Hip

Question 1

Labral Lesions

Answer 1

Usually associated with dysplasia or FAI

*80% of the time will lead to OA

Question 2

Hip pain referral

Answer 2

Intra-articular (Labral) C-sign around the hip and/or groin pain

Extra-articular (Bursitis) Lateral hip pain

Isolated buttocks pain (SIJ or LBP)

Pain with repetitive Flx/Rot, dec. ROM (FAI)

Question 3

FABER

Answer 3

Test is positive when leg is > 4 cm knee to table on the contralateral side (88% sensitive for intra-articular pathology)

Also (+) with hip, groin or butt pain

Question 4

Gait disturbances

Answer 4

Antalgic - short step, dec. stride length

Trendelenburg - contralateral hip drop (Hip ABD weakness)

Question 5

Log Roll Test

Answer 5

supine passive IR/ER combines ER/IR (test + if ER is greater than IR on the involved side)

Question 6

Hip OA Dx Cluster (Altman 6/6) to R/O

Answer 6

Age >50

Morning Stiffness

Question 7

Hip OA

Answer 7

Risk Factors - H/O impact activities, obesity, trauma, occupational

Symptoms - Lateral hip pain (sometimes groin pain), crepitus, stiffness, limited IR/Flx

Inflammation is the primary factor with decreased in hyaluronic acid

Medications: Tylenol (safer than NSAIDS), NSAIDS

Question 8

Hip OA outcome measures (Level A)

Answer 8

WOMAC
LEFS
HHS

Question 9

Hip OA activity measures (Level A)

Answer 9

6-minute walk, self-paced walk, stair test, TUG

Question 10

CPR for hip OA

Answer 10

Painful squat
painful AROM hip ext.
Lateral hip pain with flexion
Scour (+) Adduction causes lateral hip and groin pain
Passive hip IR

Question 11

Predictors of (+) response to P.T. with hip OA (3+/5 predictors = 99% success rate)

Answer 11

Pain is unilateral
Age 6/10
Symptoms

Question 12

TUG

Answer 12

Pre-op time

Question 13

Anterior Hip/Groin Pain DDx

Answer 13

Labrum
AVN
Legg-Calve-Perthes (LCP)
SCFE

Question 14

Femoral Acetabular impingement (CAM)

Answer 14

More common in Men and lead to higher incidence of demyelination

Bumpy femoral head or larger neck diameter wears out the cartilage by shearing

Question 15

Femoral Acetabular impingement (Pincer)

Answer 15

More common in women
Deeper acetabulum wears out the cartilage by crushing/pinching

*Coxa profunda, acetabular protrusion

Question 16

FAI Dx

Answer 16

(+) C-sign
Sharp, Achy pain worse with sitting
(+) FADIR
Dec. Hip IR

Question 17

Outcome measures for FAI

Answer 17

HOS (6-9 pts MCID depending on subscale)
HAGOS (young, active population)
iHot-33 (S/P arthroscopy MCID 6 pts)

Question 18

DDx of intra-articular hip pathology

Answer 18

FAI: IR ROM 30 degrees @90

Instability with squats and labral tear confirmed by MRA

Question 19

Instability (dysplasia)

Answer 19

Painful FABER/FADIR
+ Apprehension (position of posterior hip dislocation)
Hip IR > 30 deg @90
Reports popping, clicking
Dec. femoral head coverage due to increase acetabular inclincation

Question 20

FAI precautions

Answer 20

Avoid deep squats, forced IR and extreme ABduction

Question 21

Instability precautions

Answer 21

Avoid forced extension and rotation

Question 22

Hip Labral Tears

Answer 22

MOI:Microtrauma from pivoting sports, impact sports or concomitant from wearing of cartilage
*Traumatic tear with forced hip ER and extension
*FAI can be a predisposing factor
Reports of anterior groin pain

Tx:NSAIDS and P.T. (2-3 months)
Tx:If surgery involved avoid SLR and deep hip extension initially (6-12 weeks before return to sport)

Question 23

Labral Tear (Dx cluster 3/3)

Answer 23

Anterolateral pain (C-sign)
Sharp or achy pain
Worse with sitting

*Arthroscopy is the gold standard for diagnosis but MRA is best to R/O

Question 24

Hip DDx

Answer 24

OCD - deep groin pain which is worse with impact/WB
Loose Bodies - Pain, crepitus

Iliopsoas impingement/bursitis (internal snapping hip) deep groin pain with flexion/extension, + Thomas test
(+)supine heel raise test at 15 deg

Troch. Bursitis (external snapping hip) TTP over the GT, + Ober’s

Ligamentum teres tear - groin pain
Septic hip - hip held in FABER and painful

SCFE - 9-17 y/o, active or overweight with hip held in ER and pain is poorly localized (can be non-painful once chronic)

LCP - Athletic males in early teens, pain in hip/knee with limited IR and (+) Flx/Add test
AVN

Appendicitis - Rebounder tenderness at McBurney’s point (lower R quadrant) and low grade fever

Kidneys - Flank pain which is acute, sharp and unrelieved by position. Pain with percussion at the costovertebral angle and hypersensitive T10-L1 dermatomes (ureteral origin pain has similar presentation but lower in the quadrant)

Question 25

Pubic/groin pain DDx

Answer 25

Osteitis Pubis - pubic pain, perineal or scrotal pain, treat with rest

Adductor strain: Occurs at muscle tendon junction and usually can be dx with U/S

Question 26

Nerve entrapments

Answer 26

Obturator entrapment:
Ant. branch is sensory to the medial thigh while Post. is sensory to the knee capsule and cruciates
Some weakness of the adductors (AL/AM)
conservative treatment

Ilioinguinal entrapment - L1-L2 dermatome (inguinal area)
Symptoms reproduced with hyperextension and common with pregnancy or hypertrophy of the abs

Question 27

Hamstring injuries

Answer 27

Tested with “taking off the shoe test” while standing
Bent knee stretch of the hip into flexion
Puranen-Orawa test (standing Hams. stretch)

Question 28

Hernia vs. Sport’s Hernia

Answer 28

Hernia is usually inguinal and painful with Valsalva

Sport’s hernia caused by stress to posterior abdominal wall and may involved the obliques or adductor tendon tearing. Presents as chronic groin pain worse with exertion, inguinal tenderness (usually gets better after 2-3 months of conservative treatment)

Question 29

Exercises

Answer 29

Glute Med. activation is best with the clamshell

Question 30

Capsular pattern

Answer 30

IR is most limited followed by variable combination of flexion/extension/abduction