Hip Flashcards
Validated Hip outcome measures (non OA)
HOS- hip outcome score
Ihot- international hip outcome tool (ihot33)
Copenhagen ( HAGOS)- hip and groin outcome score
Hip outcome measure OA
WOMAC- Western Ontario and McMaster OA index
LEFS
Harris Hip Score
Hip OA interventions
Anti inflammatories, corticosteroid injections, manual therapy (B), Therex ( stretching, PRE, endurance) (B)
Hip OA CPR
- Stiffness < 60 min
- Age > 50
- Hip IR < 15 degrees
- limited hip IR and flex < 15 degrees vs contra - Pain with hip IR
- ESR < 45
Hip OA prognostic CPR
- age < 58
- 35.9 s or less on 40 m walk
- pain > 6/10
- Pain < 1 year
- unilateral hip pain
Inidications for hip scope
- failed conservative tx > 4 weeks
2. show signs of intra-articular hip pathology
Indications for labral repair
- labrum partially detached from acetabulum
- have intrasubstance tears
- repair over resection performed to avoid significant disruption of joint mechanics
- better outcomes with repair over resection
Hip Scope ROM and WB
- CPM 2-4 weeks postop 30-70 initially
- full PROM by 2 weeks- AROM starts 2 at weeks
- isometrics starting day 2 - Usually FFWB with AC
- Avoid excessive ER for 4 weeks due to stretching of anterior capsuloligamentous structures
- avoid flexion/ABD to prevent inflammation - microfracture or osteoplasty PWB- Wolfs law
Peds hip pain 5-8 year olds
transient synovitis
Hip pain in adolescents (pre teens)
SCFE
- groin, ant thigh, ant knee pain
- limping
- (+) drehman sign (ER and Abd with hip flex)
- pain/ liminted ROM with hip IR
Developmental hip dyspagia
infants
Coxa Saltans (snapping hip) causes
Can be intra or extraarticular
Intraarticular
1. ilipsoas- over iliopectineal eminence
Extraarticular
- ilipsoas
- over femoral head
- (pectin pubis) - ITB
- over greater troch - Glute max
- over greater troch (posterior hip) - Iliofemoral lig- over anterior femoral head
- Hamstring- over ischial tub
Femoral Triangle
Superior: inguinal ligament
Medially: adductor longus
Lateral: lat border of sartorius
Floor: Add longus, pectineus and iliopsoas
orientation of acetabulum
ventrally, laterally, caually
pubofemoral ligament
restrains ext, ER, ABD
ischiofemoral ligament
2 bands
- Pars superioris: restrics ext, ER, add
- pars inferioris: restrics ext
Flexion component movements
flex/abd/ir
Ext component movement
ext/add/er
Abd component movemnt
abd/ext/ER
ADD component movement
ADD/flex/ER
Peds hip pain 4-10 yo
transient synovitis, JRA, LCP
Hip pain 15-25
Articular Osteochondritis dissecas
Aching hip pain
bursitis, tendinopathy, arthritis or arthrosis
Sharp pain
esp when combined with clicking/locking/instability= labrum; can also be loose bodies
Groin pain with coughing sneezing or straining
Think hernia, sports hernia( tendinopathy of add longus or rectus abd), pubic symphyseal affliction, lumbar spine
Posterolateral hip pain ddx
Trochanteric bursitis, piriformis syndrom, gluteal tendonitis, loosening from THR, referred pain from lumbar/SIJ
Signs of a loose body (clinical triad)
- sharp radiating pain
- Non capsular loss of ROM with empty end feel
- instability, feeling like LE will give out
Hamstring syndrome triad sx (sciatic nerve entrapment)
- pain with palpation to lateral ischial tub
- pain with resisted knee flexion with hip at 90 and knee extended to the limit
- no pain with resisted knee flexion in prone - pain with sitting
hamstring tendonopathy
pain with resisted knee flexion in hip 90 or 0 flexion
no pain with sitting
Trochanteric bursitis differential
- pain with palpation
- pain with FADER*, FADIR (less painful than tendonopathy)
- no pain with SLR
- pain with sitting
Sports related groin pain
bilateral resisted hip ADD; accompanied by bone marrow edema
Pelvic ring instability tx
- strengthen transversus abd
- strengthen pelvic floor muscles
- wear SI belt (23 hrs/day –> less)
Symptomatic with active SLR test
- alleviated with compression to pelvis (SI compression)
Sportsmans hernia, “hockey hernia”, athletic pubalgia
- weaknening /stressing on the transversalis fascia, conjoined tendon and interal oblique fibers, creating an inside out hernia within the dorsal wall of the inguinal canal
- pain at lower ab, inguinal or groin regions exacerbated with valsalva or exertion
Tests for hip stress fx
- single leg hop
- fulcrum test ( seated, hand weaved under involved side, over contra, and push down on involved side)
- bone scan/MRI
Neuralgia Parasthetica
- lateral femoral cutaenous nerve entrapment
- best with injection or surgical management
Calcific tendonitis
occurs with persistent bursitis.
Iliopsoas bursitis
- pain to anterior hip
- pain with resisted hip flexion and passive hip ext
Special tests
1. snapping hip- supine- hip flex/add/ER then return to neutral- assess for hip click
2. supine heel raise- resisted hip flex at 15 degrees
Adductor strain imaging
ultrasound 84% sensitivity
Gadolinium enhances MRI- not great
Tx for sports hernia
aka gilmore groin
- Rest 6-8 weeks
- ADD stretching/strengthening
can return to sports 10-12 weeks if painfree
hamstring injury special tests
puranen orova- standing hamstring stretch
bent knee test- slow extension of knee with hips and knees maximally flexed
mod bent knee test- rapid ext of knee with hips and knees flexed
taling off shoes sign- biceps femoris- flexed knee that goes to take off shoes being tested
