically be worried about
hip fracture
consider blood loss
Your pt is a 82 y.o. male who has decreased LE strength and hip ROM grossly. His pain his worse in the mornings and with prolonged standing. He walks with an antalgic gait. What does he likely have?
osteoarthritis
T or F: in patients with OA you should focus on getting rid of their pain
F: you may never get rid of their pain… focus on function
