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Ortho > Hip Patholgies management > Flashcards

Hip Patholgies management Flashcards

1
Q

Pathologies, traumas, and syndromes of the hip are divided into 3 categories

A
  • strains & tendinopathies
  • bursitis
  • syndrome
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2
Q

Syndromes of the hip

A
  • iliotibial band syndrome
  • trochanter major pain syndrome
  • piriformis syndrome
  • capsular tension
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3
Q

Bursitis examples

A
  • greater trochanteric bursitis
  • iliopsoas / iliopectineal bursitis
  • ischial bursitis
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4
Q

Strain and tendinopathy examples

A
  • hamstring strain
  • strain and tendinopathies of the adductor muscles
  • gluteus medius strain
  • athletic pubalgia
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5
Q

Pathology of the hip can be classified into 3 groups, what are they ?

A
  • intra articular
  • extra articular
  • hip mimickers
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6
Q

Examples of intra articular hip pathology

A
  • osteoarthritis
  • avascular necrosis
  • femoroacetabular impingement
  • chondral defects
  • ligamentum teres tears
  • acetabular labral tears
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7
Q

Examples of hip mimickers

A
  • athletic pubalgia
  • osteitis pubis
  • lumbar radiculopathy
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8
Q

Tendinitis definition

A

Widespread degeneration of tissues rather than inflammation

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9
Q

What are the benefits of cryotherapy in the treatment of gluteal tendinopathies ?

A
  • decreases capillary blood flow
  • preserves deep tendon oxygenitation saturation
  • facilitates venous capillary outflow
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10
Q

P R I C E stands for

A

Protection, rest, Ice, compression, elevation

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11
Q

Protocols of strains in the hip

A
  • PRICE
  • NSAIDS
  • WHIRPOOL
  • US
  • Gentle exercise & stretches & hot
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12
Q

Start doing gentle hamstring stretches after a few weeks when the pain has started to subside, this should be followed by a program of gentle exercise such as walking, cycling, and hamstring strengthening exercises. True or False

A

False, a few days

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13
Q

What are the possible causes of piriformis syndrome ?

A
  • herniated disk
  • Spinal stenosis
  • infection or injury
  • fat wallet syndrome
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14
Q

In patients with piriformis syndrome, EMG results will be normal for muscles proximal to the piriformis muscle and abnormal for muscles distal to it, true or false

A

True

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15
Q

What are physical therapy methods used in piriformis syndrome ?

A
  • ROM, strengthening, and aerobic exercises
  • stretching exercises & techniques
  • heat or cold therapy
  • ultrasound
  • iontophoresis or sonophoresis
  • BTX-A injection
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16
Q

Greater Trochantaric pain syndrome consists of what

A

Gluteal tendinopathies (medius & minimus) + throcantaric bursitis

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17
Q

What are protocols for treating hip bursitis ?

A
  • rest until there is no pain
  • apply ice to the area
  • run only on flat and even surfaces
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18
Q

what are the rehabilitation phases of trochanteric bursitis ?

A

Phase I: pain relief, protection, and a progressive return to sport

phase II: restoring normal ROM and strength + treat comorbidities (such as osteoarthritis & labral tears)

Phase III: restoring full function

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19
Q

When in phase II of throcanteric bursitis rehab, restoring normal ROM and strength also means restoring muscle length, resting tension, muscle strength and endurance, proprioception, balance and gait. True or False

A

True

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20
Q

What kind of testing can we use to differentiate between piriformis syndrome and intervertebral disc herniation ?

A

(EMG) neurophysiologic testing

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21
Q

What are medical methods of treatment for glueteal tendinopathy ?

A
  • anti inflammatory agents
  • corticosteroids
  • topical glyceral trinitrate patches
  • Sclerotherapy
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22
Q

Injectable chemical into blood vessels near the tendinopathy is what

A

Sclerotherapy

23
Q

Rest is recommended in gluteal tendinopathies, true or false

A

False, not recommended

24
Q

Gluteal tendinopathy protocols

A
  • progressive loading with pain management
  • patient education related to loads on the tendon
  • stretching exercises are not recommended in insertional tendinopathies
25
Q

When do we apply ice or cold packs for gluteal tendinopathy

A

10 min for first 72 hours

26
Q

For gluteal tendinopathy we should do gentle hip ROM exercises and stretching to prevent stiffness and also take a hip core stabilization program to prevent reoccurance, true or false

A

True

27
Q

For gluteal tendinopathy, eccentric exercises are recommended, what is the optimal number of sets and repetitions for tendon repair ?

