Hip P! with Movement Coordination Impairments Flashcards
What Subjective findings may you find with this Diagnosis?
- MOI can be either traumatic or atraumatic
Traumatic
- Reports of traumatic dislocation or subluxation
- 90% of dislocations or subluxations are posterior
- Immediatly after dislocation, the LE is usually held in Adduction, IR and Flexion
Atraumatic
- Insidious onset of Anterior hip or groin pain
- No motion loss, but excessive motion especially ER and Extension
- Reports popping, locking or snapping Sx are common
- May have a Hx that involed repetitive forceful activities, especially activities involving rotation
What may you find during the Physical Examination with this Diagnosis?
- No restrictions in AROM or PROM, but excessive motion may be present
- MLTs may or may not be impaired
- MMTs may be impaired:
-Hip Abductors
-Deep Hip ERs - Joint Integrity Test
-Hypermobility is typical - Additional Test
-(+) Dial, FABER, FADIR, Scour, Resisted SLR - Palpation
What are the Prognostic Factors for Traumatic MOI?
- The direction of dislocation
- Time to reduction of dislocation
- Age
What are the Prognostic Factors for Atraumatic MOI?
- Etiology
- Age
- Activity level
What interventions can be done for Movement Coordination?
Sx Modulation
- Manual Therapy
- Dry needling
Motor control and stabilization
- Core and lumbar stability exercises
- Hip abduction/ER strengthening
- Single limb exercises focusing on motor control and stability
Functional Optimization
- Continue to focus on strength and stability
- Exercise should match sport/activity: Movement patterns, speed, energy system, intensity, muscle performance goal
What are the Characteristics of Hip Dysplasia?
- More common in females than males
- Decreased coverage of the acetabulum
- Can be congenital or acquired
- Dx via radiograph, MRI or CT
- Should be considered in athletes who benefit from increased motions such as dancers
-Up to 89% of professional ballet dancers have hip dysplasia or borderline hip dysplasia
congenital (present at birth) or acquired (develops later in life)
What may you find in the Examination with those with Hip Dysplasia?
- Typically presents as Deep Anterior Groin Pain
Test and measures that will indicate hip dysplegia
- AROM/PROM (limited IR and Excessive ER is common)
- MLT
- Joint integrity (Hypermobile)
- Additional Orthopedic Test
-Apprehension with Long Axis distraction and improvement with Axial loading is a sign of instability
Any personal or familial Hx of connective tissue disorders may also be a consideration
What are common treatments for Hip Dysplegia?
Conservative Treatment
- Activity modification and/or brief period of rest
- Strengthening of the Hip Flexors, Abductors, Short ERs, Core and Low Back muscles
- Proprioception training should be included due to joint hypermobility
Corticosterioid injection should be considered
Surgical Intervention
If conservative treatment fails
- This procedure depends on the degree of instability
What are the Characteristics of Hip Labral Tears?
The prevalence of labral tears with mechanical hip pain can be as high as 90%
- The cause of groin pain in more than 20% of athletes
- Tears can be degenerative, dysplastic, traumatic or idiopathic
-Degeneration tears can also be associated with inflammatory arthropathies
- Common MOI is Mechanical impingement and instability
What are the 2 most common patient scenarios for Hip Labral Tears?
- Younger patient with a twisting injury to the hip, usually an external rotation force in a hyperextension position
- Older patient with a history of dysplegia or repeated pivoting/twisting motion
What is the Most Common Type of Hip Labral Tear?
Radial Flap
- Radial flap labral tears are related to damage to the free margin of the labrum and therefore form a radial flap
What is a Type 1 Hip Acetabular Labral Tear?
A detachment of the labrum from the articular cartilage surface.
- These tears tend to occur at the transition zone between the fibrocartilaginous labrum and the hyaline articular cartilage. They are perpendicular to the articular surface and in some cases, extend to the subchondial bone
What is a Type 2 Acetabular Labral Tear?
Consist of one or more cleavage planes variable depth within the substance of the labrum
In other words, when 1 or 2 splits/separations of the labrum are torn either shallow or deep. Seen with MRI
What may you find in the Hx with a patient with a Hip Labral tear?
- Sx are usually mechanical: Buckling, catching, twinges, clicking, locking, instability and painful clicking.
- May or may not be a hx of trauma
- The injury is caused by the hip joint being stressed while in rotation
- The pain is mainly in the anterior groin (most commonly), but can be in the lateral or posterior thigh and/or medial knee region
- Activities that involve forced adduction of the hip joint in association with rotation in either direction tend to Agg the pain
From book, bolded was also in digital lecture
What may you find in the Examination with those with Hip Labral Tear?
Test and measures that stress the labrum
- AROM/PROM
- MLT
- Joint integrity
- Additional Orthopedic Test
Hip IR with overpressure and FABERs test show the highest sensitivity for identifying a labral tear
What are common treatments for Hip Labral Tear?
Conservative Treatment
- Activity modification
- Improve the force-producing capacity and control of hip musculature
- 12 weeks or more is recommended
Corticosterioid injection should be considered
Surgical Intervention
If conservative treatment fails
- Labral debridment
- Labral repair
- Labral reconstruction
