Hip APTA (2) Flashcards
1
Q
What is the standard demographic affected by slipped capital femoral epiphysis (SCFE)?
A
- usually male (2:1) between 13-15yo, otherwise female between 11-15 yo. Essentially during pubescent years
- frequently w/ males who are overweight and underdeveloped
2
Q
A 13 yo female presents with R hip pain that is in a noncapsular pattern. What is primary in the differential?
A
- SCFE
3
Q
What are the odds a pt with SCFE will get it in the other hip?
A
- 30% chance of asynchronous B involvement
4
Q
T of F;
SCFE will develop acutely.
A
- F-ish. The slipping event can occur gradually or more acutely
5
Q
What does SCFE initially present as?
A
- if acute, usually significant groin pain that prohibits weight bearing in functional activities
- if more gradual, starts as mild groin pain or anterior knee pain
6
Q
With slipping that advances in SCFE, what may be found clinically?
A
- muscle guarding
- limited IR with increased ER
- and obligatory abduction and ER (Drehmann sign)
- Trendelenburg
7
Q
What is Drehmann sign?
A
- obligatory abduction and ER with passive hip flexion
- associated with SCFE and FAI
8
Q
What structural dysfunction may be associated with SCFE?
A
- cam type FAI
9
Q
What is the common treatment for SCFE?
A
- surgical pinning
- 4-6 weeks of partial WB with AD until callus formation
10
Q
Avascular necrosis is associated with which diagnoses?
A
- in children, LCPD and SCFE
- in adults, is less clear
11
Q
What type of imaging may be helpful in early recognition of LCPD?
A
- CT
12
Q
What are the 4 stages of LCPD?
A
- stage I: 25% of the femoral head is involved and the CFJ has increased articular space
- Stage II: 50% of the femoral head is involved; crescent sign (half moon), with intact anterior pillar of femoral head
- Stage III: 75% femoral head involvement with progressive femoral head collapse
- Stage IV: 100% femoral head and plate involvement
13
Q
What is the primary concern for management of LCPD?
A
- prevention of further collapse and displacement
14
Q
Bracing strategies for LCPD typically involve ensuring the pt is able to maintain what two ROMs?
A
- abduction and IR
15
Q
Exercise for LCPD is typically targeting _______ to promote _________.
A
- abduction to promote containment
16
Q
Are noncontainment strategies appropriate for LCPD management?
A
- probably not. Are associated with poor articular outcomes in 68% of adults who were diagnosed with LCPD as a child
17
Q
What are potential surgical management procedures for LCPD?
A
- innominate osteotomy (Salter procedure; increases acetabular coverage of the femoral head)
- acetabular rotation osteotomy (Chiari procedure)
- medial or lateral femoral wedge derotation osteotomy
18
Q
What is appropriate management post osteotomy for LCPD?
What is a precaution following the procedure?
A
- first few days post-op can do passive ROM
- active hip flx and abduction should be avoided for the first 40 days post-op
19
Q
What is an appropriate intervention to help mitigate risk of hip flx contracture for post-op osteotomy pts?
A
- prone positioning
20
Q
How long can PWB be expected to be maintained post-op osteotomy management for LCPD?
A
- 3-6 months
21
Q
How long can avascular necrosis of the hip in adults take to develop?
A
- can be acute, or can take months to years to develop
22
Q
What are the typical signs/symptoms for an avascular necrosis of the hip in an adult?
A
- gradual increase in groin pain, with possible ROM limitations
- as it progresses, the symptoms increase, as well as potential for crepitus, with pain referral to glutes, anterior thigh, and knee
23
Q
What are some minimally nonsurgical treatment options for adult AVN? (7)
A
- bisphosphonates
- anticoagulants
- statins
- vasodilators
- extracorporeal shock wave therapy
- pulsed electromagnetic therapy
- hyperbaric oxygen
24
Q
How long will it be until a pt who has had an osteotomy or core decompression for AVN is able to WBAT?
A
- 3-6 months
25
What treatment option is most likely to improve pain and function for late stage AVN in adults?
