Hip Flashcards
What are the ligaments of the hip and what motions do they restrain?
Iliofemoral
- pars inferioris constrains hip extension
- pars superiors constrains hip extension, add, ER
Pubofemoral: constrains hip extension, ABD, ER
Ischiofemoral: hip stability in standing
What happens to the femoral head during anatomical flexion, ABD, ADD?
Flexion: femoral head flex, ABD, IR
Abduction: femoral head ABD, ER, ext
Adduction: femoral head ADD, ER, flex
What do you test with manual isometric resistance?
Supine with hip at 0, 45, 90?
Hip at 0: adductor longus/gracilis
45: pubic symphysis
90: pectineus
What are capsular pattern clinical findings?
Pain with sitting, walking, going up stairs
Anterior thigh/groin
IR limited > flex/ex/groin
Self-reported CPR of hip OA
Squatting aggravating factor
Active hip flexion causes lateral hip pain
Scour with adduction causes lateral hip/groin pain
Passive IR=25
Active extension causes pain
(3/5)
Patient can d/c from hospital post-op THA when they are able to…?
Transfer in/out of bed from stand
Sit to stand from chair
Ambulated I x100 ft
Negotiate stairs I
SCFE vs Legg-Calve-Perthes
Stages of LCP
SCFE: femoral head slides on femoral neck; overweight young males; pain with IR with increased ER
Leg-Calve- perthes: aseptic bone necrosis of femoral head
Stages:
I. <25% femoral head involved
2. 50% and subchondral fracture
3. 75% with collapse of femoral head
4. involves entire head and plate
What is osteochondritis dissecans?
Inflammation of cartilage and subchondral bone
What are the intraarticular and extraarticular causes of snapping hip?
Intraarticular:
- snapping of iliopsoas tendon over iliopectineal eminence
Extraarticular:
- thickening of ITB over greater trochanter
- iliopsoas at pectin pubis
- glute max fibrosis in posterior hip
- proximal hamstring at ischial tuberosity
- burial formation at any of those areas
What are clinical findings of hamstring syndrome?
Clinical triad: pain with sitting, resisted knee flexion at 90 and extended, worse with DF, prone resisted knee flexion is negative
+ Palpation of ischial tub (lateral)
Stretching makes it worse
What are clinical findings of piriformis syndrome?
Pain with walking, sitting decreases pain, + FAIR, +SLR, glute Max atrophy
What are clinical findings of pudendal nerve entrapment?
Treatment?
S2, 3, 4 can get trapped at sacrotuberous and Sacrospinous ligaments
Pain sitting decreased with standing, pain in buttock and perineal area
Treatment: use sacral sitting pain and avoid deep hip flexion
- neural mobs won’t work
Differentiating groin pain
What do you check first?
What if positive?
What if negative?
Painful hip adduction? Tendinopathy of hip adductors Pubic symphysis hyper mobility Hernia Obturator nerve entrapment If non painful hip adduction - urological, gynecological, lymphatic pathologies - Labral tears/FAI - Stress fx - RF tendinopathy - iliopsoas tendinopathy
How do you differentiate between adductors for pain?
What non-hip muscle might have pain with resisted hip adduction
Adductors Longus and brevis are one joint
Two-joint gracilis- resist adduction and knee flexion
Pectineus: adduction at 90 and hip flexion
Rectus abdominus might cause pain in groin with resisted hip adduction, differentiate by doing resisted trunk flexion
What is clinical presentation of Labral tear?
Pain with sitting, going up stairs, clicking and locking during weight bearing
Pain at growing, buttock, trochanter, or combination
May have decreased IR with hip flexion but not hip extension
