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Hip Flashcards

1
Q

4 areas that refer pain to the hip

A

Lumbar spine
SI joint
Knee
Foot and ankle

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2
Q

What is the most common area to refer pain to the hip?

A

Lumbar spine

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3
Q

Identify 5 areas the hip refers pain to

A
  • Knee
  • Thigh
  • Can refer to lumbar
  • SI
  • Foot, ankle UNCOMMONLY
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4
Q

For MSK issues at the knee, MUST LOOK AT ________.

A

Hip

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5
Q

What diagnosis is the following question targeting? “Have you ever had a medical practitioner tell you that you have a problem with the blood circulation in your hips?”

A

Avascular necrosis (AVN)

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6
Q

5 colon cancer red flags

A
  • Age >50 years
  • Bowel disturbances
  • Unexplained weight loss
  • History of colon cancer in immediate family
  • Pain unchanged by positions or movement
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7
Q

4 red flags for pathological fracture of the femoral neck

A
  • Older women (>70) with hip, groin, or thigh pain
  • Hx of fall from standing position
  • Severe, constant pain worse with movement
  • A shortened and externally rotated LE
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8
Q

Identify 5 red flags for BSI - femoral neck stress fracture

A
  • Younger age
  • Hormonal changes
  • Nutritional changes
  • High volume of training relative to recovery
  • Pain with WBing worsening with time
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9
Q

If a BSI is confirmed, what is required?

A

Requires differential diagnostic imaging followed by NWB order.

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10
Q

Identify 3 red flags for osteonecrosis of the femoral head

A

Hx of long term corticosteroid use
Hx of avascular necrosis of contralateral hip
Trauma

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11
Q

What Functional assessment is most often used after a THA?

A

Harris hip rating

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12
Q

What functional assessment is used to assess hip and groin disability in young patients?

A

Copenhagen Hip and Groin Outcome Score

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13
Q

The “C” sign is a strong predictor of what type of pathology?

A

Intraarticular

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14
Q

Hip flexion clinical norm

A

120 degrees

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15
Q

Hip extension clinical norm

A

15-30 degrees

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16
Q

Hip abduction clinical norm

A

45 degrees

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17
Q

Hip adduction clinical norm

A

20-30 degrees

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18
Q

Hip internal rotation clinical norm

A

30-45 degrees

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19
Q

Hip external rotation clinical norm

A

45-60 degrees

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20
Q

Test for piriformis syndrome

A

FAIR test

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21
Q

Test for stress fracture of femoral shaft

A

Fulcrum test

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22
Q

Test used if suspicion of occult hip fracture

A

Auscultatory patellar-pubic percussion test

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23
Q

What test is used to assess for intraarticular pathology at the hip?

A

Quadrant (Scour) test

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24
Q

Test for ligamentous laxity

A

Log roll test

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25
Q

Test to help differentiate between hip, back, and SI pain

A

Resisted SLR

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26
Q

Test for posterior labral tear

A

Fitzgerald test - posterior

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27
Q

Test for anterior labral tear

A

Fitzgerald test - anterior

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28
Q

Screening test for early hip dysplasia

A

Flexion-adduction test

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29
Q

Test to assess femoral anteversion/retroversion

A

Craig test

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30
Q

Test to assess closed chain muscle function

A

Lateral step down

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31
Q

Hip OA cluster 2

A

Hip pain, Hip internal rotation ROM <15 degrees, Pain with IR, Morning stiffness <60 minutes, Age >50

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32
Q

Hip OA cluster one

A

Hip pain
Hip IR <15 deg
Hip flexion ROM <115 deg

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33
Q

Differential diagnosis clues - possible causes: Dull, deep, aching

A

Arthritis
Paget’s disease

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34
Q

Differential diagnosis clues - possible causes: Sharp, intense, sudden, associated with weight bearing

A

Fracture

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35
Q

Differential diagnosis clues - possible causes: Tingling that radiates

A

Radiculopathy
Spinal stenosis
Meralgia Paresthetica

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36
Q

Differential diagnosis clues - possible causes: Increased pain while sitting with affected leg crossed

A

Trochanteric bursitis

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37
Q

Differential diagnosis clues - possible causes: Pain at sitting, legs not crossed

A

Ischiogluteal bursitis

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38
Q

Differential diagnosis clues - possible causes: Pain after standing, walking

A

Hip arthrosis (OA)

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39
Q

Differential diagnosis clues - possible causes: Pain on attempted weight bearing

A

Occult fracture
Severe arthrosis

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40
Q

Differential diagnosis clues - possible causes: Unremitting, long duration

A

Paget’s disease
Metastatic carcinoma
Severe arthrosis (occasionally)

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41
Q

T/F Hip OA is one of the most common causes of pain in older adults.

