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MSK > Hip anteromedial pathology > Flashcards

Hip anteromedial pathology Flashcards

1
Q

how does bursitis happen?

A
  • trauma
  • overuse or repetitive activity/friction
  • abnormal mechanics like limping
  • systemic (OA, RA)
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2
Q

what are the subjective compliants of bursitis?

A

pain with activities that cause compression

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3
Q

what are the objective complaints of bursitis?

A
  • pain atneromedial aspect of thigh
  • palpation tenderness (lat to fem artery in fem triangle)
  • limited PROM flexion, IR, ext (end range)
  • pain w resisted HF
  • pain with thomas test
  • +/- snapping
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4
Q

what is the prognosis of bursitis?

A

2-8 weeks

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5
Q

what is the rehab of bursitis?

A
  • modified rest/acitivty modification
  • pain/welling reduction
  • ID and resolve causative factors
  • rotational strenghtening
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6
Q

what population does coxa saltans occur?

A

athletes and dancers

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7
Q

why does coxa saltans occur?

A

snapping sensation in the hip

  • tendons over boney structures
  • ilipsoas over fem head, bursa, lesser troch, iliopectineal ridge
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8
Q

what is the clinical presentation of coxa saltans?

A

-reproducible with flex + ER into ext + IR

if asymptomatic; not something to fix

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9
Q

what is the rehab for coxa saltans?

A
  • address muscle imbalances

- manual therapy: psoas, anterior glides of hip

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10
Q

how does iliopsoas musculotendon injury occur?

A
  • acute/traumatic at musculotendionus junction (changing direction)
  • overuse strains (bones and tendons near insertions)
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11
Q

what is the clinical presentation of iliopsoas musculotendon?

A
  • pain in anterior part of prox thigh, more lateral than adductor
  • pain w palpation
  • pain w passive stretching and manual resistance
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12
Q

how does rectus femoris musculotendon injury occur?

A
  • acute/trauma at junction (kicking, sprinting)

- overuse

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13
Q

what is the clinical presentation of rectus femoris musculotendon ?

A
  • pain w palpation

- pain with passive stretching and manual resistance

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14
Q

how adductor iliopsoas musculotendon injury occur?

A
  • acute/trauma at junction (kicking, change of direction)
  • overuse

risk factors:

  • redcued adductor strength
  • reduced abdominal strength
  • ab/adductor imbalance
  • decreased hip IR
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15
Q

what is the clinical presentation of adductor musculotendon ?

A

-pain around insertion of add longus tendon. may radiate distally along medial thigh

-pain w palpation
-provocation w passive stretching and manual resistance:
adductor squeeze test

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16
Q

what is rehab for the adductor musculotendon?

A
  • pain/inflamm management
  • add/abductor, abdominal strength
  • muscle flexilbity and joint mob
  • NM coordination/biomech
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17
Q

what is the prognosis for adductor musculotendon?

A

good
75% athletes return w exercise approach
4-8 weeks acute
6 months chronic

18
Q

who is likely to get athletic pubalgia?

A

M>F

running, kicking, cutting, change of direction, accel/decel

19
Q

why does athletic pubalgia occur?

A
  • weakness of post inguinal wall without clinically palpable hernia
  • insidious: repetitive twist and turn of thigh and trunk
  • muscle imbalance: abdominals and adductors
  • trauma: trunk ext and thigh abduction
20
Q

what is the clinical presentation of athletic pubalgia?

A
  • deep lower abdominal or inguinal pain with exertion (cough, sneeze, sitting up ) possible sensory disruption
  • deeper, more intense than adductor or psoas strain
21
Q

what are the 5 signs of athletic pubalgia?

A
  1. subjective complaint of deep groin/lower abdominal pain
  2. exacerbated with exertion (sprint, cut, sit up) ; relieved with rest
  3. palapable tenderness over pubic ramus at insertion of RA and or conjoined tendon (pubic tubercule, abdominal insertions) (no palpable hernia)
  4. pain wiht resisted adduction at 0, 45, 90 degrees of hip flexion
  5. pain w resisted abdominal curl up

may present w adductor and HF weakness w dynamic mvoement

22
Q

what is the prognosis of athletic pubalgia?

