Hip Injuries Flashcards
Hip Flexor Strain
Presentation:
- C/O “deep groin pain”
- Pain radiate to the anterior hip or thigh
- A “limp” may occur
- Pain on deep palpation of femoral triangle, lateral to the femoral nerve and inferior to the inguinal ligament.
- It will be medial to the sartorius muscle
Provocative Maneuvers
- Extension of the hip (active or passive? Cyriax Diff Dx Findings)
- If a supine patient raises heels off the table to 15 degrees.
Differential Diagnosis
- Iliopsoas Bursa, between psoas muscle and femoral head.
- “Snapping HIp Syndrome”
- Osteitis Pubis
Contusion
A muscle contusion indicates a direct, blunt, compressive force to a muscle.
This results in tissue and cellular damage and bleeding deep within the muscle and between the muscle planes.
The resultant tissue necrosis and hematoma lead to inflammation.
Contusions are a very common injury in sport.
Contusion Management
RICE and Stretch
Initially avoid the use of any form of heat (superficial or deep heating forms) and massage.
Myositis Ossificans
Aberrant reparative process that causes benign heteroptopic (ie extraskeletal) ossification in soft tissue.
Two Types:
Myositis Ossificans Circunscripta
Myositis ossificans Progressiva
Myositis Ossificans Management
Typically treated symptomatically
Surgical removal is rare.
Proximal Hamstring Strain
A hamstring strain can occur during an isolated athletic activity (acute) or result from persistant repetative stress (chronic)
Risk Factors: Improper warm-up Fatigue Previous Injury Strength imbalance Poor Flexibility
Hip Adductor Strain
“Most common musculoskeletal cause of groin pain in sports”
High incidence in soccer.
Pathophysiology - The miscle is stretched or overloaded beyond normal range.
Common muscles involved - adductor longus, gracilis
Differential Diagnosis for Hip Adductor Strains
Sports Hernia
Osteitis Pubis
Femoral Neck Stress Fracture
Management for Adductor Strain
Assess biomechanical causes:
- Foot and lower leg malalignment
- Leg Length Discrepancy
- Gait Abnormality
Muscular Imbalances
Management: Chronic
Stretching program
Low intensity isotonic exercise
Consider active training exercise program
“Snapping Hip”
The snapping sensation results from the movement of a muscle or tendon over a bony structure.
In the hip, the most common site is at the lateral side where the illiotibial band passes over the greater trocanter.
Eventually this could lead to Trochanteric Bursitis
Another tendon that could cause a snapping hip is the tendon of the iliopsoas.
Hip Pointer
An injury to the iliac crest caused by a direct blow, often seen in contact sports such as football.
When someone sustains a hip pointer injury, the bone and overlying muscle can be bruised.
IN more serious cases of hip pointers, the hit can be so severe that a fracture of the bone results.
Trochanteric Bursitis
Possible Causes:
Repetitive stress (Overuse) Injuries.
Multiple minor traumatic injuries.
Leg-length inequalities.
Excessive or prolonged pressure on the hip such as from standing too long.
An acute traumatic incident such as a fall.
Signs and Symptoms:
Aching pain is usually focused on the outside of the upper thigh, just over the point of the hip.
Pain may radiate down the outside of the thigh as far as the knee.
Iliopsoas Bursitis
Inflammation of the bursa that separates the Iliopsoas muscle from the underlying articular capsule of the hip.
Typically the result of “overuse”
Ischial Bursitis
Inflammation of the bursa that separates the gluteus maximus muscle of the buttocks from the underlying bony prominence of the bone that we sit on, the ischial tuberosity.
Sciatic Nerve Involvement
Sciatica - pain along the large sciatic nerve that runs from the lower back down the back of each leg.
Sciatica is usually caused by pressure on the sciatic nerve:
- Degenerative Disc Disease
- Herniated Disc
- Lumbar Spinal Stenosis
- Spondylolisthesis