A

True

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42
Q

S/S of hip OA (3)

A

Morning stiffness <60 min
Insidious onset of pain
Decreased ROM

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43
Q

What muscle group is particularly prone to weakness with hip OA?

A

Hip abductors

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44
Q

Identify 3 predictors for hip OA

A

Obesity
Previous injury to hip and/or knee Occupational risks
Women > Men

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45
Q

CPR for Hip OA (5)

A

Pain aggravated with squatting
Lateral or anterior hip pain with scour tests Active hip flexion causing lateral pain
Pain with active hip extension
Passive range of hip IR <25 deg

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46
Q

No restriction of mobility has an Sn of ____ to rule out hip OA.

A

1.0

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47
Q

Acetabular labral tears are a COMMON/UNCOMMON cause for hip/groin pain.

A

Common

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48
Q

S/Sx of acetabular labral tears (4)

A

Pain
Clicking, catching, locking
Painful PROM
Confirmed with MRI

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49
Q

Management of Acetabular labral tears (4)

A

Rest
Protection
NSAIDS
Surgical -> arthroscopic resection repair

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50
Q

MOST acetabular labrum tears are _____________ or ______________.

A

Anterior or anterosuperior

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51
Q

Etiology of acetabular labrum tears (2)

A

Trauma
Degenerative (dysplastic or idiopathic)

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52
Q

Most common type of acetabular labrum tear

A

Radial flap

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53
Q

Clinical presentation of acetabular labrum tears (6)

A

Pain deep in groin - “C” sign
Hip instability
Buckling, catching, twinges, clicking, locking Worse with weight bearing or twisting
Pain may occur w/ climbing stairs
Pain may occur getting in/out of car

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54
Q

Conservative interventions for acetabular labrum tears (4)

A

Rest
Work on impairments
NSAIDS
Modify functional activities

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55
Q

Surgical management of acetabular labrum tears (2)

A

Arthroscopy
Debridement of labrum

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56
Q

This special test has been found to correspond to dynamic impingement and labral lesions.

A

FADIR

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57
Q

This special test is designed to provoke FAI at posterior aspect of the acetabulum.

A

Posterior impingement test

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58
Q

If angle of the greater trochanter is >8-15 degrees into IR, the femur is considered to be in __________.

A

Anteversion

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59
Q

If a patient can tolerate FAIR, flex-add axial compression, flex-IR test, impingement test, Fitzgerald what can be ruled out?

A

Labral tear

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60
Q

Identify: Abnormal contact between the femoral head and acetabular rim.

A

FAI

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61
Q

Identify three types of FAI:

A

CAM
Pincer
Mixed (most common)

62
Q

What type of FAI is pictured?

63
Q

What type of FAI is pictured?

64
Q

What type of FAI is pictured?

65
Q

What type of FAI is most common?

66
Q

Provocative test for a CAM impingement

67
Q

Provocative test for Pincer impingement

A

Hip extension, ER

68
Q

FAI type: Bony overgrowth of the femoral neck

69
Q

FAI type: Bony abnormality of the acetabulum due to increased size of the acetabular rim.

70
Q

Based on the following clinical presentation, identify the likely pathology: “C” sign pain, Pain, aching, or sharp anterior hip/groin or lateral hip region, Pain with walking, pivoting and recreational exercise, Mechanical symptoms such as popping, locking, or snapping of hip, Loss of certain ranges of motion, Pain with squatting often accompanies, Patients will hold hip in resting position.

71
Q

Functional assessment cluster for FAI:

A

Squat vs low squat
SLS/LSD
Bridge + SLR
Hopping (DL, SL)

72
Q

For FAI would FADIR or FABER rule in?

73
Q

What might you expect with MMT of a patient with FAI?

A

Hip flexor weakness
Gluteal muscle fatigue

74
Q

What is the goal of Warwick’s Agreement?

A

To reach an international and multidisciplinary agreement on the diagnosis and treatment of FAI syndrome.

75
Q

What test is generally VERY provocative with FAI?

A

Scours (if high SINS, not a good idea)

76
Q

Often FAI is accompanied by _________.

A

Labral tears

77
Q

Gluteus medius weakness is associated with ____.

78
Q

With a gluteus medius tear, what should be avoided INITIALLY? Why?

