Hip: DDx 4

Question 1

Hamstring syndrome: develops as a result of entrapment of this nerve

Answer 1

sciatic

Question 2

Hamstring syndrome: often a result of sciatic nerve entrapment an potential irritation of the epineurium as the nerve courses where?

Answer 2

around the ischial tuberosity and through a fibrous band projecting from the BICEPS FEMORIS as it inserts upon the tuberosity

Question 3

Hamstring syndrome: frequently preceded by

Answer 3

• episodic hamstring injury
• episode of LBP
• surgery that may predispose the sciatic nerve to greater vulnerability

Question 4

Hamstring syndrome: associated with these groups

Answer 4

• active individuals
• distance runners
• sprinters
• jumping athletes

Question 5

Hamstring syndrome: pain localized where?

Answer 5

ischial tuberosity

Question 6

Hamstring syndrome: localized to the ischial tuberosity…how does it progress

Answer 6

begins gradually

worsens with persistent physical activity

Question 7

Hamstring syndrome: clinical triad

Answer 7

1. increased pain with sitting
2. resisted knee flexion with the hip flexed to 90˚ and knee extended to the limit
3. provocation may be worsened during the same test with ankle and foot DF

Question 8

Hamstring syndrome: local palpation here will be painful

Answer 8

ischial tuberosity

Question 9

Hamstring syndrome: these special tests could be positive

Answer 9

• SLR

- slump test

Question 10

Hamstring syndrome: stretching

Answer 10

do not alleviate symptoms, frequently make them worse

Question 11

Hamstring syndrome: how to manage

Answer 11

• no HS stretching
• instruct to sit on a wedge (thick side to back)
• gentle neural mobilization of LE

Question 12

Hamstring syndrome: management of symptoms

neural mobilization

Answer 12

should be distally initiated at the ankle or foot

Question 13

proximal HS tendinopathy: typical cause

Answer 13

usually from micro traumatic loading of the tendinous insertion of the ischial tuberosity

Question 14

proximal HS tendinopathy: this will be painful (testing) with the hip both flexed and extended

Answer 14

resisted knee flexion

Question 15

proximal HS tendinopathy: With less severe cases, what may be required for clinical provocation?

Answer 15

eccentric loading of MTU with the pt flexed over the treatment table

Question 16

proximal HS tendinopathy: treatment can include these

Answer 16

• reduced and/or unloaded functional activity

- gradual eccentric activation, strengthening, and return to activity as pain subsides

Question 17

proximal HS tendinopathy: as irritability subsides, what can be initiated

Answer 17

gentle stretching of the HS

Question 18

piriformis syndrome: can produce buttock pain as a consequence of

Answer 18

sciatic nerve compression and irritation

Question 19

piriformis syndrome: buttock pain and sciatic nerve compression can occur as the nerve courses where?

Answer 19

our from under the inferior edge of the piriformis muscle

Question 20

piriformis syndrome: what can cause the nerve irritation? (MOI)

Answer 20

• blunt trauma to buttock region

- overuse in activities that place sciatic nerve under tension

Question 21

piriformis syndrome: example of an activity that places the sciatic nerve under tension

Answer 21

running

Question 22

piriformis syndrome: % of individuals that exhibit a perforation of the piriformis by the sciatic nerve

Answer 22

14%

Question 23

piriformis syndrome: 14% of individuals exhibit a perforation of the piriformis muscle by this branch of the sciatic nerve, which causes compression each time the piriformis is used

Answer 23

peroneal branch

Question 24

piriformis syndrome: compressed axons of this nerve may cause glute max atrophy

Answer 24

inferior gluteal nerve

Question 25

piriformis syndrome: compressed axons of the inferior gluteal nerve may cause gluteus Maximus atrophy, while this muscle is spared as it courses superiorly

Answer 25

gluteus medius (superior gluteal nerve)

Question 26

piriformis syndrome: epineural irritation and pain produced when the hip positioned…

Answer 26

< 90˚ flexion
adduction
internal rotation

(FAIR test)

Question 27

piriformis syndrome: FAIR test position has been shown to approximate the nerve closer to where?

Answer 27

ischial spine

Question 28

piriformis syndrome: FAIR test position has been shown to approximate the nerve closer to the ischial spine, which does what to the nerve?

Answer 28

angulates the nerve in a more aggressive way, leads to greater risk of injury

Question 29

piriformis syndrome: In addition to the FAIR test, these could be provocative

Answer 29

SLRDI or SDI testing

Question 30

piriformis syndrome: what should be avoided?

Answer 30

• stretching

- sitting on hard surfaces

Question 31

piriformis syndrome: PT interventions

Answer 31

gentle neural mobilizations/manipulation

Question 32

piriformis syndrome: what procedure may reduce pain and piriformis muscle activity?

Answer 32

injection of corticosteroid and analgesics under fluoroscopic guidance

Question 33

piriformis syndrome: In extreme cases that do not respond to conservative management, may require

Answer 33

surgical release