- THA
26
What is the clinical triad for a loose body presentation at the hip?
- noncapsular pattern of limitation
- pathological end feel
- sharp, shooting pain plus feeling of giving way that immediately follows the pain
27
What is the gold standard for diagnosing intraarticular loose bodies?
- arthroscopy
| - CT and Xray often underestimates prevalence
28
A pt with hip pain presents with limited/altered end feel at end passive ranges of abduction and ER. What is the dx of concern?
- loose intraarticular bodies
| - common clinical sign, in addition to the clinical triad
29
What is osteochondritis dissecans?
- begins with inflammation of the cartilage and subchondral bone
- The subchondral bone begins to die due to lack of blood flow, which can cause the bone and cartilage above to break off
- Rarely seen in the hip, but if it happens, it most commonly happens in the femoral head
30
T or F;
Osteochondritis dissecans is a loose body of cartilage/subchondral bone that has broken off due to lack of blood supply.
- F;
| - it's the death of the bone/cartilage, but it doesn't always result in a loose body
31
What conditions can result in loose bodies? (3)
- osteochondritis dissecans
- synovial osteochondromatosis (SOCM)
- osteoarthrotic cartilaginous fronds breaking off with friction during movement
- also can be idiopathic
32
How do loose bodies form in synovial osteochondromatosis? (SOCM)
- chondral plaques begin to develop in the synovial tissue, and then can shear off and float within the synovial tissue
- will create multiple loose bodies
33
What are some general red flags for non-orthopaedic process related to hip pain? (10)
- age < 20 or > 50
- previous hx of CA
- trauma
- sacral pain in the absence of trauma
- osteoporosis
- hx of IV drug use
- hx of gastrointestinal, genitourinary, or gynecological infection or inflammation
- systemic signs associated with malignancy (cachexia, fever, night sweats)
- night pain
- pain at rest
34
What is the "sign of the buttock"?
- noncapsular pattern of limitation
- painfully limited passive hip flexion with knee both flexed and extended
- may be indicative of serious pathology in the hip
35
T or F;
Primary tumors of the bone in the pelvis are usually malignant.
- T
| - Less often benign.
36
T or F;
Primary tumors of the bone in the femur are usually malignant.
- F
| - usually benign
37
The most common non-osteogenic malignancies to impact the hip and pelvis include: (5)
- prostate cancer
- breast cancer
- renal cell cancer
- thyroid cancer
- lung carcinomas
38
What is coxa saltans? Is it intra or extraarticular?
- snapping hip syndrome; a pretty broad dx
- can be considered intra or extraarticular
- Intraarticular is caused by the snapping of the iliopsoas tendon over the iliopectineal eminence
- extraarticular is related to thickening at the:
- iliotibial tract at the greater troch
- iliopsoas at the pectin pubis
- glute max fibrosis in the posterior hip
- proximal hamstring at the ischial tuberosity
- adventitious bursal formations at any of the above
39
What movements are typically limited or symptomatic with snapping hip syndrome?
- flexion, ER, or IR
| - walking is often limited
40
Is surgery appropriate for a snapping hip syndrome?
- if persistent, yes it can be managed surgically
41
A pt presents 2 weeks after a trauma, reporting severe initial pain in their groin for a few days, but currently the pain is much better. They have some weakness with hip flexion however.
Avulsion fx is in the differential; but would this indicate a complete or incomplete avulsion?
- more consistent with complete.
| - if incomplete, would expect the pain and weakness to persist at fairly high levels
42
An avulsion fx of which muscle may lead to a concommitent labral tear? What is the shoulder equivalent?
- rectus femoris, due to its periarticular origin
| - thought to be similar to a SLAP tear
43
A pt presents with a dx of avulsion fx as a result of subluxation at the hip. What should be examined given this info?
- look for nerve involvement.
| - increased concern for nerve entrapment/injury following subluxation with avulsion. Probably just the subluxation.
44
What imaging modes are appropriate to identify an avulsion fx?