A

Hip abduction strengthening as it provokes tendinopathy.

79
Q

What type of contraction will commonly tear the adductors?

A

Eccentric (slipping with foot planted)

80
Q

How might a concentric strain of the adductors occur?

A

Forceful contraction in a fully elongated position

81
Q

Two risk factors for an adductor tear:

A
  • Imbalance between strength and flexibility
  • Imbalance between ABD and ADD strength
82
Q

Two signs of an adductor strain:

A

Twinging or stabbing pain in groin, Pain with passive ABD (stretch on injured tissue)

83
Q

Body position for an eccentric strain of the rectus femoris:

A

Hip extension
Knee flexion

84
Q

Mechanism for concentric rectus femoris strain:

A

Forceful or repetitive hip flexion

85
Q

Two signs of a rectus femoris strain:

A

C/O local pain and tenderness in anterior thigh
Pain with resisted knee extension and passive stretching

86
Q

Mechanism for eccentric strain of the Iliopsoas

A

Forced hip extension (foot planted, pelvis hit from behind)

87
Q

Mechanism for concentric strain of the Iliopsoas:

A

Forceful, repetitive hip flexion

88
Q

5 treatment options for piriformis syndrome:

A
  • Hip - joint mobilization
  • ROM, stretching
  • PRE
  • Neurodynamics
  • Single leg progression (SLS, step ups, carries, frontal plane hip abduction off step, lateral taps)
89
Q

With the leg extended, the piriformis is mainly a hip _________. With the leg flexed, the piriformis is a hip ___________.

A

External rotator; abductor

90
Q

Two recommended tests for discerning piriformis syndrome:

A

FAIR, Freiberg

91
Q

What is the most commonly strained muscle(s) of the hip?

92
Q

Special test for hamstring strains with a Sn of 1.0 and a Sp of 1.0.

A

Taking off the shoe

93
Q

Which adductors are commonly involved in an adductor strain?

A

Adductor longus, Gracilis

94
Q

Timeline for phase 1 of hamstring strain rehab

95
Q

Two goals for phase 1 of hamstring strain rehab

A

Protection and healing
Minimize swelling, edema and pain

96
Q

4 areas to focus on during phase 1 of hamstring strain rehabilitation:

A

Isometrics
Single limb stance
IASTM
AROM PRE (avoiding eccentrics)

97
Q

What is the criteria to advance from phase 1 to phase 2 of hamstring strain rehabilitation?

A

Hip flexion >70 degrees with 90 degrees of knee flexion - pain free
Walking program, progressing to walk - glide

98
Q

Timeline for phase 2 of hamstring strain rehabilitation

99
Q

What is the goal of phase 2 of hamstring strain rehabilitation

A

Normalization of gait, mobility

100
Q

2 areas to focus on during phase 2 of hamstring strain rehabilitation

A
  • Lumbopelvic static and dynamic stability
  • Initiation of bridging (isometric -> concentric)
101
Q

4 criteria to advance from phase 2 hamstring strain rehabilitation to phase 3

A

Normalization of gait, <20% different involved to uninvolved - hamstring mobility, >50% isometric hamstring strength - involved to uninvolved
Tolerance to conservative jog/run (fwd/bwd)

102
Q

Timeline for phase 3 of hamstring strain rehabilitation

A

8-12 weeks

103
Q

What is the goal of phase 3 of hamstring strain rehabilitation?

A

Eccentric tolerance, sport specific training

104
Q

If there’s no MOI, piriformis strain is LIKELY/UNLIKELY.

A

Unlikely. Likely something else. Usually traumatic event associated with piriformis strain.

105
Q

2 areas to focus on during phase 3 hamstring strain rehabilitation

A

Isolated hamstring strengthening, Sport-specific drills

106
Q

What is the timeline for phase 3 of hamstring strain rehabilitation?

A

8-12 weeks

107
Q

What is the goal of phase 3 of hamstring strain rehabilitation?

A

Eccentric tolerance and sport specific training

108
Q

What are the two areas to focus on during phase 3 hamstring strain rehabilitation?

A
  • Isolated hamstring strengthening in lengthened state (eccentrics)
  • Trunk stability - dynamic
109
Q

What are the criteria to advance from phase 3 hamstring strain rehabilitation?

A

No insecurity with H test, no palpable tenderness, 5/5 MMT at 15 degrees knee flexion, active knee extension <10 degrees with hip at 90 degrees, <10% difference - hopping, S/L bridge…

110
Q

What is the timeline of phase 4 hamstring strain rehabilitation?

