Hip Classification/Diagnosis Flashcards
Viscerogenic pain that can refer to hip joint
- abdominal aortic aneurysm
- iliopsoas abcess
- appendicitis
- peritonitis
- ischemic bowel
- kidney
- GI system
Adductor muscle strain
-pain in the groin region
Hamstring muscle strain
-pain in the posterior thigh; strain near the origin at the ischial tuberosity may yield buttock pain
Gluteus medius strain
-pain near the greater trochanter
Snapping Hip Syndrome Body Chart/Location of Symptoms
-not painful at rest, usually felt with functional active use of the muscle
Greater Trochanteric Bursitis Body Chart/Location of Symptoms
-pain over the lateral hip may radiate into a C shape into the anterior/posterior regions
Iliopectineal Bursitis Body Chart/Location of Symptoms
-anterior hip pain with hip flexion & extension (must rule out other pathologies in this region); pain referral into anterior thigh & patellar region
FAI/Labral Tear Body Chart/Location of Symptoms
-Commonly felt in the anterior, superior region of the hip; complains of anterior hip pain; groin pain; can radiate to lateral thigh
DJD/OA Body Chart/Location of Symptoms
- groin, greater trochanter pain; anterior thigh & medial knee pain
- deep ache, stiffness
Piriformis Syndrome Body Chart/Location of Symptoms
-pain or spasm in posterior buttocks; shooting, burning pain in buttocks; down the back of the leg
Avascular Necrosis Body Chart/Location of Symptoms
- pain in proximal thigh or buttocks; may radiate to medial knee
- ache, stiffness
Slipped Capital Femoral Epiphysis Body Chart/Location of Symptoms
-pain in the hip; lower thigh, anterior thigh, vague pain in the supra-patellar region, groin with no mechanism of injury
Legg-Calve Perthe’s Disease Body Chart/Location of Symptoms
-anterior thigh pain; can refer to knee, groin
Agg factors for muscle strain
-running, sit to stand, squatting, single leg stance, jumping
Snapping Hip Syndrome agg factors
-hip flexion, hip adduction
Bursitis agg factors
-walking, lying with pressure over area, hip adduction
FAI/Labral tear agg factors
-running, twisting
DJD/OA agg factors
-stiff in the morning getting out of bed, walking, stairs, sit to stand
Piriformis Syndrome agg factors
-walking, crossing of legs, prolong sitting
Avascular necrosis agg factors
-walking, standing, crossing legs
Slipped capital femoral epiphysis agg factors
-walking (antalgic gait)
Legg-Calve Perthe’s Disease agg factors
-walking (antalgic gait)
Neurodynamic considerations for slump
-getting in or out of a car, taking a bath, kicking a football, prolonged sitting
Neurodynamic considerations for SLR
-any activity that includes the leg extended (gait, kicking)
Neurodynamic considerations for PKB
-any activity in which the knee is bent toward the buttocks, such as hurdling
Neurodynamic considerations for a 24 hour pattern of hip pain
-may be worse at night (posture), worse in AM due to night position or worse at end of day - latent effect from a sustained posture or repetitive activity
Ease factors for muscle strain
-NSAIDS, ice, rest, soft tissue massage
Snapping Hip Syndrome ease factors
-stretching, avoiding provocative movements
Bursitis ease factors
-NSAIDS
FAI/Labral tear ease factors
-rest, non-weight bearing
Ease factors for DJD/OA
-rest, NSAIDS, use of assistive device, AROM
Ease factors for piriformis syndrome
-soft tissue massage
Avascular necrosis ease factors
-NSAIDS sometimes are effective; rest
Slipped capital femoral epiphysis ease factors
-rest
Legg-Calve Perthe’s Disease ease factors
-rest
History of muscle strain in the hip
-over dominance of the antagonist muscle (i.e. quadriceps > hamstrings); repetitive trauma or overuse of the muscle
Snapping hip syndrome external cause (history)
-snapping of the ITB or gluteus maximus over the greater trochanter
Snapping hip syndrome internal cause (history)
-snapping iliopsoas tendon over iliopectineal eminence
Snapping hip syndrome history
- also called “ITB subluxation or iliopsoas syndrome”
- 15-40 years old, females more affected than males
- increased varus angle at the hip
History of bursitis of the hip
- tightness in the ITB
- weakness of gluteal muscles (glue medium, glute minimus, maximus)
Iliopectineal bursitis history
-anterior groin pain provoked with sagittal plane movements
Trochanteric bursitis history
-women > men; RA
FAI/Labral tear history
- trauma or gradual overuse, sports with twisting, sports with repetitive running (endurance); hip dysplasia (femoral acetabular impingement)
- clicking, popping, buckling, locking
- compression through the joint increases symptoms
- 20% of athletes with groin pain
Primary history of DJD/OA
-idiopathic
Secondary history of DJD/OA
-injury, disease, abnormal biomechanics, FAI
History of DJD/OA
- overweight, leg length discrepancy, family history of OA, age
- c/o stiffness in the morning; better with movement
- increased sx in weight-bearing
History of piriformis syndrome
-overuse, tightness in the hip external rotators
Avascular necrosis history
- trauma, steroids, alcohol
- may be congenital
- idiopathic: 30-60 y/o males
Slipped capital femoral epiphysis history
- males 10-17
- females 8-15
- males > females
- obesity
- adductor spasm, quad atrophy, decreased internal/external rotation
Legg-Calve Perthe’s Disease history
- 2-13 y/o
- males > females
- no hx of trauma
Neurodynamic considerations in history of hip pain/trauma
- history of postsurgical (neuromeningial invasion), history of trauma (may be long time ago), or predisposing occupation (one that requires repetitive activity
- neural complaints associated with hamstring strains, lateral knee & ankle pain, plantar fasciitis, medial foot pain in conjunction with running activities, calcanea pain, interdigital neuromas; lumbar or thoracic radiculopathy
Neurodynamic testing for hip muscle strain
- PKB, + hip ext, + hip abd + hip lateral rotation (obturator)
- SLR + DF (tibial)
- PKB + hip ext + hip adduction (lat fem cutaneous)
Snapping hip syndrome neurodynamic testing
Neg
check PKB or SLR
FAI/Labral tear neurodynamic testing
Neg
check PKB
Neurodynamic testing for DJD/OA
Neg
Check PKB & PKB + hip ext + hip adduction
Piriformis syndrome neurodynamic testing
- Slump
- SLR
Avascular necrosis neurodynamic testing
Neg
check PKB
Neurodynamic testing for slipped capital femoral epiphysis
Neg
Legg-Calve Perthe’s Disease neurodynamic testing
Neg
Which hip disorder could present with signs/sx indicative of performing a neurological exam?
