Hip: DDx 5 Flashcards
pudendal neuralgia: involves the terminal branches of these nerves
S2-4 from the sacral plexus
pudendal neuralgia: where does the nerve become entrapped?
- between sacrotuberal and sacrospinous ligaments
- within the pudendal canal
- as it crosses the falciform process of the sacrotuberal ligament
pudendal neuralgia: buttock pain from the pudendal nerve will be witnessed where?
lower inner gluteal quadrant
pudendal neuralgia: buttock pain on the lower inner gluteal quadrant and typically accompanied by
pain or burning in the perineal area
pudendal neuralgia: pain or burning sensation in the perineal area worsens with which activity
sitting
pudendal neuralgia: pain or burning sensation in the perineal area improves with which activity
standing
pudendal neuralgia: symptoms may be due to issues related to…
- childbirth
- pelvic surgery
- skeletal abnormalities
pudendal neuralgia: in addition to anatomical changes, may also be elicited during these activities
bicycling - too narrow saddle pressing against the pudendal nerves within the pudendal canal
pudendal neuralgia: nonoperative treatments
- relaxation of pelvic floor muscles
- implementing strategies to minimize compression
pudendal neuralgia: this can ease discomfort in sitting
use of sacral sitting pad with perineal cutout
pudendal neuralgia: avoiding these can reduce irritation from the sacrospinous ligament
avoiding deep squatting and sustained sitting with greater hip flexed postures
pudendal neuralgia: neural mobilization
not possible due to its location and course
pudendal neuralgia: other management if conservative care not successful
- local nerve blocks
- steroid injections
bursitis: 3 major types in the hip
- iliopsoas
- ischiogluteal
- trochanteric
What is a bursa?
fluid filled sac that decreases friction between structures of movement
bursitis: vascularity/nerve supply
highly vascular with rich nerve supply
bursitis: primary or secondary disorder
rarely a primary disorder
bursitis: occurs secondary to
- sprains
- strains
- contusions
- tendonitis
bursitis: key to diagnosis
palpation
bursitis: treatment overall
- rest
- modalities/meds
- address “muscle imbalances”
trochanteric bursitis: common misdiagnosis from
- referred lumbar or SIJ pain
- muscular pain
- femoral stress fx
trochanteric bursitis: pain over the lateral hip, especially during which activities?
- standing from chairs
- ascending stairs
- WB
- sidelying on affected side
trochanteric bursitis: pain with palpation of
greater trochanter
trochanteric bursitis: pain with resisted
hip abduction/ER
trochanteric bursitis: special testing
(+) Ober
trochanteric bursitis: these can be diagnostic
injections
trochanteric bursitis: radiographs may reveal
calcification of bursa
greater trochanteric pain syndrome: pain location
- lateral hip/thigh
- buttock
greater trochanteric pain syndrome: ttp over
greater trochanter
greater trochanteric pain syndrome: same as trochanteric bursitis?
no
greater trochanteric pain syndrome: inflammation
no s/s of inflammation
greater trochanteric pain syndrome: etiology
unknown - high correlation with glute med tears
greater trochanteric pain syndrome: ddx
- LBP
- femoral neural tension
- fibromyalgia
- DJD
- bursitis
- insufficiency fx of proximal femur
- trauma
- AVN
- glute med/min tendon tears
greater trochanteric pain syndrome: more common in males/females
females
greater trochanteric pain syndrome: correlated with
- female sex
- ITB tenderness
- knee OA
- LBP
- increased time with STS test
- increased 20MWT
greater trochanteric pain syndrome: correlated with BMI?
no
greater trochanteric pain syndrome: correlated with hip IR ROM?
no
greater trochanteric pain syndrome: imaging
- imaging has found NO BURSITIS in those with GTPS
- often presence of glute med/min tears and/or tendinosis
