Hip and thigh conditions

Question 1

Femoroacetabular impingement (FAI)

Answer 1

Two main types:
- CAM: a bump or bony formation found on the femoral head surface
- Pincer (see below): lesion appears on the acetabulum

Injury mechanisms:
Abnormal contact between proximal femur and acetabulum

S&S:
- Hip pain, clicking, catching, stiffness or giving away
- Radiological findings

CT:
Hip FL and IR ROM <
FADDIR +
FABER +
Scour +
Thomas +

Question 2

Hip Labral Tear

Answer 2

Common with FAI, but can occur without

IM:
- Type I – detachment of the labrum from the acetabular rim
- Type II – separation within the labrum alone

S&S:
Painful clicking

CT:
FADIR +
FABER +
Hip dial test +
Scour +
Thomas +

Question 3

Hip OA

Answer 3

Degenerative condition

S&S:
-Pain surrounding lateral hip (C-sign) or anterior hip
- Stiffness (eases in less than 30 mins)
- Worse at the end of the day if patient has been standing or walking for long periods

CT:
Stairs, STS, walking and/or squatting
< PROM (mainly IR)
Active hip EX (pain)
Active hip FL (pain)
Scour +
FABER +
FADDIR +
Thomas +
IR < 15°
> 50 years old

Question 4

Acute groin injury

Answer 4

Explosive MOI: kicking, change of direction, reaching with leg

Question 5

Adductor tear (acute groin injury)

Answer 5

Common during football, ice hockey and rugby

MOI:
- Normally occurs during a lunge and/ or change of direction with excessive stretch of adductor group
- Sudden onset injury

CT:
Palpation (muscle, pubic bone and pubic symphysis)
Adductor squeeze t +
> Resisted hip ADD (pain)

Question 6

Pubic bone overload (Osteitis pubis)

Answer 6

Chronic injury
Symphysis and surrounding tissue

MOI:
- Overuse injury of the pubic
- Develops from abnormal loading of the adductor tendons

CT:
Pain on palpation (pubic bone and pubic symphysis) +/-
Adductor squeeze test +/-
Resisted hip FL +/-
Single leg hop test +/-

Question 7

Hamstring Tears

Answer 7

Two main types of injury:
Type I – running injuries:
- Terminal swing
- Sprinting
- Biceps femoris

Type II – dancing injuries
- End range
- Over-stretched
- Semimembranosus

Previous hamstring injury have higher risk

MOI:
Disruption of the muscle fiber/s

S&S:
Sudden onset of posterior thigh pain

CT:
Hamstring palpa (pain)
SLR +
Resisted isometric knee flexion +
Single leg bridge +
Slump test +
90/90 test +

Question 8

Proximal Hamstrings Tendinopathy

Answer 8

Need to rule out lumbar spine and hamstring tears before considering it

RF: Distance runners and jumpers

MOI:
- Compressive forces surrounding the proximal hamstring tendon combined with abnormal loading/biomechanics
- Overuse injury

S&S:
Pain around the gluteal fold or buttock region

CT:
Ischial tub palpa (pain)
Heavy iso knee FL (pain and reduced strength)
90/90 test +
Modified single leg bridge

Question 9

Greater Trochanteric Pain Syndrome - Gluteal tendinopathy

Answer 9

RF:
- Distance runners
- Woman > 40 years old

MOI:
< compressive tensile load of gluteal tendons on greater trochanter

S&S: Pain over the lateral hip region

CT:
Stair climbing / crossing legs (pain lat hip)
FABER +
Trendelenburg +
Derotation test +
Ober’s test +
Pain affected hip on top during side lying