hip patho Flashcards
What are the clinical presentations of OA
-60+yrs
worse in am no more than 30-45
(if it is linked to inflammatory conditions
- pain in flexion and rotation
- worse on activity as the day goes on
movement and pain in IR
What positive tests would show hip OA
- +ve FADIRS and FABERS for pain and reduced movement
- +ve log roll = reduced hip
what are the risk factors of OA
Previous hip replacements
- obesity
- genetics
- repetitive stress
-farmers/ construction workers.
- trauma, e.g fractures
-Acetabular dysplasia
- Femoroacetabular impingement
- Slipped capital femoral epiphysis
- Perthes disease
High impact sports eg football, handball, hockey, wrestling, weight-lifting, and long-distance running
Differential diagnoses for OA
osteonecrosis
- IT band syndrome
- spinal stenosis
- septic arthritis
What treatment plan for hip oa
- weight loss/lifestyle advice if appropriate
- referral to secondary care
- walking aids
- MT
- Psychologically informed practice
- Acupuncture
-Thermo/cryotherapy
references ffor hip OA treatment
Hermann et al (2015) demonstrated feasibility of providing high velocity resistance training in patients with hip pain. 60-minute sessions, 2 x per week for 10 weeks were provided. 3 sets of 8-12 reps of 3 high speed concentric and slow eccentric phase exercises demonstrated a reduction in pain during and post session, with carryover to the next day. No long term follow up.
what is Femoro-acetabular impingement
Motion related disorder of the hip where there is premature contact between acetabulum and proximal femur
what are the clinical presentations for FAI
20-40yrs
- onset or
- trauma related or gradual onset
History of
-clicking/locking/catching and instability.
- pain on hip flexion activities/ loading
-pain reported in thigh,back or bum
what test would indicate FAI
FADDIR +ve
FABER’S test -
risk factors for FAI
repetitive stress on the area
- Young athletes
- pregnant women
- weight bearing activities
differential diagnosis for FAI
Tumour
Infection
Septic arthritis
Osteomyelitis
Fracture
Avascular necrosis
OA/labral
treatment plans for FAI ?
- advice/re-assure them on condition
- heat/analgesia
- Mobs – PA, lateral & caudal distraction
Exercise = standing hip abduction
= hip hinge
anterior labrum clinical p
-locking/catching/clunking
- Anterior hip pain
what tests would be positive for labrum tear
FADIRS/FABERS/SCOOP
risk factors for labrum tear
- repetitive hip movements
- hypermobility
- Trauma
- OA
- FAI
- Leg length discrepancy
differential diagnosis for labrum tear
impingement
- OA
- Fracture
Treatments for labrum tear
- Management
- Advice on management
- Heat/ice/analgesia
- Rehab focussing on core and glutes
- Mobs – Physiological movements or METs for hip in symptomatic muscles(muscle pain) and ROM
clinical p of Greater Trochanter pain syndrome/Lateral hip pain
pain at lateral side of hip and GT
- history of loading/ overload
- linked with gluteal tendinopathy(max/medius)
Normally bursae related.
- pain laying on the problem side
- pain with prolonged sitting
- weak hip abductors
- pain with resisted abduction
- sitting crossed legs increases pain
- pain can refer to lateral thigh and knee
- pain will worsen overtime(episodic)
- pain with weightbearing activities e.g walking, standing etc.
- tender LH and especially GT when palpated
risk factors for GTPS
Obesity
- Women
- increased BMI
differential diagnosis for Greater Trochanter pain syndrome/Lateral hip pain
- HIP OA
- Labrum tear
- AV
- FAI
what treatment plan for GTPS
Progressive loading
- education around activity mod +Reduction in compressive load
- Weight loss management
- surgery only if all other conservative methods considered
- imaging for other differential diagnosis consideration
- corticosteroid injections
- fenestration
Proximal hamstring tendinopathy
clinical p
- deep glute bum pain
- pain in deep flexion/ sitting
- eases with standing and movement
- palpation pain on ischial tuberosity
risk factors of hamstring tendnopathy
- history of load activity in deep squat/ lungs position
differential diagnosis for proximal hamstring Tendinopathy
- Posterior Labrum
- sciatic nerve
- posterior hip impingement
Treatment plan for proximal tendinopathy
- Management
- Load and load management
- Graded rehab focussing on hamstrings/glutes/quads - nordic hamstring exercise
- Heat/ice/analgesia
- Shockwave
Adductor related groin pain clinical p
- localised groin pain
- squeeze test
Pain on resided testing
risk factors for Adductor-related groin pain
- history of trauma/repeated load normally sport related
differential diagnosis for Adductor related groin pain
- Hernia inguinal/sportsmans +ve cough/sneeze
- Iliopsoas related groin pain
treatment for Adductor related groin pain
Load management advice – Copenhagen Adductor Exercise
- Heat/ice/analgesia
- Soft tissue techniques
- Graded rehab – start with Isos and slowly progress
Iliopsoas related groin pain clinical P
- Anterior hip/groin pain
- Pain on resisted testing
- ?+ve Thomas test
risk factors for Iliopsoas related groin pain
- History of increased load
differential diagnosis for iiopsoas related groin pain
iliopsoas- Adductor related groin pain
- Hernia
- Hip pathology intra articular/extra articular
treatment for Iliopsoas related groin pain
- Load management advice
-Heat/ice/analgesia - Soft tissue techniques
-Graded rehab – start with Isos and slowly progress
Supine hip flexor holds
Standing knee raises
Concentric and eccentric: - Seated hip flexion
Supine leg raises
Standing knee raises with resiisted band
