Hip Lecture

Question 1

Hip functions

Answer 1

Supports weight of load, arms, trunk
Static & Dynamic
Pathway for transmission of forces between pelvis & lower extremities

Question 2

Mechanical stresses on hip

Answer 2

Tensile, torsional, compressive loading
SLS: 2.4-2.6x
Walking: 1.3-5.8x
Stairclimbing: 3x
Running: 4.5+x

Question 3

Compressive Forces

Answer 3

Body Weight

Muscular Activity

Question 4

Process of differential diagnosis

Answer 4

85% of the info for accurate dx is acquired during the subjective exam

Question 5

3 deciding questions:

Answer 5

appropriate for this pt
appropriate w/ additional referral
inappropriate for PT at this time

Question 6

Categorizing sources

Answer 6

Local neuro/mesculoskeletal
- Intra-articular
- Extra-articular
Remote/referred neuro/musculoskeletal
Systemic sources

Question 7

Intra-articular causes

Answer 7

Ball & Socket articulation (femur/pelvis)
Impressive Load Transmission & ROM
Open & closed kinetic chain, compression/shear forces

Refer pain to anterior groin, buttock, greater trochanter, anterior thigh, medial knee

Question 8

Intra-articular

Answer 8

Femur/Acetabulum - stress fx, bone bruise, chondral lesions, bone spurs/OA
Acetabular Labrum, tears
Transverse Acetabular Ligament - sprain/strain
Joint Capsule/synovium - strain or inflammation
Ligamentum Teres - tear/strain

Question 9

Intra-articular: additional

Answer 9

Local infection
Septic arthritis
Neoplasm (tumor)
Avascular necrosis
DDH, birth
LCP, 6-10 years
SCFE, 11-14 years

Question 10

Extra-articular

Answer 10

Ligament sprain
-Inguinal
-Iliofemoral
-Pubofemoral
-Ischiofemoral
Muscle Strain/Tear
-Superficial & deep flexors, adductors, extensors, rotators
Bursitis
Iliopsoas bursa
Trochanteric bursa
Ishiogluteal bursa

Question 11

Referred sources

Answer 11

Lumbar disc pahtology
Lumbar spine degenerative joint disease
Athletic pubalgia
Radiculopathy
Piriformis Syndrome
SIJ pathology
Genitourinary tract pathology
Abdominal wall pathology

Question 12

Systemic Sources

Answer 12

RA
Crohn's
Psoriasis
Reiter's
Systemic Lupus erythematosus

Question 13

Musculocutaneus

Answer 13

OA

Muscle strain

Question 14

OA

Answer 14

Primary OA vs Secondary

Question 15

OA

Answer 15

Disorder of synovial joints w/ deterioration of articular cartilage and new bone formation

Question 16

OA: Symptoms

Answer 16

Groin & thigh pain most common (98% intra)

Question 17

OA: 24 hours pattern

Answer 17

Morning stiffness

Question 18

OA: MOI

Answer 18

may/may not be related to h/o trauma

Question 19

OA: Limitations

Answer 19

Transitional movements w/ pain
Walking antalgic
Stiffness impaired donning shoes/socks

Question 20

OA: Findings

Answer 20

Antalgic gait
Trendelenberg Test
Restricted ROM
Capsular: IR>Flexion>Abducion = Ext
Limited IR/ER/Flexion
Flexion

Question 21

Adductor Muscle Strain: subjective

Answer 21

MOI: overstretch or excessive load on muscle
Symptoms: sore, tight, tearing
Aggravating: adductor stretching, rapid stretch/contraction
Functional limits: walk, run, lunge
Hurdle, steps, stretch

Question 22

Adductor Muscle Strain: objective

Answer 22

edema/ecchymosis
tender to palpation
pain with manual resistance to suspected muscle
pain w/ stretching/ decrease muscle length

Question 23

Examination is driven by…

Answer 23

SINS

Question 24

Arrange examination by position:

Answer 24

Stadning
Sitting
Supine
Side-lying
Prone

Question 25

MMT

Answer 25

5 - 55-60% max 4 - 40% max 3+ - 25 %

Question 26

Functional Tests

Answer 26

Timed activity & quality Single leg squats Single leg bridge

Question 27

Hip Abductor demand

Answer 27

Stabilizer Trendelenberg: single limb standing Compensations: contralateral pelvic drop Ipsilateral trunk lean

Question 28

Hip Abductor: Impairments

Answer 28

LOB Weakness of a muscle influence balance Hip fatigue caused greater postural changes than from ankle fatigue

Question 29

Labral Tears

Answer 29

Capsular laxity FAI Acetabular dysplasia (15-22%) Chondral lesions (73%)

Question 30

Labrum assists...

Answer 30

maintenance of negative intra-articular pressure for improved stability

Question 31

Labral tear: Pain location

Answer 31

Groin - 92-100 Lateral hip - 59 Ant thigh/medial knee 52 Buttock - 38 Sharp/Dull

Question 32

Labral tear: 24 hour pattern

Answer 32

activity - 91 night - 71 constant pain - 55

Question 33

Clicking/catching

Answer 33

58-100 | painful locking - 89

Question 34

Labral tear: MOI

Answer 34

acute: 30% trauma: 9% gradual onset: 61%

Question 35

Labral tear: subjective

Answer 35

``` antalgic gait - 89 stairs painful - 69 pivot pain - 70 pain w/ high impact - 62 pain w/ sitting - 61 ```

Question 36

Labral tear: objective

Answer 36

``` Limited ROM w/ w/o capsular pattern IR>Flexion>Abduction = Extension + FAI test Hypermobile joint accessory +FABER ```

Question 37

Trochanteric bursitis

Answer 37

- Reduces friction between ITB, glut med/min, greater trochanter - Excessive shear/compression bursa inflamed/painful

Question 38

Trochanteric bursitis: subjective

Answer 38

fall into lateral hip repeititive flexion/extension activity Symptoms: lateral hip pain Aggravated: - Ipsilateral sidelying - Repeated Flexion/Extension in WB

Question 39

Trochanteric bursitis: objective

Answer 39

tender at greater troch palpable/audible crepitus/popping w/ flexion/extension Ober test for ITB