Hip Pathologies

Question 1

AVN

Answer 1

Often 30-50 year olds
Pain typically in the high or buttock; typically described as dull ache or throbbing
Loss of ROM in all directions. Pain on ambulation, abduction, IR and ER.
May be due to direct trauma, corticosteroid use, chemotherapy

Question 2

Acetabular Labral Tear

Answer 2

MOI: Not a known cause, can be young person with twisting injury to hip, or older people with hx of hip dysplasia or repeated twist/pivot
Pain mainly in the anterior groin - thigh, medial knee, trochanteric or buttock pain. Acute onset or gradual. Clicking, catching, locking.
Hip adduction with rotation aggrevate
Pain at extremes ROM (Flexion, adduction, IR) but NO RESTRICTION in ROM
Pain with active SLR

Question 3

Femoral Acetabular Impingement (FAI)

Answer 3

Occurs with decreased joint clearance between femur and acetabulum.
Correlated with labral tears.
Flexion, adduction, IR ROM may be painful

Question 4

Contusion or “Hip Pointer”

Answer 4

MOI: likely a fall or direct trauma
Pain on palpation
Skin discoloration/hematoma
Antalgic gait with loss of ROM due to pain

Question 5

Myositis Ossificans

Answer 5

Usually occurs post trauma
Typically 2-4 weeks post contusion with hematoma
PROM or stretching contraindicated as it can tear the muscle

Question 6

Hamstring Strain

Answer 6

One of the most common muscle injuries especially biceps femoris
Often occur during the eccentric phase, can be avulsed from ischial tuberosity
Pain in the posterior thigh; strain near the origin at the ischial tuberosity may yield buttock pain
RROM pain with hip extension + knee flexion, PROM pain with hip flexion + knee extension

Question 7

Adductor Strain

Answer 7

Associated with running, jumping, twisting
Pain in groin area
Increased pain with twisting, quick start and stop motion
Pain with passive abduction and resisted adduction
Leg straight with resisted adduction = Gracilis
Hip at 45 with resisted adduction = longus or brevis
Hip at 90 with resisted adduction = pectineus

Question 8

Iliopsoas Strain

Answer 8

MOI: forced extension of hip while it is actively flexing
Pain with acceleration and high stepping
Pain with resisted hip flexion, adduction
Often reoccurrence

Question 9

Gluteus Medius Strain

Answer 9

Usually at attachment of greater trochanter
Pain buttock, lateral hip, or groin, pain near the greater trochanter
Trendelenburg gait and Weakness
Avoid hip abductor strengthening b/c provokes tendonitis

Question 10

Quadriceps Strain

Answer 10

Usually rectus femoris
Often involved in jumping, sprinting, or kicking sports
Local pain, tenderness
Pain with resisted knee extension and hip flexion
Pain with passive knee flexion and hip extension

Question 11

Snapping Hip Syndrome

Answer 11

Not painful at rest, usually felt with a functional active use of the muscle
ITB or glut max over greater trochanter
more common in females and can be exacerbated with running on banked surfaces
May be painful or painless
Symptoms reproduced with passive hip rotation or hip flexion/extension in supine; Hip adduction painful

Question 12

Trochanteric Bursitis

Answer 12

MOI: direct trauma, repetitive stress, friction
More common in females aged 40-60
Can be seen with arthritis, fibromyalgia, leg-length discrepancies
Lateral thigh pain most common but can be in groin or gluteal
Pain with palpation, stretching ITB across trochanter, hip adduction, or end range rotation
Pain with resisted hip abduction, extension,ER
Tight hip adductors

Question 13

Iliopsoas Bursitis

Answer 13

Pain with passive hip flexion and adduction at end range
Pain with passive hip extension and ER
Pain with palpation

Question 14

Ischial Bursitis

Answer 14

Pain with sitting in firm chair
Women > Men
Cyclist and thinner people more commonly

Question 15

Sciatic Nerve Injury

Answer 15

Entrapped Piriformis
Restriction in hip adduction, IR
Positive FAER
Neurologic symptoms in posterior leg
Reproduction of symptoms with active ER and passive IR

Question 16

Femoral Nerve Injury

Answer 16

MOI: gunshot or knife wounds
Diabetic patients usually
Weakness in quadriceps

Question 17

Lateral Femoral Cutaneous Nerve Injury

“Meralgia paresthetica”

Answer 17

Entrapment at inguinal ligament: pregnancy, tumors, trauma, tight garments or belts, prolonged siting, diabetes
Lateral and anterior thigh pain/paresthesia
Symptoms increase with hip extension

Question 18

Pelvic/Femoral Fractures

Answer 18

MOI: powerful contraction, repetitive stress, direct trauma
Typically older adults
Severe pain

Question 19

Total Hip Replacement Precautions: Posterior-lateral approach restrictions

Answer 19

No flexion past 90
No adduction past midline
No IR past neutral

Question 20

Total Hip Replacement: Anterior lateral approach restrictionss

Answer 20

No extension beyond neutral
No ER beyond neutral
No extreme abduction
No flexion past 90

Question 21

Congenital Hip DDislocations

Answer 21

Present at birth
Uneven appearance of buttock folds
Click sound when moved

Question 22

Slipped Femoral Capital Epiphysis

Answer 22

Slow onset, males (10-17) > females (8-15)
Knee, lower thigh, groin, or medial thigh pain
Short limb, obesity, adductor spasms, quad atrophy
Decreased IR, abduction, flexion

Question 23

Legg- Calve- Perthes Disease

Answer 23

Hip, knee, or groin pain
Insidious onset
Increased symptoms with movement or activity 
2-13 in age, males > females
Decreased abduction and extension
Pain in extreme motion
Limited IR, abduction, flexion
ER of hip with hip flexion

Question 24

Transient Synovitis

Answer 24

Inflammation and swelling of tissues around hip
Lasts only a short amount of time
Most common cause of sudden hip pain in children
2-12; males > females
Pain limits mobility

Question 25

OA Pathology

Answer 25

Insidious onset, stiffness, progressive pain
Pain in the groin, buttock, thigh, or knee
Aching to sharp pain
Capsular pattern restriction: IR = flexion= abduction