Hip Lecture Flashcards
Hip functions
Supports weight of load, arms, trunk
Static & Dynamic
Pathway for transmission of forces between pelvis & lower extremities
Mechanical stresses on hip
Tensile, torsional, compressive loading SLS: 2.4-2.6x Walking: 1.3-5.8x Stairclimbing: 3x Running: 4.5+x
Compressive Forces
Body Weight
Muscular Activity
Process of differential diagnosis
85% of the info for accurate dx is acquired during the subjective exam
3 deciding questions:
appropriate for this pt
appropriate w/ additional referral
inappropriate for PT at this time
Categorizing sources
Local neuro/mesculoskeletal - Intra-articular - Extra-articular Remote/referred neuro/musculoskeletal Systemic sources
Intra-articular causes
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
Intra-articular
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
Intra-articular: additional
Local infection Septic arthritis Neoplasm (tumor) Avascular necrosis DDH, birth LCP, 6-10 years SCFE, 11-14 years
Extra-articular
Ligament sprain -Inguinal -Iliofemoral -Pubofemoral -Ischiofemoral Muscle Strain/Tear -Superficial & deep flexors, adductors, extensors, rotators Bursitis Iliopsoas bursa Trochanteric bursa Ishiogluteal bursa
Referred sources
Lumbar disc pahtology Lumbar spine degenerative joint disease Athletic pubalgia Radiculopathy Piriformis Syndrome SIJ pathology Genitourinary tract pathology Abdominal wall pathology
Systemic Sources
RA Crohn's Psoriasis Reiter's Systemic Lupus erythematosus
Musculocutaneus
OA
Muscle strain
OA
Primary OA vs Secondary
OA
Disorder of synovial joints w/ deterioration of articular cartilage and new bone formation
OA: Symptoms
Groin & thigh pain most common (98% intra)
OA: 24 hours pattern
Morning stiffness
OA: MOI
may/may not be related to h/o trauma
OA: Limitations
Transitional movements w/ pain
Walking antalgic
Stiffness impaired donning shoes/socks
OA: Findings
Antalgic gait Trendelenberg Test Restricted ROM Capsular: IR>Flexion>Abducion = Ext Limited IR/ER/Flexion Flexion
Adductor Muscle Strain: subjective
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
Adductor Muscle Strain: objective
edema/ecchymosis
tender to palpation
pain with manual resistance to suspected muscle
pain w/ stretching/ decrease muscle length
Examination is driven by…
SINS
Arrange examination by position:
Stadning Sitting Supine Side-lying Prone
MMT
5 - 55-60% max
4 - 40% max
3+ - 25 %
Functional Tests
Timed activity & quality
Single leg squats
Single leg bridge
Hip Abductor demand
Stabilizer
Trendelenberg: single limb standing
Compensations: contralateral pelvic drop
Ipsilateral trunk lean
Hip Abductor: Impairments
LOB
Weakness of a muscle influence balance
Hip fatigue caused greater postural changes than from ankle fatigue
Labral Tears
Capsular laxity
FAI
Acetabular dysplasia (15-22%)
Chondral lesions (73%)
Labrum assists…
maintenance of negative intra-articular pressure for improved stability
Labral tear: Pain location
Groin - 92-100
Lateral hip - 59
Ant thigh/medial knee 52
Buttock - 38
Sharp/Dull
Labral tear: 24 hour pattern
activity - 91
night - 71
constant pain - 55
Clicking/catching
58-100
painful locking - 89
Labral tear: MOI
acute: 30%
trauma: 9%
gradual onset: 61%
Labral tear: subjective
antalgic gait - 89 stairs painful - 69 pivot pain - 70 pain w/ high impact - 62 pain w/ sitting - 61
Labral tear: objective
Limited ROM w/ w/o capsular pattern IR>Flexion>Abduction = Extension \+ FAI test Hypermobile joint accessory \+FABER
Trochanteric bursitis
- Reduces friction between ITB, glut med/min, greater trochanter
- Excessive shear/compression bursa inflamed/painful
Trochanteric bursitis: subjective
fall into lateral hip
repeititive flexion/extension activity
Symptoms: lateral hip pain
Aggravated:
- Ipsilateral sidelying
- Repeated Flexion/Extension in WB
Trochanteric bursitis: objective
tender at greater troch
palpable/audible crepitus/popping w/ flexion/extension
Ober test for ITB
