Hip Injuries Flashcards
True or false:
Many injuries refer pain to the groin.
True
What are the three most common injuries responsible for refering pain to the groin?
Muscle strain
SI joint or lumbar back referred pain
Stress fracture
What is a hip pointer (hip contusion)?
A contusion of the iliac crest or abdominal muscles (sometimes ASIS)
What is the MOI of a hip pointer?
Direct blow
What are the signs and symptoms of a hip pointer?
Pain and spasm
Decreased ROM due to pain
Possible ecchymosis and effusion
True or false:
Volleyball players may be prone to getting hip pointers. Why?
True–they dive on the floor a lot
True or false:
It is common for athletes to get a hip sprain. Why or why not?
False–the hip has great bony stability, a lot of dynamic (muscular stability, and some of the strongest ligaments and joint capsule in the body
What is the MOI of a hip sprain?
Any movement that exceeds the normal ROM
What are the signs and symptoms of a hip sprain?
Signs of an acute injury
Pain with AROM and PROM
Pain in hip region
**Hip rotation increases the pain
What is the MOI of a hip strain?
Overstretch or rapid, forceful contraction of the muscles (they can’t dissipate the eccentric load)
**Could also be fatigue induced (the quick increase in intensity could cause a grade I strain in the hip muscles)
What muscles could be involved in a hip strain? (x5)
Hip flexors Glutes Hamstrings Groin Quads
What are the signs and symptoms of a hip strain?
Pain on palpation
Pain on contraction
Pain on stretch
What is one of the most common bursitis in the body?
Trochanteric bursitis
What is trochaneric bursitis (snapping hip)?
Inflammation of the bursa at the site withere the gluteus medius and IT band insert on the greater trochanter
What are the signs and symptoms of trochanteric bursitis? (x4)
Lateral hip pain that may radiate down the leg or up into the butt area
Possible snapping of the IT band
Tenderness over the lateral aspect of the greater trochanter
Positive IT band tests
True or false:
You may feel some inflammatory conditions with palpation of a trochanteric bursitis.
True
What is ischial bursitis?
Inflammation of the bursa at the ischial tuberosity
What are the signs and symptoms of ischial bursitis? (x3)
Pain with sitting
Palpable tenderness over ischial tuberosity
Pain with PROM hip flexion, AROM/RROM hip extension
What other condition may present like ischial bursitis?
Hamstring tendonopathy
What lateral rotator of the hip is often in spasm or tight?
Piriformis
What is a tight piriformis usually associated with?
SI joint dysfunction
What are some of the signs and symptoms of a piriformis spasm?
Pain/spasm with palpation
Pain on stretch (internal rotation)
Pain with contraction
True or false:
Spasm of the piriformis is often secondary to another hip problem.
True
How would an athlete “describe” femoral acetabular impingement?
“C” shaped pain…it may refer to the LBP, SI, or groin
What two tests would be positive for FAI?
Sharp pain with FABER and FADIR
What are the three types of FAI?
CAM (excess bone on femoral head and neck)
PINCER (enlarged lip of the acetabulum)
MIXED (both camp and pincer)
Where could FAI refer pain to?
LBP, SI, or groin
What structures could FAI possible injury?
Labrum or articular cartilage
What is the treatment for FAI?
Surgery with 3-4 months rehab
True or false:
FAI can only happen congentially.
False. It can happen congenitally, but it can also be acquired (such as in the case of bone spurs)
What is the MOI for a labrum tear? (x3)
Trauma (hip joint injury or dislocation) Structural abnormalities Repetitive motions (sudden twisting or pivoting motions)
What sports is a labrum tear common in?
Golf or hockey (because of the skating or twisting motions)
What are the signs and symptoms of a labral tear?
Locking, clicking, catching sensation
Pain in hip or groin
Stiffness or limited ROM
True or false:
With a possible labrum tear, the surround muscles of the hip joint will probably tighten and spasm.
True
What is an athletic pubalgia?
