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Sports and Exercise Medicine iBSc > Hip and Groin > Flashcards

Hip and Groin Flashcards

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Sports Trivia flashcards
1
Q

Football

A

Prevalence 12-16%

Account for 11-16% of all FB injuries

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2
Q

hockey

A

20 GI/100 players/year
Increasing rate of 1.32/100 players/year
3rd most common injury
8% of all injuries

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3
Q

Australian football

A

GI incidence failed to decrease since 2002
Prevalence 2nd highest after H/S
Highest recurrence rate

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4
Q

Rugby

A

3.29/1000 player hours (training)
0.1/1000 player hours (match)
101/25 absence days (training/match)
Ranked 4th most severe injuries
23% risk of sustaining GI in RB

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5
Q

history

A

Gilmore’s groin
Hockey’s groin
Sportsman’s hernia
Adductor-related groin pain

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6
Q

Hip joint anatomy

A

V stable and robust
Subject to high loads through many movements
Joint supported by v powerful muscles
Functionally, muscles act like slings- abdominal muscles connected to adductor muscles

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7
Q

Contributor factors- Load

A

Complex loading through pelvis/groin region
Sudden dynamic changes of load in sports specific movements
Lack of functional training for changing load

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8
Q

Contributing factors- other

A

Age
Lack of adequate training- less training hours in pre-season is a RF
Other injuries
Lack of proper conditioning
Hamstring + adductor muscles injuries seem to be well correlated

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9
Q

Hip anatomy recab

A

Multiple muscle attachments

Potentially natural deficits in abdo wall e.g. hernias

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10
Q

Hip biomechanics

A

Important biomechanical associations
Spine, pelvis, hip etc all meet at pubic symphysis
Central –> lateral loading distribution
Muscle (im)balance

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11
Q

Groin triangle- Superiorly

A

Pubic Symphysis
Abdo Wall
Hernias

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12
Q

Groin triangle- Medial

A

Adductor muscles

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13
Q

Groin triangle- Within

A

Iliopsoas
Rectus Femoris
Nerves

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14
Q

Groin triangle- Lateral

A

Femoral acetabular joint
Tensor fascia lata
Hip joint

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15
Q

Pubic tubercle- adductor tendon enthesopathy

A

Insidious onset, warms up with onset
Guarding on passive abduction, weakness
Pubic clock 6-8

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16
Q

Pubic tubercle- rectus abdominis enthesopathy

A

Well localised to insertion, acute or insidious onset
Pain from resisted sit up
Pubic clock 12

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17
Q

Pubic tubercle- pubic bone stress injury

A

Non-specific diminished athletic performance, loss of propulsive power
Bone tenderness predominates
Diagnosis of exclusion

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18
Q

Medial to triangle- Adductor/gracilis enthesopathy

A 
Insidious onset
Diminished performance
Warms up
Proximal adductor pain, at enthesis
Guarding, weakness
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19
Q

Medial to triangle- Adductor longus pathology at musculotendinous junction

A

Acute onset, worse during exercise
Pain in proximal adductor
(2-4cm distal to enthesis), guarding, weakness

20
Q

Medial to triangle- Pubic bone stress injury

A

Pain primarily at pubis radiating to proximal thigh
Bone tenderness
Lack of point muscular tenderness

21
Q

Superior to base- rectus abdominis tendinopathy

A

Well localised to insertion, acute or insidious onset
Pain from resisted sit-up
Pubic clock 12

22
Q

Lateral to triangle- Impingement/labral pathology, femoro-acetabular joint

A

Mechanical signs
Clicking in joint and/or catching
Impingement test

23
Q

Lateral to triangle- Osteoarthritis/chondral damage, femoro-acetabular joint

A

History of traumatic/congenital insult
Older age group
Persistent lateral hip pain worse on lying on affected side
Limited ROM
Pain on weight bearing
Pain on transition between lying/standing

24
Q

Lateral to triangle- Iliotibial band friction syndrome

A

External snapping and/or lateral knee pain
Re-create snapping
Ober’s test

25
Q

Within- Iliopsoas syndrome

A

Pain above and below inguinal ligament- associated snapping at hip joint
Thomas test, modified

26
Q

Adductor related pathologies

A

Palpation + resisted adduction

27
Q

Iliopsoas related pathologies

A

Palpation + resisted flexion OR extension stretch

28
Q

Inguinal related pathologies

A

Palpation

29
Q

Pubic related pthologies

A

Palpation

30
Q

Hip related pathologies

A 
Passive ROM (PROM)
Flexion adduction internal rotation (FADIR)
Flexion abduction external rotation (FABER)
31
Q

Neural

A

Ilioinguinal nerve

Genitofemoral

32
Q

True hernia

A

Cough sign

33
Q

Pelvis sign

A

Warning signs of acute pathology
Morning pain + stiffness
Feeling of warmth and fullness
Swelling

34
Q

Acute hip

A

Majority of studies using 4-6 weeks
Sharp, obvious pain in groin
Big haemorrhage
Instant loss of balance and performance

35
Q

What injuries account for majority of acute groin injuries

A

Adductor injuries

36
Q

What other injuries common for acute

A

Proximal rectus femoris and iliopsoas

37
Q

More than — injuries showed no imaging signs of acute injuries

A

1 in 5

38
Q

Clinically diagnosed adductor injuries often confirmed on

A

Imaging

39
Q

Iliopsoas + rectus femoris injuries showed

A

a different radiological injury location in more than 1/3 of cases

40
Q

Acute - 0-48 hours

A

RICE
Gentle stretching to P1
Active pain-free ex
Phys mod (TENS, laser)

41
Q

Acute- after 1st 48 hours

A

Gradually increase stretching
Gradually increase strengthening (act abd/add, add/flex against resistance, stabilizing exs)
Functional strengthening
Sport-specific skills

42
Q

Movement patterns

A

Groin/hip pain usually multi-structural, multi-planar and multi-directional
A number of research without stringent inclusion/exclusion criteria found strong associations
Still high incidence, still high recurrence, still no reliable treatment strategy

43
Q

Treatment

A
  • Active rehab with manual elements
  • Including mainly the adductor and abdominal muscle
  • Regardless of evidence, not all discovered elements are present in exercise programmes
  • Common: abdominal, adductor work
  • Missing: sport specific rehab, other muscle groups (adductors? Hip ROM?)
44
Q

Prehab groin

A

Adductors + trunk flexors + glutes

Functional work

45
Q

Hip pathologies

A

Labral tears

FAI (morphology, not pathology)

46
Q

Hip pathologies- treatment

A

o Usual patient: M/F, active (loading activities) professional
o Treatment: usually good and quick improvement (to the point) with intense gluteal exercises (off-loading) and temporary avoiding painful activities
o Some further improvement (usually including increase of strength and stability)
o Recovery either plateaus, or go back to square 1 with going back to sports
o Loading management
o Injection
o Surgery

Sports and Exercise Medicine iBSc (13 decks)

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