hip conditions Flashcards
what are the s&s of AVN in the hip?
deep, dull hip pain
limp/waddling gait
decreased ROM (particularly internal rotation)
what are the possible causes of AVN?
Pancreatitis/pregnancy
Lupus (SLE)
Alcoholism/atherosclerosis
Steroids
Trauma (eg. femoral neck fracture)
Infections/idiopathic (legg-calve perthes’ disease)
Collagen vascular disease
RA/ radiation therapy
Amyloid(osis)
Gout
Sicke cell disease
what are s&s of trochanteric bursitis?
aching lateral hip pain (may radiate to groin and lateral thigh)
what are the findings in the physical exam for trochanteric bursitis
weak hip flexors
tight ITB
PROM: abduction and external rotation painful
RROM: abduction painful
+ve fabere’s test
what are aggravating factors for trochanteric hip bursitis?
prolonged standing
lying on affected side
climbing stairs
running
what are possible treatment options for trochanteric bursitis?
trigger points of affected muscles
Ober’s PIR
hamstring PIR
US or electrical stimulation options
what are s&s of ischial bursitis?
unilateral pain while seated
pain around ischial tuberosity
what are treatment options for ischial bursitis?
trigger point therapy to ischial tuberosity
hamstring PIR
US or electrical stimulation options
what are the s&s of iliopsoas bursitis?
anterior hip and/or groin pain
worse with leg extension
better with flexion-external rotation (fabere position)
what is hip capsulitis?
adhesion within the hip capsule and surrounding structures
what are s&s of hip capsulitis?
insidious, rapid onset of pain and stiffness
pain worse with activity
decreased ROM (flexion-adduction, rotation+hyperextension the earliest loss)
pain settles over several months but stiffness improves more slowly
what is a disordered hip complex?
complex signs and symptoms of myofascial origin causing anterior hip pain and anterior impingement
what are possible causes of disordered hip complex?
prolonged hip flexion (sitting)
adductor or psoas strain
repetitive hip flexion during gait
what are s&s of disordered hip complex?
pain in groin/buttock
weak hip flexors (difficulty climbing stairs)
what are the most common muscles involved in a disordered hip complex?
iliopsoas
adductors
what is femoral-acetabular impingement?
impingement of the psoas or rectus femoris tendons between the femur and acetabulum
what is type 1 or cam impingement?
change in femoral head shape (bony bumps on superior aspect)
MC in young athletes
may abrese the acetbular cartilage –> riks of labral tear
what is type 2 or pincer impingement?
abnormally deep acetabulum or osteophyte formation
slow onset, intermittent groin pain
decreased and painful hip extension
+ve flexion-adduction test
+ve FAIR test
what is the female athlete triad?
amenorrhea (absence of menstruation)
eating disorder
osteoporosis
what are s&s of a stress fracture of the hip?
pain progressing with activity
focal area of tenderness, erythema, swelling and warmth
which special test can indicate a hip stress fracture?
single leg hop test
what is the imaging of choice for a stress fracture?
x-ray
if normal, bone scan (+ve within 48-72 hours after injury)
who is most at risk for pubic ramus stress fracture?
long distance runners
what are s&s of pubic ramus fracture?
pain in inguinal/perianal/adductor region
cannot bear weight on affected side
antalgic gait
normal hip ROM
very tender around pubic ramus
who is most at risk for a femoral neck stress fracture?
long distance runners
female athletes (female athlete triad)
what are s&s of a femoral neck stress fracture?
pain in groin/anterior thigh
pain related to activity
antalgic gait
reduced ROM (especially internal rot)
pain on axial compression
pain on end range in external rotation
what are s&s of femoral shaft fracture?
groin pain
worse with activity
pain at night
+ve fulcrum test
which condition can mimic trochanteric bursitis?
gluteus medius tendinopathy
how can we distinguish between trochanteric bursitis and a gluteus medius tendinopathy?
in a gluteus medius tendinopathy the TTP area is superior to the greater trochanter
what are possible causes of gluteus medius overload?
ankle hyperpronation
ITB syndrome
leg lengTH
what is an inguinal or femoral hernia?
part of the intestine herniates through a weak part of the transverse abdominis
what are s&s of inguinal hernia?