A

4-6 months

111
Q

What is the goal of phase 4 hamstring strain rehabilitation?

A

Return to sport and prevention!

112
Q

What are the four areas to focus on during phase 4 of hamstring strain rehabilitation?

A

Jumping and landing tasks, running, sprinting, agility

113
Q

What are the three criteria to advance phase 4 of hamstring strain rehabilitation?

A

Advancement is return to play, complete all activities without S/Sx without hesitation, H-test!

114
Q

When returning to sport, what is the timeline for the highest risk of reinjury?

A

First 2 weeks

115
Q

What are the four modifiable risk factors for soft tissue strains?

A

Muscle weakness
Fatigue
Lack of flexibility
Poor coordination

116
Q

What are two immediate interventions for contractile problems (12-18 hours)?

A

Minimize bleeding (RICE or PRICE) and compression as able

117
Q

What are five interventions after 24 hours of a contractile problem?

A

Anti-inflammatory modalities
Heat/ice
Massage
Stretching
Modifying activities

118
Q

Once you have full, pain-free PROM after a contractile problem, what are three interventions to use?

A

Sub-maximal isometrics -> progress to resistive exercises
Progress to full isometrics
Work towards sport/work specific tasks

119
Q

What are three common areas for tendinopathy?

A

Proximal hamstrings
Rectus femoris
Adductors

120
Q

Reactive tendinopathy results from?

A

Acute overload

121
Q

How does a reactive tendinopathy present and in what demographic is it common?

A

Swollen, may be painful to the touch. Common in younger patients.

122
Q

Tendon disrepair results from?

A

Matrix breakdown

123
Q

What is the presentation of tendon disrepair?

A

Tendons may appear thick. Stiffness predominates.

124
Q

Degenerative tendinopathy results from?

A

Cell death and matrix disorganization

125
Q

How does a degenerative tendinopathy present?

A

Focal nodular areas, general thickening, repeated bouts of tendon pain

126
Q

What are two types of intervention for tendinopathy?

A

Eccentrics and heavy slow resistance

127
Q

What are three things tendons do?

A

Energy storage/release
Compression
Friction

128
Q

Energy storage occurs at this part of the tendon:

A

Mid-tendon

129
Q

Compression occurs at which part of the tendon?

130
Q

Friction occurs at what part of the tendon?

A

Peritendon

131
Q

For tendinopathy, should volume or intensity be prioritized?

132
Q

True or False: Stretching is an important part of tendinopathy intervention.

A

False! Should be avoided

133
Q

What are the descriptive stages for tendinopathy rehab plan?

A

Load, move, bounce, hop and bound

134
Q

How does bursitis present?

A

Pain with passive movement

135
Q

When considering Iliopectineal bursitis, what are two differential diagnoses to consider?

A
  • OA (Pain with PROM and AROM)
  • Iliopsoas tear (pain with resisted hip flexion)
136
Q

What is the 2nd most common cause of lateral hip pain?

A

Trochanteric bursa (GTPS)

137
Q

What is the general idea with bursitis intervention?

A

Non-mechanical interventions: Rest, ice, NSAIDs, anti-inflammatory modalities, injection, gentle stretching, strengthening of weak muscles

138
Q

Identify the borders of the femoral triangle.

A

Inguinal ligament
Sartorius
Adductor longus

139
Q

What are three tests when a proximal femur fracture is suspected?

A

Heel strike test
Fulcrum test
Patellar pubic percussion

140
Q

What are two signs/symptoms of loose bodies in the LE?

A

Sudden onset of pain with weight bearing, decreased ROM

141
Q

What are two management strategies for loose bodies?

A

Manipulation and surgical excision

142
Q

AVN of the femoral head is more common in which gender?

143
Q

The hip most often dislocates in which direction?

A

Posteriorly

144
Q

What is the most common cause of meralgia paresthetica?

A

Entrapment at the level of the inguinal ligament.

145
Q

What nerve is affected in meralgia paresthetica?

A

Lateral femoral cutaneous nerve

146
Q

Meralgia paresthetica is exacerbated by what movement?

A

Hip extension

147
Q

What is the PT management of meralgia paresthetica?

A

TENS and exercise (aerobic, flexibility, strength)

148
Q

True or False: Weight loss may help treat meralgia paresthetica.

149
Q

What are three treatment options for meralgia paresthetica?

A

Conservative, nerve block, surgery

150
Q

What are the two types of leg length discrepancy?

A

True discrepancy and functional (apparent) discrepancy

Musculoskeletal (14 decks)

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