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MSK 1 > Hip Classification/Diagnosis > Flashcards

Hip Classification/Diagnosis Flashcards

1
Q

Viscerogenic pain that can refer to hip joint

A
  • abdominal aortic aneurysm
  • iliopsoas abcess
  • appendicitis
  • peritonitis
  • ischemic bowel
  • kidney
  • GI system
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2
Q

Adductor muscle strain

A

-pain in the groin region

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3
Q

Hamstring muscle strain

A

-pain in the posterior thigh; strain near the origin at the ischial tuberosity may yield buttock pain

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4
Q

Gluteus medius strain

A

-pain near the greater trochanter

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5
Q

Snapping Hip Syndrome Body Chart/Location of Symptoms

A

-not painful at rest, usually felt with functional active use of the muscle

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6
Q

Greater Trochanteric Bursitis Body Chart/Location of Symptoms

A

-pain over the lateral hip may radiate into a C shape into the anterior/posterior regions

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7
Q

Iliopectineal Bursitis Body Chart/Location of Symptoms

A

-anterior hip pain with hip flexion & extension (must rule out other pathologies in this region); pain referral into anterior thigh & patellar region

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8
Q

FAI/Labral Tear Body Chart/Location of Symptoms

A

-Commonly felt in the anterior, superior region of the hip; complains of anterior hip pain; groin pain; can radiate to lateral thigh

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9
Q

DJD/OA Body Chart/Location of Symptoms

A
  • groin, greater trochanter pain; anterior thigh & medial knee pain
  • deep ache, stiffness
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10
Q

Piriformis Syndrome Body Chart/Location of Symptoms

A

-pain or spasm in posterior buttocks; shooting, burning pain in buttocks; down the back of the leg

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11
Q

Avascular Necrosis Body Chart/Location of Symptoms

A
  • pain in proximal thigh or buttocks; may radiate to medial knee
  • ache, stiffness
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12
Q

Slipped Capital Femoral Epiphysis Body Chart/Location of Symptoms

A

-pain in the hip; lower thigh, anterior thigh, vague pain in the supra-patellar region, groin with no mechanism of injury

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13
Q

Legg-Calve Perthe’s Disease Body Chart/Location of Symptoms

A

-anterior thigh pain; can refer to knee, groin

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14
Q

Agg factors for muscle strain

A

-running, sit to stand, squatting, single leg stance, jumping

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15
Q

Snapping Hip Syndrome agg factors

A

-hip flexion, hip adduction

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16
Q

Bursitis agg factors

A

-walking, lying with pressure over area, hip adduction

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17
Q

FAI/Labral tear agg factors

A

-running, twisting

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18
Q

DJD/OA agg factors

A

-stiff in the morning getting out of bed, walking, stairs, sit to stand

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19
Q

Piriformis Syndrome agg factors

A

-walking, crossing of legs, prolong sitting

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20
Q

Avascular necrosis agg factors

A

-walking, standing, crossing legs

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21
Q

Slipped capital femoral epiphysis agg factors

A

-walking (antalgic gait)

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22
Q

Legg-Calve Perthe’s Disease agg factors

A

-walking (antalgic gait)

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23
Q

Neurodynamic considerations for slump

A

-getting in or out of a car, taking a bath, kicking a football, prolonged sitting

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24
Q

Neurodynamic considerations for SLR

A

-any activity that includes the leg extended (gait, kicking)

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25
Q

Neurodynamic considerations for PKB

A

-any activity in which the knee is bent toward the buttocks, such as hurdling

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26
Q

Neurodynamic considerations for a 24 hour pattern of hip pain

A

-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

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27
Q

Ease factors for muscle strain

A

-NSAIDS, ice, rest, soft tissue massage

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28
Q

Snapping Hip Syndrome ease factors

A

-stretching, avoiding provocative movements

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29
Q

Bursitis ease factors

A

-NSAIDS

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30
Q

FAI/Labral tear ease factors

A

-rest, non-weight bearing

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31
Q

Ease factors for DJD/OA

A

-rest, NSAIDS, use of assistive device, AROM

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32
Q

Ease factors for piriformis syndrome

A

-soft tissue massage

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33
Q

Avascular necrosis ease factors

A

-NSAIDS sometimes are effective; rest

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34
Q

Slipped capital femoral epiphysis ease factors

A

-rest

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35
Q

Legg-Calve Perthe’s Disease ease factors

A

-rest

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36
Q

History of muscle strain in the hip

A

-over dominance of the antagonist muscle (i.e. quadriceps > hamstrings); repetitive trauma or overuse of the muscle

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37
Q

Snapping hip syndrome external cause (history)

A

-snapping of the ITB or gluteus maximus over the greater trochanter

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38
Q

Snapping hip syndrome internal cause (history)

A

-snapping iliopsoas tendon over iliopectineal eminence

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39
Q

Snapping hip syndrome history

A
  • also called “ITB subluxation or iliopsoas syndrome”
  • 15-40 years old, females more affected than males
  • increased varus angle at the hip
40
Q

History of bursitis of the hip

A
  • tightness in the ITB

- weakness of gluteal muscles (glue medium, glute minimus, maximus)

41
Q

Iliopectineal bursitis history

A

-anterior groin pain provoked with sagittal plane movements

42
Q

Trochanteric bursitis history

A

-women > men; RA

43
Q

FAI/Labral tear history

A
  • 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
44
Q

Primary history of DJD/OA

A

-idiopathic

45
Q

Secondary history of DJD/OA

A

-injury, disease, abnormal biomechanics, FAI

46
Q

History of DJD/OA

A
  • overweight, leg length discrepancy, family history of OA, age
  • c/o stiffness in the morning; better with movement
  • increased sx in weight-bearing
47
Q

