Hip Patholgies management Flashcards
Pathologies, traumas, and syndromes of the hip are divided into 3 categories
- strains & tendinopathies
- bursitis
- syndrome
Syndromes of the hip
- iliotibial band syndrome
- trochanter major pain syndrome
- piriformis syndrome
- capsular tension
Bursitis examples
- greater trochanteric bursitis
- iliopsoas / iliopectineal bursitis
- ischial bursitis
Strain and tendinopathy examples
- hamstring strain
- strain and tendinopathies of the adductor muscles
- gluteus medius strain
- athletic pubalgia
Pathology of the hip can be classified into 3 groups, what are they ?
- intra articular
- extra articular
- hip mimickers
Examples of intra articular hip pathology
- osteoarthritis
- avascular necrosis
- femoroacetabular impingement
- chondral defects
- ligamentum teres tears
- acetabular labral tears
Examples of hip mimickers
- athletic pubalgia
- osteitis pubis
- lumbar radiculopathy
Tendinitis definition
Widespread degeneration of tissues rather than inflammation
What are the benefits of cryotherapy in the treatment of gluteal tendinopathies ?
- decreases capillary blood flow
- preserves deep tendon oxygenitation saturation
- facilitates venous capillary outflow
P R I C E stands for
Protection, rest, Ice, compression, elevation
Protocols of strains in the hip
- PRICE
- NSAIDS
- WHIRPOOL
- US
- Gentle exercise & stretches & hot
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
False, a few days
What are the possible causes of piriformis syndrome ?
- herniated disk
- Spinal stenosis
- infection or injury
- fat wallet syndrome
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
True
What are physical therapy methods used in piriformis syndrome ?
- ROM, strengthening, and aerobic exercises
- stretching exercises & techniques
- heat or cold therapy
- ultrasound
- iontophoresis or sonophoresis
- BTX-A injection
Greater Trochantaric pain syndrome consists of what
Gluteal tendinopathies (medius & minimus) + throcantaric bursitis
What are protocols for treating hip bursitis ?
- rest until there is no pain
- apply ice to the area
- run only on flat and even surfaces
what are the rehabilitation phases of trochanteric bursitis ?
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
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
True
What kind of testing can we use to differentiate between piriformis syndrome and intervertebral disc herniation ?
(EMG) neurophysiologic testing
What are medical methods of treatment for glueteal tendinopathy ?
- anti inflammatory agents
- corticosteroids
- topical glyceral trinitrate patches
- Sclerotherapy
Injectable chemical into blood vessels near the tendinopathy is what
Sclerotherapy
Rest is recommended in gluteal tendinopathies, true or false
False, not recommended
Gluteal tendinopathy protocols
- progressive loading with pain management
- patient education related to loads on the tendon
- stretching exercises are not recommended in insertional tendinopathies
When do we apply ice or cold packs for gluteal tendinopathy
10 min for first 72 hours
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
True
For gluteal tendinopathy, eccentric exercises are recommended, what is the optimal number of sets and repetitions for tendon repair ?
20-30 reps (if no discomfort go for 30)
3 sets of 10 reps
For gluteal tendinopathy, eccentric exercises are recommended, what are some example of these exercises ?
- Nordic hamstrings
- sidestepping (X-band)
- side plank clam
- single leg deadlift
- bird dog
- split squat / lunge
What are some key goals in physical therapy of piriformis syndrome ?
- 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
Examples of pathologies of joint
- acetabular labral tear
- osteoarthritis
- osteoitis pubis
- femoroacetabular impingement
- snapping hip
What are causes of acetabular labral tear ?
- 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)
what are physical therapy methods for acetabular labral tear
- 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
Examples of conditions related to groin pain
- osteoitis pubis / athletic pubalgia
- adductor tendinopathy
- iliopsoas dysfunction
examples of non specific exercise related to groin pain
- adductor longus and rectus abdominus
- indirectly to transversus abdominus and rectus abdominus sheath
what are the anterior pubic insertions
- abdomen
- quads
- sartorius
- iliopsoas
- pectineus
what are the medial pubic insertions
- the 3 adductor muscles
- gracillis
- obturator externus
what are the posterior pubic insertions
hamstrings and part of the adductor magnus
osteitis pubis usually presents itself with
pubic symphysis or proximal adductor pain
osteitis pubis pain may involve what areas, adding uncertainty to diagnosis
- lower abdomen
- hip
-perineal - scrotal
a pathological condition leading to abutment between the proximal femur and acetabular rim
femoral acetabular impingement
what are the two types of femoral acetabular impingement
pincer lesion and CAM lesion
soft tissue abnormality creating excessive coverage of the acetabulum
pincer lesion
bony abnormality such as a non spherical femoral head
CAM lesion
what causes pincer lesion
repetitive contact of the over covered acetabulum rim and femoral neck with hip flexion or internal rotation which creates impingement
what causes CAM lesion
repetitive contact with hip flexion or internal rotation will create impingement due to the abnormal shape of the femoral head
what are conservative methods of treatment for osteitis pubis
- rest
- physical therapy
- ultrasonography
- NSAIDS / oral glucocorticoids
- shock absorbing footwear (diminishes shear forces across symphysis pubis)
to decrease detrimental antagonistic muscle forces at the pubis symphysis we can do
- core stability
- strengthening
- muscle force balancing at the core
what are the two types of snapping hip
lateral and internal
what causes lateral snapping hip
muscle fibers rolling across the greater trochanter, clicking feeling is not usually painful
what causes internal snapping hip
iliopsoas muscle as it rolls across hip bone, this form is more likely to cause pain
how do we treat a snapping hip
- rest
- ice consistently
- stretch the muscles around the thigh and hip
- get a coach to check your technique and form in your sport
condition characterized by tingling, numbness, and burning pain in outer thigh caused by the compression of the lateral femoral cutaneous nerve
meralgia paresthetica
what are the basic protocols for non operative femoral acetabular impingement
- posture
- core stabilization
- proximal strengthening
- static and dynamic stretching
