Hip and Thigh Conditions

Question 1

Sources of Hip Pain (2)

Answer 1

Intra-articular: Capsular and articular
Extra-articular: Referred and Localized (MSK and Non-MSK)

Question 2

Common Conditions With Anterior Hip Pain (6)

Answer 2

FAI
Labral tear
Osteoarthritis
Ligament teres tear
Hip joint instability
Groin related pain

Question 3

Common and Not to be Missed Conditions with Lateral Hip Pain (4)

Answer 3

Common: Gluteus med. tendinopathy and tears.
Not to be missed:
- Femoral neck fracture
- Nerve root compression
- Tumour

Question 4

Common Conditions with Posterior Hip Pain (4)

Answer 4

Posterior labral tear
Posterior chondral lesion
Ligament teres tear
Posterior instability

Question 5

Femoroacetabular Impingement (FAI) - Characteristics and Types (2)

Answer 5

Abnormality that develops on femoral head, acetabulum or both.
Cam: Bump or bony formation on femoral head.
Pincer: Lesion on acetabulum.
Anterior pain, limits flexion and IR.

Question 6

FAI - Diagnostic Criteria (3)

Answer 6

Has to have at least 1 from each category.
Symptoms: hip pain, clicking, catching, stiffness, giving way.
Clinical signs: restricted ROM or positive impingement test.
Radiological findings: Cam or Pincer.

Question 7

FAI - Clinical Tests (5)

Answer 7

Hip ROM: painful and decreased hip flexion and IR.
FADDIR: Pain (reproduction of symptoms)
FABER: Pan (reproduction of symp.)
Scour: Pain
Thomas: Pain in hip flexion, decreased ROM in extension.

Question 8

Hip Labral Tear - Characteristics and Types (2)

Answer 8

Common in athletes that do huge amount of ROM, people with FAI.
Type 1: Labrum detached from acetabular rim.
Type 2: Separation within labrum alone.

Question 9

Hip Labral Tear - Clinical Tests (6)

Answer 9

Painful clicking!!! (different to FAI)
FADDIR: pain (reproduction of sympt)
FABER: pain (reproduction of sympt.)
Hip Dial Test: Increased ER on affected side, loss of elasticity in hip.
Scour Test: pain
Thomas Test: Pain in hip flexion.

Question 10

Hip OA - Risk Factors and Symptoms (3)

Answer 10

Degenerative, Female, >40y.
Lateral pain (c-sign) or anterior.
Morning stiffness eases <30 min.
Worse at end of day if patient has done prolonged standing/walking.

Question 11

Hip OA - Assessment (5)

Answer 11

Painful stairs, STS, walking, squatting.
Hip ROM: pain and/or decreased ROM (mainly IR).
Active hip flexion/extension: pain.
Scour: pain.
FABER + FADDIR: pain.

Question 12

Adductor Tear - Characteristics (2) and Clinical Tests (3)

Answer 12

Football, ice hockey, rugby.
Rapid change in direction or lunge with excessive stretch.
Palpation (muscle, pubic bone, symphysis).
Positive adductor squeeze test.
Decreased resisted hip add. (pain).

Question 13

Pubic Bone Overload (Osteitis Pubis) - Characteristics (1) and Clinical Tests (4)

Answer 13

Chronic, abnormal loading of adductor tendons.
Sometimes pain on palpation.
Sometimes pain with adductor squeeze test.
Sometimes pain with resisted add.
Sometimes positive hop test.

Question 14

Hamstring Tear - Types (2)

Answer 14

Sudden onset of posterior thigh pain.
Type 1: Running injury during eccentric contraction. Terminal swing. Biceps femoris.
Type 2: Dancing injury. End-range, over stretching, semimembranosus.

Question 15

Hamstring Tear - Risk Factors (3)

Answer 15

Short muscle fascicles
Decreased strength
Previous hamstring injury

Question 16

Hamstring Tear - Assessment (6)

Answer 16

Palpation: pain over muscle belly.
SLR: no neuro signs, post. thigh pain.
Resisted isometric knee flexion: Pain and decreased strength.
Single leg bridge: Pain and decreased strength.
Slump test: No neural symptoms.
90/90 test: pain and/or decreased ROM.

Question 17

Proximal Hamstring Tendinopathy - Characteristics (4)

Answer 17

Pain around gluteal fold or buttock.
Rule out lumbar and hamstring tear.
Distance runners, jumpers.
Over-use, gradual onset.

Question 18

Proximal Hamstring Tendinopathy - Assessment (4)

Answer 18

Ischial tuberosity palpation: pain.
Heavy isometric knee flexion: pain and reduced strength.
90/90 test: pain and/or decreased ROM.
Modified single leg bridge: pain over ischial tuberosity.

Question 19

Greater Trochanteric Pain Syndrome (Gluteal Tendinopathy) - Characteristics (5)

Answer 19

Lateral hip pain.
Distance runners, women >40 y.
Compressive tensile load of gluteal tendons on greater trochanter.
Gluteus medius and minimus!

Question 20

Greater Trochanteric Pain Syndrome (Gluteal Tendinopathy) - Assessment (6)

Answer 20

Stairs/crossing legs: lateral pain.
FABER: pain anterolateral/lateral.
Trendelenburg: contralateral pelvic drop.
Derotation: lateral hip pain.
Ober’s: lateral hip pain.
Side lying: pain with affected side on top.