A

20-30 reps (if no discomfort go for 30)
3 sets of 10 reps

28
Q

For gluteal tendinopathy, eccentric exercises are recommended, what are some example of these exercises ?

A
  • Nordic hamstrings
  • sidestepping (X-band)
  • side plank clam
  • single leg deadlift
  • bird dog
  • split squat / lunge
29
Q

What are some key goals in physical therapy of piriformis syndrome ?

A
  • 2-3 sessions per week for the duration of the treatment + home exercise
  • to increase ROM of surrounding muscle groups and joints
  • increase strength of muscle groups specifically adductor muscles of the hip
30
Q

Examples of pathologies of joint

A
  • acetabular labral tear
  • osteoarthritis
  • osteoitis pubis
  • femoroacetabular impingement
  • snapping hip
31
Q

What are causes of acetabular labral tear ?

A
  • bony abnormalities (impingement)
  • weakened hip muscles
  • faulty movement mechanics (repetitive activities)
  • distance running
  • sports requiring jumping, cutting, twisting, kicking
  • excessive repetitive stretching (yoga, dance, gymnastics)
32
Q

what are physical therapy methods for acetabular labral tear

A
  • dry needling
  • extracorporeal shock wave therapy (ESWT)
  • Computer assisted rehab environment (CAREN)
  • force plate and motion capture analysis
  • feedback and feed forward retraining
  • dynamic neuromuscular stabilization (DNS)
  • Exercises
33
Q

Examples of conditions related to groin pain

A
  • osteoitis pubis / athletic pubalgia
  • adductor tendinopathy
  • iliopsoas dysfunction
34
Q

examples of non specific exercise related to groin pain

A
  • adductor longus and rectus abdominus
  • indirectly to transversus abdominus and rectus abdominus sheath
35
Q

what are the anterior pubic insertions

A
  • abdomen
  • quads
  • sartorius
  • iliopsoas
  • pectineus
36
Q

what are the medial pubic insertions

A
  • the 3 adductor muscles
  • gracillis
  • obturator externus
37
Q

what are the posterior pubic insertions

A

hamstrings and part of the adductor magnus

38
Q

osteitis pubis usually presents itself with

A

pubic symphysis or proximal adductor pain

39
Q

osteitis pubis pain may involve what areas, adding uncertainty to diagnosis

A
  • lower abdomen
  • hip
    -perineal
  • scrotal
40
Q

a pathological condition leading to abutment between the proximal femur and acetabular rim

A

femoral acetabular impingement

41
Q

what are the two types of femoral acetabular impingement

A

pincer lesion and CAM lesion

42
Q

soft tissue abnormality creating excessive coverage of the acetabulum

A

pincer lesion

43
Q

bony abnormality such as a non spherical femoral head

A

CAM lesion

44
Q

what causes pincer lesion

A

repetitive contact of the over covered acetabulum rim and femoral neck with hip flexion or internal rotation which creates impingement

45
Q

what causes CAM lesion

A

repetitive contact with hip flexion or internal rotation will create impingement due to the abnormal shape of the femoral head

46
Q

what are conservative methods of treatment for osteitis pubis

A
  • rest
  • physical therapy
  • ultrasonography
  • NSAIDS / oral glucocorticoids
  • shock absorbing footwear (diminishes shear forces across symphysis pubis)
47
Q

to decrease detrimental antagonistic muscle forces at the pubis symphysis we can do

A
  • core stability
  • strengthening
  • muscle force balancing at the core
48
Q

what are the two types of snapping hip

A

lateral and internal

49
Q

what causes lateral snapping hip

A

muscle fibers rolling across the greater trochanter, clicking feeling is not usually painful

50
Q

what causes internal snapping hip

A

iliopsoas muscle as it rolls across hip bone, this form is more likely to cause pain

51
Q

how do we treat a snapping hip

A
  • rest
  • ice consistently
  • stretch the muscles around the thigh and hip
  • get a coach to check your technique and form in your sport
52
Q

condition characterized by tingling, numbness, and burning pain in outer thigh caused by the compression of the lateral femoral cutaneous nerve

A

meralgia paresthetica

53
Q

what are the basic protocols for non operative femoral acetabular impingement

A
  • posture
  • core stabilization
  • proximal strengthening
  • static and dynamic stretching

Ortho (4 decks)

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