Sports hernia
What is the MOI for a sports hernia (athletic pubalgia)?
Repetitive stress to the pubic symphysis (shearing forces go through the pubic symphysis to the insertion of the rectus abdominalis, hip adductors, and conjoint tendon–this results in microtears of the transversalis abdominis fascia/aponeurosis of the obliques that causes the anterior abdominal wall to become weak). This can result in a tear on the backside of the inguinal canal.
What is a possible red flag for an athlete that may start you thinking that have a sports hernia?
Chronic pubic pain…it may present as a groin strain that just won’t get better with time.
True or false:
There is a noticeable presence of a hernia with a sports hernia (athletic pubalgia).
False…there is no presence of a hernia (no bulging).
What are some of the signs and symptoms of a sports hernia (athletic pubalgia)? (x4)
- Chronic pain during exertion
- Sharp and burning pain that later radiates into the adductors and testicles
- Groin strain that won’t go away
- Point tendernesss on the pubic tubercle
In which sports is it common to have a sports hernia (athletic pubalgia)? Why?
Football and soccer (specifically kickers) because the position they’re in when kicking the ball is pulling on the adductors and abdominals.
What would an athlete with a sports hernia have increased pain with?
Resisted hip flexion, internal rotation, abdominal contraction, resisted hip adduction
What is the treatment of a sports hernia?
Referral…an experienced surgeon is needed
What is osteitis pubis?
A stress fracture in the pubic symphysis
What causes osteitis pubis?
Repetitive stress to the pubic symphysis (it gets inflammed) from the tendons of the surrounding muscles continuing to pull on it
What type of athletes is it common to see osteitis pubis?
Distance runners, soccer, and rugby players
What are the signs and symptoms of osteitis pubis? (x3)
Chronic pain and inflammation of the groin (it may switch sides)
Point tenderness on the pubic tubercle
Pain with running, sit-ups, and squats
What are the most common sites for stress fractures in this hip region?
Femoral neck, pubic ramus, and subtrochacnteric area of the femur
What type of athlete is it common to see stress fractures in the hip?
Distance runners
What are the signs and symptoms of a stress fracture in the hip?
-Groin pain with aching sensation in thigh
-The pain/aching sensation increases with activity and feels better with rest
-It may be impossible to stand on one leg
Point tenderness upon deep palpation
What should you possible inquire about with an athlete that has a stress fracture?
Eating disorder
What three types of stress fractures have a high occurance among athletes suffering from eating disorders?
Femoral neck, calcaneus, and vertebral stress fractures
Where would the pain from a femoral neck fracture refer to? What is a common complaint with this injury?
Radiate down the shaft of the femus;
“My whole thigh just hurts”
What is the management of a hip stress fracture?
Rest 2-5 months
How long is a hip stress fracture patient on crutches?
6-8 weeks
If using swimming as a cross-training method for a stress fracture patient, what stroke should be avoided?
Breast stroke
What is usually the MOI for a hip/pelvic fracture?
Direct blow or loading
Where does the fracture occur normally for a hip fracture? What sport is this common and why?
Acetabulum…hurdlers because they hit the hurdle with their foot
What commonly causes a pelvic fracture? What typically causes it?
High impact crash (autoracing or skiing)
True or false:
Hip and pelvic fractures are normally displaced. Why or why not?
True…this is because the muscles go into spasm displace the fracture.
How will a hip fracture usually present in terms of leg position?
The leg will be shorter and the externally rotated
What are the signs and symptoms of a hip/pelvic fracture?
Immediate palpable pain and deformity, swelling, loss of function, and the leg will be shorter and externally rotated
What is the MOI of an avulsion fracture?
Violent contraction of a muscle that is attached to the bone.
What is an avulsion fracture?
When a muscle violently contracts and pulls the tendon off of its insertion into the bone. It can also take a little chunk of bone with it.