A

significant improvement with 6-8 weeks of PT

23
Q

what is the 4 phase rehab protocolr for athletic pubalgia?

A
  1. week 1-2: tone reduction and tissue extensibility
  2. week 3-4: abdominal muscle strenghtening
  3. week 5: functional activities initiated
  4. week 6: return to sport activities and week 10-12: return to comp

note: cue breathing throughout to avoid valsalva

24
Q

who is likely to get pubic stress syndrome?

A
  • athlete w high-stress forces transferred through pelvis and pubic symph (kicking, accel/decel, change in direction)
  • pregnancy, pelvic trauma, pelvic surgery
25
Q

why does pubic stress syndrome occur?

A
  • overuse/ sheer injury
  • pubic bone stress= inflammation of pubic bones

risk factors:

  • reduced hip abduction and abdominal strength
  • limited hip IR ROM
26
Q

what is the clinical presentation of pubic stress syndrome?

A

-pain in pubic symphysis

27
Q

what is the prognosis of pubic stress syndrome?

A

up to 6 months prior to preinjury level

28
Q

what is rehab for pubic stress syndrome?

A
  • activity modification, ice, NSAIDs
  • strength/coordination of hip rotators, flexors, adductors , abdominals
  • flexiblity/mobility (hip, thorax)
  • functional movement retraining
29
Q

who is likely to get FAI?

A

pincer: female: overcoverage
cam: male: acetabular retroversion
mixed: most common : carilage abrasion

30
Q

what happens with a FAI?

A
  • hip condition causing groin pain and impaired aciyvity
  • history of childhood hip diseaes; fractures
  • repetivie motion= continuous insult
31
Q

what are the subjective complaints of FAI?

A

-activity and/or position related pain (aching or sharp) in the groin/hip, +/- clicking, snapping, locking, stiffness, giving away

  • sitting, squatting , WB
  • pain may be over greater troch (C sign), buttock or thigh
32
Q

what are the objective findings of FAI?

A
  • no single sign
  • provocation: FADIR and FABER
  • limited ROM: flexion, IR, adduction
  • HIP IR <20 w hip at 90
  • limited accessory joint motion
  • abnormal movement pattners (gait, SLS)
  • weak hip muscles
  • muscle tenderness
33
Q

what are the stages of rehab for FAI?

A

stage 1: pain control
stage 2: muscle flexilibty
stage 3: normalize ROM

34
Q

who is likely to have a labral tear?

A

-70% asymptomatic
-22-55% groin pain
20% athletes
prevalance increases with age 88%> 30

35
Q

why does a labral tear occur?

A

traumatic: rapid motion, sudden stops and turns

insidious: impingement of labrum against femoral neck can occur with extremes of movement (repetitive HF)
even with normal hip morphology
risk factor for OA

36
Q

what are risk factors for a labral tear?

A
  • perthes disease
  • previous trauma
  • SCFE
  • FAI
  • reptitive HF or pivtiong (hocket, soccer, football, dance, running
37
Q

what does the labrum do?

A
  • stabilibty
  • proprioception
  • force transduction buffer
38
Q

what are the subjective complaints of a labral tear?

A 
groin pain (dull or sharp)
\+/- click
39
Q

what are the objective findings of a labral tear?

A
  • clicking
  • provocation of FADIR, FABER, fitzgerald
  • impairments: movement coordination, ROM, muscle tone
40
Q

what is the prognosis of a labral tear?

A
  • vascular

- prolonged recovery= 8 months

41
Q

what is rehab for a labral tear?

A
  • no gold standard
  • education
  • manual therapy: lumbopelvic and hip (manipulation included)
  • exercise: strenghten glutes, lumbar, adductors, rotators
42
Q

what are the phases of labral tear rehab?

A

phase 1: pain control
education in trunk stabilization
correction of abnormal joint movement

phase 2: muscular strenghtening
recovery of normal ROM
sensory motor training

phase 3: advanced sensory motor training
sport-specific functional progression
reassess ROM, strength, flexibility, pain, special tests, level of function

MSK (17 decks)

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