- MRI
| - US
45
What is the appropriate treatment course for an avulsion fx in the initial 4-6 weeks of dx?
- conservative care (whatever that means)
- and rest
- return to activity is typically as tolerated following the rest period
46
T or F;
Tendopathic changes may be the most common cause of pain in the pubic and medial thigh regions.
- T
47
What muscles would be associated with tendinopathy at the following points:
- ischial tuberosity
- greater trochanter
- AIIS
- ASIS
- iliopectineal eminence
- ischial tuberosity: Hamstrings
- greater trochanter: various glutes
- AIIS: rectus femoris
- ASIS: Sartorius
- iliopectineal eminence: iliopsoas
48
What is the primary characterization of a tendinopathy?
- provocation of pain during a specific pattern of isometric contraction
49
T or F;
Friction massage is appropriate for treatment of a tendinopathy.
- T; although its efficacy has been questioned
50
What are the potential benefits of transverse friction massage for a tendinopathy?
- stimulates fibroblast proliferation/recruitment to promote tissue healing
- stimulates blood flow
- the noxious stimulus (for at least 2 minutes) can result in an analgesic effect that can last for a couple hours to a couple days.
51
What structures are in the differential for generating buttock pain? (9)
- sciatic nerve (piriformis or hamstring syndrome)
- ischial bursitis
- coxafemoral joint
- labral lesion
- trochanteric bursitis
- lumbar disc radiculopathy
- lumbar zygapophyseal joint
- SIJ
- sacrococcygeal joint
52
A pt with buttock pain reports increased pain in sitting vs standing. Of the following pathoanatomical regions, which is this more consistent with:
- Lumbar spine
- L4-S2 neural
- Hamstring syndrome
- Hamstring tendinopathy
- SIJ
- Piriformis syndrome
- Gluteal bursitis
- Gluteal tendinopathy
- Gluteal bursitis (likely quite painful/positive)
- Lumbar spine
- L4-S2 neural
- Hamstring syndrome
- Piriformis syndrome
- Gluteal tendinopathy
53
A pt with buttock pain reports increased pain with standing/walking/running. Of the following pathoanatomical regions, which is this more consistent with:
- Lumbar spine
- L4-S2 neural
- Hamstring syndrome
- Hamstring tendinopathy
- SIJ
- Piriformis syndrome
- Gluteal bursitis
- Gluteal tendinopathy
- SIJ (likely significantly irritable)
- Hamstring syndrome (more with walk/run)
- Piriformis syndrome
- L4-S2 neural (variable)
- Hamstring tendinopathy (variable)
54
A pt with buttock pain reports increased pain with trunk motions. Of the following pathoanatomical regions, which is this more consistent with and a very important diagnostic criteria to meet:
- Lumbar spine
- L4-S2 neural
- Hamstring syndrome
- Hamstring tendinopathy
- SIJ
- Piriformis syndrome
- Gluteal bursitis
- Gluteal tendinopathy
- Lumbar spine (possibly)
55
A pt with buttock pain reports increased pain with trunk flexion with Neri (chin tuck). Of the following pathoanatomical regions, which is this more consistent with:
- Lumbar spine
- L4-S2 neural
- Hamstring syndrome
- Hamstring tendinopathy
- SIJ
- Piriformis syndrome
- Gluteal bursitis
- Gluteal tendinopathy
- L4-S2 neural
| - Lumbar spine (variable)
56
A pt with buttock pain reports increased pain with SLR and/or slump. Of the following pathoanatomical regions, which is this more consistent with:
- Lumbar spine
- L4-S2 neural
- Hamstring syndrome
- Hamstring tendinopathy
- SIJ
- Piriformis syndrome
- Gluteal bursitis
- Gluteal tendinopathy
- L4-S2 neural
- Hamstring syndrome
- Piriformis syndrome
- Lumbar spine (possibly)
57
A pt with buttock pain reports increased pain with SIJ provocation tests. Of the following pathoanatomical regions, which is this more consistent with:
- Lumbar spine
- L4-S2 neural
- Hamstring syndrome
- Hamstring tendinopathy
- SIJ
- Piriformis syndrome
- Gluteal bursitis
- Gluteal tendinopathy
- SIJ
58
A pt with buttock pain reports increased pain with resisted knee flexion. Of the following pathoanatomical regions, which is this more consistent with:
- Lumbar spine
- L4-S2 neural
- Hamstring syndrome
- Hamstring tendinopathy
- SIJ
- Piriformis syndrome
- Gluteal bursitis
- Gluteal tendinopathy
- Hamstring syndrome (only in active SLR)
| - Hamstring tendinopathy
59
A pt's buttock pain is aggravated with with the FADIR and palpation. What is the most likely pathoanatomical dx?
