Hip: DDx 5

Question 1

pudendal neuralgia: involves the terminal branches of these nerves

Answer 1

S2-4 from the sacral plexus

Question 2

pudendal neuralgia: where does the nerve become entrapped?

Answer 2

• between sacrotuberal and sacrospinous ligaments
• within the pudendal canal
• as it crosses the falciform process of the sacrotuberal ligament

Question 3

pudendal neuralgia: buttock pain from the pudendal nerve will be witnessed where?

Answer 3

lower inner gluteal quadrant

Question 4

pudendal neuralgia: buttock pain on the lower inner gluteal quadrant and typically accompanied by

Answer 4

pain or burning in the perineal area

Question 5

pudendal neuralgia: pain or burning sensation in the perineal area worsens with which activity

Answer 5

sitting

Question 6

pudendal neuralgia: pain or burning sensation in the perineal area improves with which activity

Answer 6

standing

Question 7

pudendal neuralgia: symptoms may be due to issues related to…

Answer 7

• childbirth
• pelvic surgery
• skeletal abnormalities

Question 8

pudendal neuralgia: in addition to anatomical changes, may also be elicited during these activities

Answer 8

bicycling - too narrow saddle pressing against the pudendal nerves within the pudendal canal

Question 9

pudendal neuralgia: nonoperative treatments

Answer 9

• relaxation of pelvic floor muscles

- implementing strategies to minimize compression

Question 10

pudendal neuralgia: this can ease discomfort in sitting

Answer 10

use of sacral sitting pad with perineal cutout

Question 11

pudendal neuralgia: avoiding these can reduce irritation from the sacrospinous ligament

Answer 11

avoiding deep squatting and sustained sitting with greater hip flexed postures

Question 12

pudendal neuralgia: neural mobilization

Answer 12

not possible due to its location and course

Question 13

pudendal neuralgia: other management if conservative care not successful

Answer 13

• local nerve blocks

- steroid injections

Question 14

bursitis: 3 major types in the hip

Answer 14

• iliopsoas
• ischiogluteal
• trochanteric

Question 15

What is a bursa?

Answer 15

fluid filled sac that decreases friction between structures of movement

Question 16

bursitis: vascularity/nerve supply

Answer 16

highly vascular with rich nerve supply

Question 17

bursitis: primary or secondary disorder

Answer 17

rarely a primary disorder

Question 18

bursitis: occurs secondary to

Answer 18

• sprains
• strains
• contusions
• tendonitis

Question 19

bursitis: key to diagnosis

Answer 19

palpation

Question 20

bursitis: treatment overall

Answer 20

• rest
• modalities/meds
• address “muscle imbalances”

Question 21

trochanteric bursitis: common misdiagnosis from

Answer 21

• referred lumbar or SIJ pain
• muscular pain
• femoral stress fx

Question 22

trochanteric bursitis: pain over the lateral hip, especially during which activities?

Answer 22

• standing from chairs
• ascending stairs
• WB
• sidelying on affected side

Question 23

trochanteric bursitis: pain with palpation of

Answer 23

greater trochanter

Question 24

trochanteric bursitis: pain with resisted

Answer 24

hip abduction/ER

Question 25

trochanteric bursitis: special testing

Answer 25

(+) Ober

Question 26

trochanteric bursitis: these can be diagnostic

Answer 26

injections

Question 27

trochanteric bursitis: radiographs may reveal

Answer 27

calcification of bursa

Question 28

greater trochanteric pain syndrome: pain location

Answer 28

- lateral hip/thigh | - buttock

Question 29

greater trochanteric pain syndrome: ttp over

Answer 29

greater trochanter

Question 30

greater trochanteric pain syndrome: same as trochanteric bursitis?

Answer 30

no

Question 31

greater trochanteric pain syndrome: inflammation

Answer 31

no s/s of inflammation

Question 32

greater trochanteric pain syndrome: etiology

Answer 32

unknown - high correlation with glute med tears

Question 33

greater trochanteric pain syndrome: ddx

Answer 33

- LBP - femoral neural tension - fibromyalgia - DJD - bursitis - insufficiency fx of proximal femur - trauma - AVN - glute med/min tendon tears

Question 34

greater trochanteric pain syndrome: more common in males/females

Answer 34

females

Question 35

greater trochanteric pain syndrome: correlated with

Answer 35

- female sex - ITB tenderness - knee OA - LBP - increased time with STS test - increased 20MWT

Question 36

greater trochanteric pain syndrome: correlated with BMI?

Answer 36

no

Question 37

greater trochanteric pain syndrome: correlated with hip IR ROM?

Answer 37

no

Question 38

greater trochanteric pain syndrome: imaging

Answer 38

- imaging has found NO BURSITIS in those with GTPS | - often presence of glute med/min tears and/or tendinosis