Hip Flashcards
What is the CPG for DX of Hip OA?
- Adults >50
- Reports moderate pain in lateral or anterior hip with WB
- Morning stiffness < or = to 60 min.
- Pain with hip IR and hip IR less than 15 degrees
- Hip flexion less than 115 degrees
What are the CPR for Hip OA?
- squat is an aggravating factor
- AROM hip extension causes pain
- AROM Hip flexion causes lateral pain
- Scour test with addiction causes lateral hip/ groin pain
- PROM hip IR < 25 degrees
Name three self reported outcome measures that are considered to have strong evidence for activity limitations in patients with Hip OA.
- WOMAC
- LEFS
- Harris Hip Score
List four functional measures that are considered strong evidence for measuring functional deficits in Hip OA.
- 6 minute walk
- 30 second chair stand test
- timed up and go test
- stair measure
What are two types of FAI?
- CAM impingement
- increased femoral neck diameter
- Pincer impingement
- increased acetabular depth
What are characteristics of CAM impingement.
- Typical in men 20-30 years of age
- Shears at chondrolabral junction as it enters the acetabulum during hip flexion
- results in chondolabral seperation
What are characteristics of pincer impingement?
- Typical in women 30-40 years old
- overcoverage crushes the labrum against the normal femoral neck in flexion and IR.
- results in labral degeneration without chondral injury
- possible ossification of rim
What are the signs of FAI?
- C/O
- c sign
- anterior groin pain
- pain with sitting, standing, walking, and sports activities
- sharp pain with clicking
What are the symptoms of FAI?
- Muscle weakness(abd, flex and add)
- gait limitations
- joint mobility deficits
What special tests can you use to diagnose FAI?
- FABER
- FADIR
- resisted SLR
What is a sports hernia?
- Weakness of the posterior inguinal wall without a clinically palpable hernia.
What is the consensus meeting cluster to diagnose a sports hernia?
- Pinpoint tenderness over the pubic tubercle at conjoined tendon
- Palpable tenderness over the deep inguinal ring.
- Pain with no obvious hernia.
- Pain at the origin of the adductor log us tendon.
- Dull, diffuse pain in the groin.
Need 3/5
Manual therapy is considered to have ___________ evidence for treatment in hip OA
Strong
Patient education - teaching activity modification, supporting weight reduction and methods of off loading are considered to have ________ evidence according to CPG.
Moderate
According to CPG, functional gait and balance training, weight loss and an individual prescription for therex are considered to have _______ evidence
Weak
According to CPG, flexibility, strengthening and endurance exercises are considered to have ___________ evidence to support the use as an intervention in treating hip OA.
Strong
What treatments can you use to treat patients with FAI.
- Trigger point massage of RF, TFL, glute med
- Lumbar spine mobilizations - grade 3-4
- Hip capsule distraction( mulligan w/ movement)
- electroacupuncture at L2-5
- rehab exercises for strength,endurance and lumbopelvic stability
Is an MRI effective in diagnosing Hip OA?
- No
- SR for MRI- Sn 61%, Sp 82%; -LR .47, +LR 3.4
What is the CPG for diagnosing FAI?
- Sharp or aching pain in the anterior hip/groin and or lateral hip.
- Pain is aggravated by sitting.
- FABER +
- Hip IR<20 degrees with hip at 90
- Limitations with hip abd and flexion
- treatment with HVLA, low amp traction and rotational manip/mobs
What outcome measures show level 1 evidence for the hip?
- Hip outcome score
- HAGOS - young population
- International Hip outcome Tool(iHOT 33) MCID s/p arthroscopy 6 points
Characteristics of Hamstring syndrome- sciatic nerve entrapment
- Associated with active individuals; distance runners, sprinters, jumpers
- Pain with sitting, resisted knee flexion with hip flexed to 90
- pain free resisted knee knee flexion with hip extended
- do not perform HS stretching
- have them sit on dorsal wedge pillow
- gentle neural mobilizations
Hamstring tendinopathy
Microtraumatic loading of the tendinous junction
- (+) Pain with resisted knee flexion, hip flexed to 90
- (-) slump, SLR
- transverse friction massage, gentle hs stretching, gradual eccentric activation
Illiopsoas bursitis
- TTP along bursa
- anterior hip pain, worse with passive hip extension and resisted hip flexion
- May complain of snapping
Trochanteric bursistis
- treat with rest, NSAIDs, ice
- posterior taping to glut med
Calcified tendinitis/ glut med tear
Treatment
- injections, heel lifts, avoid crossing legs
Groin pain diff diagnosis
Adductor tendinopathy- (+) Pain with resisted hip add with hip neutral
Gracious tendinopathy- (+) Pain with resisted hip add and resisted knee flexion
Pectineus tendinopathy-(+) Pain with resisted hip hip flexion and add ( hip 90)
Illiopsoas tendinopathy- (+) Pain with resisted hip flex. And ER
Pubic symphysis Pain
Pain with resisted hip add with hip at 45
- can be decreased with stabilization belt
- (+) active SLR
Symptoms of osteitis pubis
- Severe groin pain from isolated or repetitive trauma to pubic symphysis
- Seen during vaginal birth or with athletes with rapid acc/deceleration.
- rest, NSAIDs, PT, prolotherapy
Symptoms of sports hernia
Experience twisting or tearing of transversalis fascia
- Pain with resisted double hip add, unchanged with pelvic ring stabilization
- Pain with resistive hip test and oblique abdominals
Symptoms of o treat obturator nerve entrapment
Worse with resisted hip add
- c/o post exercise adductor weakness and parasthesia in medial thigh
- confirmed with emg and diagnostic nerve block
Lateral femoral cutaneous nerve entrapment
- sensory changes to lateral thigh or knee
- possibly quad weakness
Symptoms of stress fracture for hip
Immediate onset of hip pain upon weight bearing
- need bone scan or mri
Slipped Capital Femoral Epiphysis (SCFE)
Seen in adolescent males
+ groin pain that prohibits weight bearing in functional activities
+ limping/ waddling gait, limited hip rom
- treatment with percutaneous surgical pinning/ fixation, pwb crutches- 3 weeks
- strengthens hip abductors
Symptoms of Leg Calve Perthes
- AVN of femoral head, boys> girls
- treatment : conservative management, remodeling through bed rest with traction in hip abd, serial casting, functional orthosis, to allow WB while maintaining hip abd and IR
AVN
- seen in 4 th decade
- imaging unless advanced would not show any findings for three months
- sickle cell anemia, gout, alcoholism, steroid usage, renal disease, radiation, trauma from previous Injury