- piriformis syndrome
60
A pt's buttock pain is significantly aggravated with passive flexion, adduction, internal rotation, or external rotation, and with palpation. What is the most likely pathoanatomical dx?
- gluteal bursitis
61
A pt's buttock pain is significantly aggravated with resisted IR in flexion, adduction, and external rotation, and with palpation. What is the most likely pathoanatomical dx?
- gluteal tendinopathy
62
T or F;
MRI and CT are of limited diagnostic value for SI disease.
- T
63
A pt presents with L buttock pain that worsens with trunk flexion, extension and R SB, as well as provocation of pain with palpation of the erector spinae. WB tests and SIJ provocation tests are negative. What is the most likely dx?
- at this point, lumbar spine referral
64
Describe how discogenic pain can be radicular or nonradicular in nature?
- protrusion, prolapse or extrusion may directly compress the nerve root, which would create a dermatomal pattern of pain
- Otherwise, the inflammatory response due to the disc irritation may created referred aching pain to the buttock region
65
What is the overarching theme for buttock pain management from a lumbar disorder?
- regulating disc hydration
| - repetitive movements, traction
66
T or F;
Axial lumbar traction has been show to reduce disc protrusion and motor function impairment associated with radiculopathy, as well as low back/radicular symptoms.
- T
67
Where is the sciatic nerve thought to be entrapped with hamstring syndrome?
- near the ischial tuberosity in between bands of fibrous tissue from the hamstrings origin as the sciatic nerve courses laterally
68
What demographics or preceding episodes are often associated with a hamstring syndrome?
- distance runners, sprinters, and jumpers
- often preceded by hamstring injury
- hx of LBP (not as helpful) or surgery
69
What is the typical pattern of pain experienced by those with hamstring syndrome?
- pain localized to the ischial tuberosity
| - begins gradually and worsens with persistent physical activity
70
What is the "clinical triad" for hamstring syndrome?
- increased pain with seated resisted knee flexion with hip flexed to 90* with full knee extension; provocation may be increased with ankle/foot dorsiflexion
- painfree resisted knee flexion with hip in neutral (prone)
- TTP at the ischial tuberosity
71
T or F;
Stretching is an appropriate intervention for hamstring syndrome.
- F
| - does not alleviate symptoms and often can be aggravating
72
What is appropriate management for hamstring syndrome?
- not stretching the hamstrings
- sitting on a wedge that is thicker dorsally
- gentle neural mobilization/manipulation of the LE that is distally initiated at the knee or ankle/foot
- some recommend exam/retraining of pelvic floor musculature in women
- surgical release is appropriate in recalcitrant cases
73
Where is the sciatic nerve thought to be entrapped with piriformis syndrome?
- under the inferior edge of the piriformis as the nerve travels caudally
- due to compression for the 14% of people who have that nerve running through the piriformis
- venous aneurysm compressing the nerve
74
What are typical preceding episodes or activities that are associated with piriformis syndrome?
- general overuse that places the nerve under tension; e.g., running
- blunt trauma to the buttock region
75
What does the pain with piriformis syndrome typically look like?
- increased pain in the buttock with walking, decreased with sitting
- can refer to the posterior thigh and knee when more severe
76
Which glute may become atrophied with a piriformis syndrome? Which is spared?
