Hip anteromedial pathology Flashcards
how does bursitis happen?
- trauma
- overuse or repetitive activity/friction
- abnormal mechanics like limping
- systemic (OA, RA)
what are the subjective compliants of bursitis?
pain with activities that cause compression
what are the objective complaints of bursitis?
- 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
what is the prognosis of bursitis?
2-8 weeks
what is the rehab of bursitis?
- modified rest/acitivty modification
- pain/welling reduction
- ID and resolve causative factors
- rotational strenghtening
what population does coxa saltans occur?
athletes and dancers
why does coxa saltans occur?
snapping sensation in the hip
- tendons over boney structures
- ilipsoas over fem head, bursa, lesser troch, iliopectineal ridge
what is the clinical presentation of coxa saltans?
-reproducible with flex + ER into ext + IR
if asymptomatic; not something to fix
what is the rehab for coxa saltans?
- address muscle imbalances
- manual therapy: psoas, anterior glides of hip
how does iliopsoas musculotendon injury occur?
- acute/traumatic at musculotendionus junction (changing direction)
- overuse strains (bones and tendons near insertions)
what is the clinical presentation of iliopsoas musculotendon?
- pain in anterior part of prox thigh, more lateral than adductor
- pain w palpation
- pain w passive stretching and manual resistance
how does rectus femoris musculotendon injury occur?
- acute/trauma at junction (kicking, sprinting)
- overuse
what is the clinical presentation of rectus femoris musculotendon ?
- pain w palpation
- pain with passive stretching and manual resistance
how adductor iliopsoas musculotendon injury occur?
- acute/trauma at junction (kicking, change of direction)
- overuse
risk factors:
- redcued adductor strength
- reduced abdominal strength
- ab/adductor imbalance
- decreased hip IR
what is the clinical presentation of adductor musculotendon ?
-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
what is rehab for the adductor musculotendon?
- pain/inflamm management
- add/abductor, abdominal strength
- muscle flexilbity and joint mob
- NM coordination/biomech
what is the prognosis for adductor musculotendon?
good
75% athletes return w exercise approach
4-8 weeks acute
6 months chronic
who is likely to get athletic pubalgia?
M>F
running, kicking, cutting, change of direction, accel/decel
why does athletic pubalgia occur?
- 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
what is the clinical presentation of athletic pubalgia?
- deep lower abdominal or inguinal pain with exertion (cough, sneeze, sitting up ) possible sensory disruption
- deeper, more intense than adductor or psoas strain
what are the 5 signs of athletic pubalgia?
- subjective complaint of deep groin/lower abdominal pain
- exacerbated with exertion (sprint, cut, sit up) ; relieved with rest
- palapable tenderness over pubic ramus at insertion of RA and or conjoined tendon (pubic tubercule, abdominal insertions) (no palpable hernia)
- pain wiht resisted adduction at 0, 45, 90 degrees of hip flexion
- pain w resisted abdominal curl up
may present w adductor and HF weakness w dynamic mvoement
what is the prognosis of athletic pubalgia?
significant improvement with 6-8 weeks of PT
what is the 4 phase rehab protocolr for athletic pubalgia?
- week 1-2: tone reduction and tissue extensibility
- week 3-4: abdominal muscle strenghtening
- week 5: functional activities initiated
- week 6: return to sport activities and week 10-12: return to comp
note: cue breathing throughout to avoid valsalva
who is likely to get pubic stress syndrome?
- athlete w high-stress forces transferred through pelvis and pubic symph (kicking, accel/decel, change in direction)
- pregnancy, pelvic trauma, pelvic surgery
why does pubic stress syndrome occur?
- overuse/ sheer injury
- pubic bone stress= inflammation of pubic bones
risk factors:
- reduced hip abduction and abdominal strength
- limited hip IR ROM
what is the clinical presentation of pubic stress syndrome?
-pain in pubic symphysis
what is the prognosis of pubic stress syndrome?
up to 6 months prior to preinjury level
what is rehab for pubic stress syndrome?
- activity modification, ice, NSAIDs
- strength/coordination of hip rotators, flexors, adductors , abdominals
- flexiblity/mobility (hip, thorax)
- functional movement retraining
who is likely to get FAI?
pincer: female: overcoverage
cam: male: acetabular retroversion
mixed: most common : carilage abrasion
what happens with a FAI?
- hip condition causing groin pain and impaired aciyvity
- history of childhood hip diseaes; fractures
- repetivie motion= continuous insult
what are the subjective complaints of FAI?
-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
what are the objective findings of FAI?
- 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
what are the stages of rehab for FAI?
stage 1: pain control
stage 2: muscle flexilibty
stage 3: normalize ROM
who is likely to have a labral tear?
-70% asymptomatic
-22-55% groin pain
20% athletes
prevalance increases with age 88%> 30
why does a labral tear occur?
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
what are risk factors for a labral tear?
- perthes disease
- previous trauma
- SCFE
- FAI
- reptitive HF or pivtiong (hocket, soccer, football, dance, running
what does the labrum do?
- stabilibty
- proprioception
- force transduction buffer
what are the subjective complaints of a labral tear?
groin pain (dull or sharp) \+/- click
what are the objective findings of a labral tear?
- clicking
- provocation of FADIR, FABER, fitzgerald
- impairments: movement coordination, ROM, muscle tone
what is the prognosis of a labral tear?
- vascular
- prolonged recovery= 8 months
what is rehab for a labral tear?
- no gold standard
- education
- manual therapy: lumbopelvic and hip (manipulation included)
- exercise: strenghten glutes, lumbar, adductors, rotators
what are the phases of labral tear rehab?
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