What are the common sites (and muscle attachments) for an avulsion fracture? (x4)
ASIS (sartorius)
AIIS (rectus femoris)
Lesser trochanter (iliopsoas)
Ischial tuberosity (hamstrings)
What are the signs and symptoms of an avulsion fracture?
Sudden pain after feeling a pop
Swelling
Loss of function
Palpable deformity
True or false:
Avulsion fractures are more common in adults than children.
False..they are more common in children because their tendons and ligaments are stronger than their bones. In adults, their bones are stronger
How far apart would an avulsion fracture need to be in order for it to be surgically repaired?
More than 1 mm
True or false:
A hip dislocation is uncommon in sports.
True
What is the MOI of a hip dislocation?
A traumatic force directed along the long axis of the femur (posterior dislocation with hip flexed/adducted and the knee flexed)
What is the presentation of a hip that is dislocated?
Flexed
Adducted
Internally rotated
What would palpation of a possible hip location find?
A displaced femoral head…think about Nealton’s line with the greater trochanter
Why is a hip dislocation considered a serious injury?
Because of all the soft tissue damage, the possibility of nerve damage, possible fracture, and the pt going into shock
In dealing with pediatric conditions, what is the common term for “apophysitis”? What is the condition?
Growing pains. This condition is where extra bone is laid down where the tendons attach to the bones. These tendons can eventually become inflamed because of the use of these muscles. This could lead to avulsions and avulsion fractures
In dealing with pediatric conditions, where are the common sites for them to get apophysitis?
ASIS, AIIS, and ischial tuberosity
In dealing with pediatric conditions, what activity of sports is when apohpysitis are seen?
Sudden acceleration and deceleration
In dealing with pediatric conditions, what are the signs and symptoms of an apophysitis? What part of an eval could increase their pain?
Sudden localized pain with limited movement
Pain, swelling, point tenderness
Muscle testing increases pain
In dealing with pediatric conditions, how to we treat apophysitis if its shown to be uncomplicated on an x-ray?
**Control the inflammtion
RICE,
NSAIDs
Crutch toe-touch walking
In dealing with pediatric conditions, how do we treat apophysitis if its shown to be complicated on an x-ray?
The pt will have to have a pin put in
In dealing with pediatric conditions, after the inflammatory condition of apophysitis is controlled, how we progress in our treatment?
Gradual stretching for 2-3 weeks
In dealing with pediatric conditions, where does epiphyseal fractures usually occur?
Greater trochanter
Capital femoral epiphysis (right at the femoral head)
What is an epiphyseal plate?
Growth plate
In a pt with an epiphyseal fracture of their hip, how do they present?
With a limp (waddle), shortened leg, and rotated leg
Why would a patient with an epiphyseal fracture waddle when they walk?
The femoral head slips off the femoral neck
What important anatomical structure could possibly be severed in a hip dislocation? What do is supply?
Ligamentum teres…supplies 1/3 of the femoral head’s blood supply
What causes avascular necrosis?
Temporary or permanent loss of blood supply to the proximal femur
What is the MOIs for avascular necrosis?
Traumatic conditions (hip dislocation, femoral neck fracture) Non-traumatic conditions (steroids, blood coagulation disorders)
True or false:
There are no signs or symptoms of avascular necrosis in the early stages.
True…this is why this condition is potentially very dangerous
Once the symptoms of avascular necrosis begin, what are they?
Joint pain with weight bearing progresses to pain at rest
Pain gradually increases (bone collapse will occur)
How long can the signs and symptoms of avascular necrosis possible progress over?
The course of months to a year
If a person is suffering from avascular necrosis, what will they eventually need?
Hip replacement
How will avascular necrosis cause the femoral head to appear on an x-ray?
Flattened
What is Legg-Calve’-Perthes Disease? What is usually its cause?
Avascular necrosis of the proximal femoral epiphysis;
its congenital
In what population are we worried about seeing legg-calve’-perthes disease?
Adolescent males
How does legg-calve’-perthes disease present?
The pt will waddle