History of piriformis syndrome

A

-overuse, tightness in the hip external rotators

48
Q

Avascular necrosis history

A
  • trauma, steroids, alcohol
  • may be congenital
  • idiopathic: 30-60 y/o males
49
Q

Slipped capital femoral epiphysis history

A
  • males 10-17
  • females 8-15
  • males > females
  • obesity
  • adductor spasm, quad atrophy, decreased internal/external rotation
50
Q

Legg-Calve Perthe’s Disease history

A
  • 2-13 y/o
  • males > females
  • no hx of trauma
51
Q

Neurodynamic considerations in history of hip pain/trauma

A
  • 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
52
Q

Neurodynamic testing for hip muscle strain

A
  • PKB, + hip ext, + hip abd + hip lateral rotation (obturator)
  • SLR + DF (tibial)
  • PKB + hip ext + hip adduction (lat fem cutaneous)
53
Q

Snapping hip syndrome neurodynamic testing

A

Neg

check PKB or SLR

54
Q

FAI/Labral tear neurodynamic testing

A

Neg

check PKB

55
Q

Neurodynamic testing for DJD/OA

A

Neg

Check PKB & PKB + hip ext + hip adduction

56
Q

Piriformis syndrome neurodynamic testing

A
  • Slump

- SLR

57
Q

Avascular necrosis neurodynamic testing

A

Neg

check PKB

58
Q

Neurodynamic testing for slipped capital femoral epiphysis

A

Neg

59
Q

Legg-Calve Perthe’s Disease neurodynamic testing

A

Neg

60
Q

Which hip disorder could present with signs/sx indicative of performing a neurological exam?

A

-piriformis syndrome

61
Q

Hip muscle strain OE exam

A
  • pain in the direction that the muscle shortens (concentric)
  • pain in the direction that the muscle lengthens (eccentric)
62
Q

Adductor muscle strain OE findings

A

-pain with adduction, abduction of the thigh

63
Q

Hamstrings muscle strain OE findings

A

-hip extension + knee flexion, hip flexion + knee extension

64
Q

Gluteus medius muscle strain OE findings

A

-hip abduction, hip adduction

65
Q

OE exam findings with snapping hip syndrome

A
  • passive IR & ER of the hip

- hip adduction

66
Q

Greater trochanteric bursitis OE exam findings

A

-hip abduction, hip flexion, hip adduction, external rotation

67
Q

Iliopectineal bursitis OE exam findings

A

-hip flexion, hip extension

68
Q

FAI/Labral tear OE exam findings

A

-flexion, adduction, IR

69
Q

OE exam findings for hip DJD/OA

A

-capsular pattern is present (flexion = abduction = IR)

70
Q

Piriformis syndrome OE exam findings

A

-external rotation, internal rotation

71
Q

OE exam findings for avascular necrosis

A

-limited ROM all directions, active & passive

72
Q

Slipped capital femoral epiphysis OE exam findings

A
  • pain in extreme motion
  • limited IR, abduction, flexion
  • ER of hip with hip flexion
73
Q

Legg-Calve Perthe’s Disease OE exam

A

-limited abduction & extension, IR

74
Q

Special tests for muscle strain of the hip

A

none

75
Q

Snapping hip syndrome special tests

A

-can try GT Bursitis test to see if reproduction of the snapping occurs

76
Q

Bursitis special tests

A

-greater trochanteric bursitis test, OBER

77
Q

FAI/Labral tear special tests

A
  • FADDIR (SN = 96-100; SP = poor)
  • Scour
  • FABER (SN = 57; SP = 71) could be (+)
78
Q

DJD/OA special tests

A
  • Scour (hard or abnormal end feels)

- FABER

79
Q

Piriformis syndrome special tests

A

-FADDIR

80
Q

Special tests for avascular necrosis

A

none

81
Q

Palpation findings for muscle strain of the hip

A

-pain to palpation over the strain site at the muscle; muscle guarding

82
Q

Snapping hip syndrome palpation findings

A

-tenderness to palpation over the ITB, lateral glute max, greater trochanter bursa

83
Q

Bursitis palpation findings

A

-painful palpation over the GT or deep hip flexor region

84
Q

FAI/Labral tear palpation findings

A

-compression & IR/ER through the joint; cannot palpate the labrum directly

85
Q

Hip DJD/OA palpation findings

A

-compression through the joint

86
Q

Piriformis syndrome palpation findings

A

-compression over the piriformis muscle to reproduce symptoms

87
Q

Palpation findings for slipped capital femoral epiphysis

A

-quadriceps atrophy, short limb, adductor spasm

88
Q

Palpation findings for Legg-Calve Perthe’s Disease

A

-short limb, atrophy of thigh muscles, higher greater trochanter

89
Q

Physical outcome measure for hip disorders

A

-WOMAC for arthritis

90
Q

Pathological considerations for arthritis

A

-capsular pattern is typically present but resisted movements may not hurt. Joint mobilization is often used with positive effects in the presence of arthritis

91
Q

Hip Degenerative Joint Disease (DJD) pathological considerations

A
  • 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.
92
Q

Shock Loading

A
  • 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
93
Q

Pathological considerations for hip dislocation

A
  • 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
94
Q

Total hip arthroplasty revision pathological considerations

A

-grade II mobilizations were effective in controlling hip pain following THA revision (in case report by Howard & Levitsky)

95
Q

Pathological considerations for hip ROM & back pain

A

-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

96
Q

Hip mobilization for knee OA pathological considerations

A

-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

MSK 1 (15 decks)

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