- Glute max due to the inferior gluteal nerve being compressed
- Glute med is spared with its superior gluteal nerve
77
What position is likely to produce irritation with piriformis syndrome?
- FADIR (FAIR); flexion, adduction, internal rotation
78
What is appropriate management for piriformis syndrome?
- not stretching the hamstrings
- avoiding sitting on hard surfaces
- gentle neural mobilization/manipulation of the LE that is distally initiated at the knee or ankle/foot
79
Are corticosteroid injections appropriate for piriformis syndrome?
- yes they can be to reduce pain and improve piriformis activity
80
What are the primary differences clinically between a hamstring tendinopathy and hamstring syndrome?
- pain likely not provoked with sitting or dural tension tests
- resistive knee flexion will be provocative in both hip flexed and extended positions
81
What is appropriate management for a hamstring tendinopathy?
- transverse friction massage, gentle stretching of the hamstring, reduced activity/loading
- gradual eccentric activation, strengthening, and return to activity
82
What are potential causes for lateral buttock pain?
- greater troch stress fracture
- loosened prosthesis
- trochanteric bursitis
83
What are the primary clinical findings to diagnose a trochanteric bursitis?
- no dural tension provocation
- TTP at greater troch
- provocation with hip flexion, adduction, and IR/ER passively
84
What is a primary differentiation for glute tendinopathy and trochanteric bursitis?
- glute tendinopathy won't be as provoked by passive movements; more provoked with resisted IR with hip in flexion, adduction, and ER.
85
T or F;
Corticosteroid injection is appropriate for both glute tendinopathy and bursitis.
- T
86
T or F;
There is no value to transverse friction for a glute bursitis.
- T, but maybe F.
- transverse friction may worsen the pt's symptoms if it's a gluteal bursitis, which is helpful from a diagnostic standpoint. Can be helpful for tendinopathy.
87
A pt has been diagnosed with trochanteric bursitis and it has failed conservative management and the symptoms persist. What is a concern for further dx?
- calcific tendinitis or glute med tear
88
What is the typical presentation/demographic for a glute med tear?
- insidious onset
- pain localized around the greater troch
- more often female
- more often > 50yo
89
What are potential causes for glute med tears?
- friction from the ITB
- OA
- hyperadduction injury
90
What mode of imaging is appropriate to detect glute med tears?
- MRI
91
T or F;
Pts with trochanteric pain always have peritrochanteric T2 abnormalities and are more likely to have abductor tendinopathy on MRI
- T...although maybe an overstatement
92
T or F;
peritrochanteric T2 abnormalities are helpful to diagnose trochanteric pain syndrome.
- F. Often found in asymptomatic individuals
93
What is the Hip Lag Sign?
- designed/validated to detect hip abductor damage
- pt in sidelying with affected leg on top. Examiner stabilizes pelvis. Hip is then passively extended 10*, abducted 20*, and maximally internally rotated while maintaining knee in 45* flexion. Pt then asked to maintain this position. Considered positive if pt not able to maintain the position and the foot drops >10 cm.
94
More centrally located buttock pain may be associated with which bursa?
- ischiogluteal bursa.
95
Sharp burning buttock pain may be associated with what?
- pudendal nerve entrapment within the pudendal canal (sacrotuberous and sacrospinal ligaments), or as it crosses the falciform process of the sacrotuberous ligament
96
What is the clinical presentation for a pudendal nerve entrapment?
- sharp, burning buttock pain with potential for perineal burning pain that worsens with sitting and improves with standing
- may be associated with cycling
97
T or F;
nerve mobilization is not appropriate for pudendal nerve entrapment.
- T; it's not compressed in a spot that can be mobilized directly
98
What are some activity modifications to assist with pudendal nerve entrapment symptoms?
- relaxation of pelvic floor muscles to reduce compression in the perineal area
- sacral sitting pad with perineal cutout
- avoiding deep squatting
- avoiding greater degrees of hip flexion
99
What is a key component of exam/screening with groin pain?