pain in area of herniation (superior and medial to pubic tubercle)
pain may radiate to upper thigh or scrotal region
pain worse with Valsalva manoeuvres
what are s&s of femoral hernia?
pain in area of herniation (inferior and lateral to pubic tubercle)
pain may radiate to upper thigh and scrotal region
pain worse with Valsalva manoeuvres
what is the management for inguinal or femoral hernia?
surgical referral
what is a iliac crest contusions?
bruise over iliac crest due to direct trauma
what are s&s of labral tear?
sharp anterior hip/groin pain
deep clicking in the hip
feeling like the joint is giving away
+ve FAIR test
what is the imaging of choice for a labral tear?
MRI
what is the most common hip adductor injury?
adductor longus strain
what causes an adductor longus strain?
forced external rotation of the hip
what are s&s of an adductor longus strain?
sudden, stabbing pain in groin
swelling and bruising over origin or insertion of muscle
pain on passive stretch of muscle
pain on resisted adduction
what is the treatment for adductor longus strain?
RICE
myofascial release
exercises as soon as pain allows
NSAIDs
what are s&s of a rectus femoris strain?
sudden, stabbing pain over anterior acetabulum
swelling and bruising over muscle
pain on passive stretching of muscle
pain on resisted hip flexion
in which type of athletes is an iliopsoas strain common?
weight lifting
uphill running
sit ups
what are s&s of iliopsoas strain?
sudden, stabbing pain over groin
swelling and bruising over muscle
pain on passive stretching of muscle
pain on resisted hip flexion at 90°
what are s&s of rectus abdominis strain?
sudden, stabbing pain over pubic symphysis
swelling and bruising over muscle
pain on actively lifting legs or head while supine
what condition can rectus abdominis strain mimic and how can you differentiate between those two?
appendicitis
if pain related to muscle contracture –> strain
what is osteitis pubis?
instability/inflammation of the symphysis between the two pubic bones
in which athletes is osteitis pubis common?
football players
runners
what are s&s of osteitis pubis?
BL groin pain
pain on extension and adduction of thigh
clicking during certain movements
‘unable to kick a football’
secondary Trp’s in stabilising muscles (adductor longus and rec fem)
BL pubic symphysis TTP
+ve single leg standing
+ve single leg hyperextension
pain in PROM abduction and RROM adduction
what are the x-ray findings of osteitis pubis?
sclerosis and irregularity of the pelvic bone at the symphysis pubis
what are s&s of hip OA?
hip pain
morning stiffness (<30 min)
antalgic gait
reduced ROM (especially internal rot)
what are the x-ray findings in hip OA?
non-uniform loss of joint space
osteophyte formation
subchondral cyst
subchondral scleroris
buttressing
joint deformity
what are s&s of osteoid osteoma?
night pain
pain relieved by NSAIDs
what are s&s of a ilioinguinal neuralgia?
burning/shooting pain in the base of penis to medial thigh
pain around ASIS
loss of soft tissue perception in medial thigh
pain worse in hyperextension of leg
what are the causes of an ilioinguinal neuralgia?
trauma
abdominal muscle training
inflammatory conditions
what is the cause of an obturator neuralgia?
exercise: running, twisting, kicking
what are the s&s of an obturator neuralgia?
insidious onset pain at adductor origin (pubic tubercle) into the groin
POC produced with pectineus stretch
what is the cause of genitofemoral neuralgia?
excessively tight clothing over the inguinal ligament
what are s&s of genitofemoral neuralgia?
pain on proximal thigh/groin just under the inguinal ligament
pain worse in hip extension
pain worse with pressure over inguinal hernia
what is the snapping hip syndrome?
a condition covering ddx’s that cause clicking of the hip
what is the most common cause of a snapping hip?
snapping of the ITB/TFL muscle over the greater trochanter
what is a sports hernia?
a strain or tear of any soft tissue (muscle, tendon, ligament) in the lower abdomen or groin area.
what are s&s of sport’s hernia (Gilmore’s groin)?
groin pain during sports
hard to localise groin pain
pain may radiate to adductors or testicles
stiffness and soreness after sports (day after)
pain on coughing, squeezing legs together and sitting up from lying
