Hip Injuries Flashcards
Hip Flexor Strain (Presentation)
- c/o “deep groin pain”
- pain radiates to anterior hip or thigh
- “limp” may occur
- pain on deep palpation of Femoral Triangle
- medial to sartorius muscle
Hip Flexor Strain (Provocative Manuvers)
- extension of affected hip
- supine patient raises heels off table to 15 degrees
Differential Diagnosis for Hip Flexor Strain
- iliopsoas bursa (between psoas muscle and femoral head
- “Snapping Hip Syndrome”
- Osteitis Pubis (athletic hernia)
Quadricepts Contusion Management
- RICE and stretch
* * Initially avoid the use of any form of heat and massage
Myositis Ossificans
- aberrant reparative process that causes benign heterotopic (extra skeletal) ossification in soft tissue
What are the two types of Myositis Ossificans
- Myositis ossificans circumscripta
2. Myositis ossificans progressiva (genetic, won’t ever see it)
Management of Myositis Ossificans
- treated symptomatically
- surgical removal is rare
- put a pad over it
Proximal Hamstring Strain
- can occur during an isolated athletic activity (acute) or result from persistent repetitive stress (chronic)
Risk factors that cause proximal hamstring strain
- improper warm-up
- fatigue
- previous injury
- strength imbalance
- poor flexibility
Hip Adductor Strain (Groin)
- most common musculoskeletal cause of groin pain in sports
- muscule stretched or overloaded beyond normal range
- muscles involved = adductor longs and gracilis
Differential Diagnosis for Hip Adductor Strain
- sports hernia
- osteitis pubis
- femoral neck stress fracture
Management for Hip Adductor Strain
- assess biomechanical causes
- foot and lower leg mal- alignment
- leg length discrepancy
- gait abnormality
- Muscular imbalance
- Site, source and cause: shorter leg is more prone, pronates the foot
Management for a Chronic Hip Adductor strain
- stretching program
- low intensity isotonic exercise
- consider active training exercise program
- soft tissue management
“Snapping Hip”
A snapping sensation results from the movement of a muscle or tendon over a bony structure
- most common site in hip is the lateral side where the IT band passes over the greater trochanter
- or tendon of iliopsoas
Hip Pointer
- injury to the iliac crest caused by a direct blow
- the bone and overlying muscle can be bruised
- in more serious cases, 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 (standing too long)
- an acute traumatic incident such as a fall
Signs and Symptoms of Trochanteric Bursitis
- 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
- shorter leg more prone to bursitis
- adductors are tight
- feet are pronated
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 bursa that separates the gluteus maximus muscle from the underlying bony prominence of the bone that we sit on, the ischial tuberosity
- caused by prolonged sitting on hard surfaces
Sciatica
Pain along the large sciatic nerve that runs from the lower back down the back of each leg
Causes of Sciatica
- degenerative disc disease (DDD)
- HNP
- Lumbar Spinal Stenosis
- Spondylolisthesis
- Piriformis Syndrome
Presentation of Sciatica
- pain in the rear or leg that is worse when sitting
- weakness, numbness or difficulty moving the leg or foot
- radiculopathy (tingling down the leg)
- bowel/bladder issues
Piriformis Syndrome
- neuromuscular disorder that occurs when the piriformis muscle compresses or irritates the sciatic nerve
- pain described as tingling or numbness in the buttocks and along the nerve
- pain may worsen as a result of sitting for a long period of time, climbing stairs, walking or running
Treatment for Piriformis Syndrome
- stretching exercises
- massage
Activity modification - cessation of running, bicycling, or similar activities may be advised
Hip Labral Tear
- can be caused by repetitive motions (running/pivoting)
- or from traumatic cause (hip dislocation)
Signs and Symptoms of Hip Labral Tear
- catching or locking
- limited ROM
- Symptoms radiating into the groin
Femoral Neck Fracture
- 90% of hospitalizations for hip fractures are for people older than age 65
- more common in females than males
Presentation of Femoral Neck Fracture
- severe pain in your hip or groin
- inability to put weight on your injured leg
- shorter leg on the side of your injured hip
- may present with ER and slight abduction on the side of the injured hip
Acute Management of Femoral Neck Fracture
- Immediate immobilization: traction splint
- transport to hospital, typically treated with ORIF
Femoral Neck Stress Fracture Symptoms
- groin pain or anterior thigh pain
- provoked by activity (weight bearing)
- relieved with rest
Femoral Neck Stress Fracture Signs
- antalgic gait (trendelenburg gait)
- pain on internal hip rotation
Osteitis Pubis
- common cause chronic groin pain in athletes
- caused by pregnancy
- caused by vigorous weight bearing activity
Pathophysiology of Osteitis Pubis
Pregnancy
- expanding pressure from growing fetus
Sports related repetitive stress injuries
- long distance running
- traction on pelvic musculature
Predisposing factors in sports
- limited internal hip rotation
- sacroiliac joint fixation
- lower limb biomechanics abnormalities
- leg length discrepancy
- over pronation
- genu varum
- genu valgum
Signs for Osteitis Pubis
- Tenderness to palpation of pubic symphysis
- Provocative manuevers
- active adduction (distal)
- sit ups (proximal)
Hip Dislocation
- typical MOI involves a violent traumatic force such as MVA or fall from a height
- 9/10 dislocations are posterior
Presentation/Treatment for Hip Dislocation
- very painful
- possible nerve damage
- may not have feeling in the foot
- orthopedic emergency
- call for help immediately
- do NOT move injured person
Ligamentus Teres Femoris
- contain a small artery to the head of the femur
- attaches to the margins of the ace tabular notch and transverse acetabular ligament and attached to the fovea/pit of femur
Avascular Necrosis
- disease resulting from temporary or permanent loss of the blood supply to the bones
- can be caused by injury
Presentation of Avascular necrosis
- early stages could be asymptomatic
- most pt. experience joint pain only when weight bearing and then later on when resting
Legg-Calve-Perthes Disease
osteonecrosis of the capital femoral epiphysis of the femoral head
Characteristics of LCP Disease
- caucasians are affected more frequently
- males are affected 4-5 times more than females
- most common in ages 3-12 years
- congenital
Slipped Capital Femoral Epiphysis
Refers to a fracture through the physics of the femoral head which results in slippage of the overlying end of the femur
Slipped Capital Femoral Epiphysis - where it’s seen
- mostly in boys between the ages of 10-17
- characteristically tall and thin or obese
- may occur bilaterally