- Bilateral resisted hip adduction
- if provocative, it is diagnostic of sports-related groin pain that is frequently associated with bone marrow edema. This has been found to be valid, specific, and sensitive.
100
What are diagnoses that are positive with resisted hip adduction? (7)
- adductor tendinopathy (acute or chronic)
- rectus abdominis...damage?
- obturator nerve involvement
- osteitis pubis
- ossifying myositis
- symphsitis
- SIJ dysfunction
101
Describe the mechanism for the most common type of groin pain.
- typically increased tendon load during directional changes in sports, then associated with stress shielding in the insertion of the tendon, with the collagen gradually transitioning to mineralized cartilage/bone
102
What is stress shielding?
- avoiding loading of a tendon to avoid irritation. Thought to lead to maladaptive tissue remodeling
103
Adductor longus and brevis tendinopathies are going to be most provoked with resistance of adduction in which position?
- neutral hip
104
Gracilis tendinopathies are going to be most provoked with resistance of adduction in which position?
- neutral hip as well as painful resisted knee flexion
105
Pectineus tendinopathies are going to be most provoked with resistance of what movements in which position?
- resisted hip flexion and hip adduction in 90* hip flexion
106
What can help rule out rectus abdominis involvement in groin pain?
- resisted trunk flexion in supine
| - insertion of the rectus abdominis can be loaded during hip adduction
107
What is general management of groin pain tendinopathy?
- transverse friction
- stretching
- gradual strengthening
108
What is appropriate management if initial conservative management fails for groin pain tendinopathy?
- injections
109
What would be a strong clinical sign for iliopectineal bursitis over a tendinopathy?
- pain with passive hip extension, flexion, and external rotation when the hip is in full flexion (compresses the lesser trochanter against the bursa)
110
What in the subjective or PMH would make you take a closer look at the pubic symphysis as a source of anterior groin pain when that is provoked by resisted adduction?
- pregnancy (hormonal changes)
- athletic microtrauma/overuse
- hip joint limitations (less PMH I guess...)
- RA
- gout
111
When associated with the symphysis, the greatest provocation of groin pain can be provoked in which position?
- resisted hip adduction with the hip in 45* flexion, then alleviated with the same loading, but with a stabilizing strap/force for the pelvic ring
112
What is osteitis pubis? What is the general prognosis?
- pubic bone stress injury, often associated with athletic trauma.
- Conservative treatment often fails, requiring more aggressive management strategies. Prolotherapy has been promising to stimulate healing and strengthening of tissues. Otherwise surgery can be used to stabilize the area, with generally favorable outcomes.
113
Describe the structures impacted with a sports hernia. What are other terms that are equivalent?
- athletic pubalgia or hockey hernia
- essentially an injury to the transversalis fascia, conjoined tendon, and/or internal oblique fibers, causing an inside-out hernia within the dorsal wall of the inguinal canal
114
What is the mechanism that is often associated with athletic pubalgia?
- twisting, turning, or directional changes in speed that cause the hip to move into abduction, adduction, or extension. These ballistic movements can cause shearing at the pubic symphysis which impacts the structures above.
115
Sports hernia is often aggravated by something that does not require hip movement. What is it?
What are some other clinical signs or differentiating features? What is the best imaging mode for diagnosis?
- valsalva, i.e. increased intraabdominal pressure
- resisted double hip adduction is painful
- palpation of adductors is often unprovocative
- US
116
What are the two surgical procedures that are used to manage athletic pubalgia/sports hernia? Are there differences in outcomes? Are the outcomes favorable?
- laprascopic repair and open mesh repair
- authors seem to favor open mesh, but not super convincingly. Also report there is no significant difference per current data.
- outcomes are generally favorable, with 97% returning to sport that have a surgical repair
117
Obturator nerve pain usually happens in the context of what?
- fx of the pelvic ring or acetabulum
- post surgical fibrosis
- can occur with overuse, with vascular changes under a deep fascia that is posterior to the adductor longus and pectineus.
118
What might an overuse obturator n. entrapment patient describe their symptoms as during the subjective?