-piriformis syndrome
Hip muscle strain OE exam
- pain in the direction that the muscle shortens (concentric)
- pain in the direction that the muscle lengthens (eccentric)
Adductor muscle strain OE findings
-pain with adduction, abduction of the thigh
Hamstrings muscle strain OE findings
-hip extension + knee flexion, hip flexion + knee extension
Gluteus medius muscle strain OE findings
-hip abduction, hip adduction
OE exam findings with snapping hip syndrome
- passive IR & ER of the hip
- hip adduction
Greater trochanteric bursitis OE exam findings
-hip abduction, hip flexion, hip adduction, external rotation
Iliopectineal bursitis OE exam findings
-hip flexion, hip extension
FAI/Labral tear OE exam findings
-flexion, adduction, IR
OE exam findings for hip DJD/OA
-capsular pattern is present (flexion = abduction = IR)
Piriformis syndrome OE exam findings
-external rotation, internal rotation
OE exam findings for avascular necrosis
-limited ROM all directions, active & passive
Slipped capital femoral epiphysis OE exam findings
- pain in extreme motion
- limited IR, abduction, flexion
- ER of hip with hip flexion
Legg-Calve Perthe’s Disease OE exam
-limited abduction & extension, IR
Special tests for muscle strain of the hip
none
Snapping hip syndrome special tests
-can try GT Bursitis test to see if reproduction of the snapping occurs
Bursitis special tests
-greater trochanteric bursitis test, OBER
FAI/Labral tear special tests
- FADDIR (SN = 96-100; SP = poor)
- Scour
- FABER (SN = 57; SP = 71) could be (+)
DJD/OA special tests
- Scour (hard or abnormal end feels)
- FABER
Piriformis syndrome special tests
-FADDIR
Special tests for avascular necrosis
none
Palpation findings for muscle strain of the hip
-pain to palpation over the strain site at the muscle; muscle guarding
Snapping hip syndrome palpation findings
-tenderness to palpation over the ITB, lateral glute max, greater trochanter bursa
Bursitis palpation findings
-painful palpation over the GT or deep hip flexor region
FAI/Labral tear palpation findings
-compression & IR/ER through the joint; cannot palpate the labrum directly
Hip DJD/OA palpation findings
-compression through the joint
Piriformis syndrome palpation findings
-compression over the piriformis muscle to reproduce symptoms
Palpation findings for slipped capital femoral epiphysis
-quadriceps atrophy, short limb, adductor spasm
Palpation findings for Legg-Calve Perthe’s Disease
-short limb, atrophy of thigh muscles, higher greater trochanter
Physical outcome measure for hip disorders
-WOMAC for arthritis
Pathological considerations for arthritis
-capsular pattern is typically present but resisted movements may not hurt. Joint mobilization is often used with positive effects in the presence of arthritis
Hip Degenerative Joint Disease (DJD) pathological considerations
- capsular tightness may be a condition that accelerates hip deg.
- Weight bearing is post to sup: degeneration occurs on the periphery of this small surface
- at push-off gait, hip is brought into a position of ext, int. rot., & abduction, taking up most of the slack in the joint capsule by twisting the capsule on itself. Normal twisting of capsule, as well as weight bearing, creates a compression of joint surfaces.
Shock Loading
- weight bearing normally is loaded onto the joint progressively, rather than all at once (shock loading)
- shock loading occurs if the hip joint capsule loses its extensibility & may be one of the most important factors in fatigue of the articular cartilage. Pain on weight bearing may be due to the strain of the capsule-ligamentous structures as they pull prematurely tight with each step
Pathological considerations for hip dislocation
- normal hip joint rarely dislocates, when the hip does dislocate it usually occurs in the posterior direction since the hip is weakest posteriorly & strongest anteriorly/superiorly.
- The motions that contribute to hip dislocation are flexion (since the ligaments are lax), adduction & medial rotation (since the joint is non-congruent when adducted & medially rotated). Compare this combination of motions to the motions that create the bony close packed position: they’re almost completely opposite
Total hip arthroplasty revision pathological considerations
-grade II mobilizations were effective in controlling hip pain following THA revision (in case report by Howard & Levitsky)
Pathological considerations for hip ROM & back pain
-several authors have discovered a relationship between impaired ROM & lumbosacral pain. Manipulation of the lumbosacral spine has been shown to reduce quadriceps inhibition, and, in another study, to reduce anterior hip & groin pain
Hip mobilization for knee OA pathological considerations
-Currier et al identified a clinical prediction rule for using hip mobilization (each pt received 4 procedures: caudal glide, A-P glide, P-A glide, & P-A glide with flexion, abduction & lateral rotation) to treat knee osteoarthritis
