Hip: DDx 4 Flashcards
Hamstring syndrome: develops as a result of entrapment of this nerve
sciatic
Hamstring syndrome: often a result of sciatic nerve entrapment an potential irritation of the epineurium as the nerve courses where?
around the ischial tuberosity and through a fibrous band projecting from the BICEPS FEMORIS as it inserts upon the tuberosity
Hamstring syndrome: frequently preceded by
- episodic hamstring injury
- episode of LBP
- surgery that may predispose the sciatic nerve to greater vulnerability
Hamstring syndrome: associated with these groups
- active individuals
- distance runners
- sprinters
- jumping athletes
Hamstring syndrome: pain localized where?
ischial tuberosity
Hamstring syndrome: localized to the ischial tuberosity…how does it progress
begins gradually
worsens with persistent physical activity
Hamstring syndrome: clinical triad
- increased pain with sitting
- resisted knee flexion with the hip flexed to 90˚ and knee extended to the limit
- provocation may be worsened during the same test with ankle and foot DF
Hamstring syndrome: local palpation here will be painful
ischial tuberosity
Hamstring syndrome: these special tests could be positive
- SLR
- slump test
Hamstring syndrome: stretching
do not alleviate symptoms, frequently make them worse
Hamstring syndrome: how to manage
- no HS stretching
- instruct to sit on a wedge (thick side to back)
- gentle neural mobilization of LE
Hamstring syndrome: management of symptoms
neural mobilization
should be distally initiated at the ankle or foot
proximal HS tendinopathy: typical cause
usually from micro traumatic loading of the tendinous insertion of the ischial tuberosity
proximal HS tendinopathy: this will be painful (testing) with the hip both flexed and extended
resisted knee flexion
proximal HS tendinopathy: With less severe cases, what may be required for clinical provocation?
eccentric loading of MTU with the pt flexed over the treatment table
proximal HS tendinopathy: treatment can include these
- reduced and/or unloaded functional activity
- gradual eccentric activation, strengthening, and return to activity as pain subsides
proximal HS tendinopathy: as irritability subsides, what can be initiated
gentle stretching of the HS
piriformis syndrome: can produce buttock pain as a consequence of
sciatic nerve compression and irritation
piriformis syndrome: buttock pain and sciatic nerve compression can occur as the nerve courses where?
our from under the inferior edge of the piriformis muscle
piriformis syndrome: what can cause the nerve irritation? (MOI)
- blunt trauma to buttock region
- overuse in activities that place sciatic nerve under tension
piriformis syndrome: example of an activity that places the sciatic nerve under tension
running
piriformis syndrome: % of individuals that exhibit a perforation of the piriformis by the sciatic nerve
14%
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
peroneal branch
piriformis syndrome: compressed axons of this nerve may cause glute max atrophy
inferior gluteal nerve
piriformis syndrome: compressed axons of the inferior gluteal nerve may cause gluteus Maximus atrophy, while this muscle is spared as it courses superiorly
gluteus medius (superior gluteal nerve)
piriformis syndrome: epineural irritation and pain produced when the hip positioned…
< 90˚ flexion
adduction
internal rotation
(FAIR test)
piriformis syndrome: FAIR test position has been shown to approximate the nerve closer to where?
ischial spine
piriformis syndrome: FAIR test position has been shown to approximate the nerve closer to the ischial spine, which does what to the nerve?
angulates the nerve in a more aggressive way, leads to greater risk of injury
piriformis syndrome: In addition to the FAIR test, these could be provocative
SLRDI or SDI testing
piriformis syndrome: what should be avoided?
- stretching
- sitting on hard surfaces
piriformis syndrome: PT interventions
gentle neural mobilizations/manipulation
piriformis syndrome: what procedure may reduce pain and piriformis muscle activity?
injection of corticosteroid and analgesics under fluoroscopic guidance
piriformis syndrome: In extreme cases that do not respond to conservative management, may require
surgical release