- deep vague groin pain
| - post-exercise adductor weakness and paresthesia in the medial thigh
119
What conditions may cause groin pain that is not provoked with resisted hip adduction?
- urinary, gynecological, or lymphatic pathologies
| - also, sacroiliitis may refer to the groin and be difficult to reproduce on exam
120
What is the rough percentage of labral lesions that are:
- traumatic
- degenerative
- congenital
- traumatic: 46%
- degenerative: 49%
- congenital: 5%
121
What are some of the closer differential dxs to labral tear that should be ruled out?
- internal snapping hip syndrome
- loose bodies
- cystic changes in the coxafemoral joint
- hip chondromalacia
122
How can intra vs extraarticular symptoms be differentiated?
- intraarticular injection...which we wouldn't do, but it's good to know
123
Where is the labrum more likely to tear? Why?
- anterior superior or posterior superior margins.
- increased mechanical demand
- compromised mechanics
- poor vascular supply
124
T or F;
- a labral tear can serve as a precursor to arthritis
- T
| - labrum provides stability; lack of stability in general breeds OA
125
What are the two types of impingement that may contribute to FAI?
- cam impingement: decreased roundness of the femoral head/neck
- pincer impingement: increased covering of the femoral head by the acetabulum
- FAI can also have a mixed impingement
126
Pincer impingement is usually secondary to what potential structural deviations?
- retroversion; turning back of the acetabulum
- profunda; too deep a socket
- protrusio; femoral head extends into the pelvis
127
What are some of the expected subjective complaints for someone with a labral tear?
- increased pain with sitting, climbing stairs
- possible clicking, locking, or giving way in WB
- pain could be anywhere related to the hip
128
With a labral tear, one would expect what pattern of provocation with passive movement?
- provocation with passive internal rotation in flexion, but not in extension
129
What is the standard approach to management of hip labral tears?
- education; avoid sitting in significant flexion and for longer periods of time. Avoid stairs as possible...(I don't like that)
- open-chain therex
- initially, an AD for ambulation may be appropriate
- cycling at low loading is appropriate
- HVLA mobs/manips may be appropriate if necrotic changes are ruled out
130
Where are common locations for stress fractures of the hip?
- proximal third of the femur and femoral neck
| - pubic ramus
131
What is the expected clinical picture for a stress fracture?
How will it look on exam?
- provocation in weightbearing that is fairly immediate; relieved with removal of loading
- typically clinical exam is negative. Can provoke pain with SL hop or the Fulcrum test (pt sitting, therapist forearm under thigh, then push down on knee, levering proximal femur into pelvis)
132
What types of imaginge are appropriate to detect a stress fracture?
- MRI
| - bone scan
133
What is the pattern of provocation for a rectus femoris tendinopathy?
- resisted knee extension w/ hip in neutral (prone)
| - mild/moderate provocation with hip flexion
134
What is the pattern of provocation for an iliopsoas tendinopathy?
- resisted hip flexion and external rotation
| - not with adduction
135
What may produce a similar pattern of pain/symptoms to an iliopsoas tendinopathy? What is a differentiating characteristic?
- iliopectineal bursitis
| - less likely to be provoked with resisted hip flexion, but will be provoked with passive ER in full flexion
136
Is stretching appropriate for tendinopathy?
- yes...well...at least this author supports it
| - it doesn't seem to be contraindicated at the hip in general
137
A pt was playing football in the backyard and got hit in the L groin about 3 months ago. The pain got a little better, but now feels like it's getting worse, and feels like they can't fully straighten their hip What may be a concern other than fx?
- myositis ossificans of the iliopsoas
| - more likely with trauma
138
How would one test for femoral nerve entrapment at the hip?
- pt in sidelying. Therapist brings hip to full extension, then bends knee to provoke symptoms. Pt then extends neck. If provoked further with head movement, positive
- in general considered positive with provocation of the pt's symptoms, which should be "nerve-y"
139
What nerve is impacted by meralgia paresthetica?
- lateral femoral cutaneous nerve
