hip pathologies Flashcards
what is OA?
degenrative condition affecting joints
damage to joint surface
irregular loss of ac
Why does a joint w/ OA become hypo-mobile over time?
thickening of the subchondral bone
what happen to the muscles around a joint affected by OA?
muscles are hypertonic due to aims to provide more stability
what happens to the ligament and capsule as they try to stabilize joint w/ OA
stress that leads to irritation/thickening and scar tissue leading to joint hypomobility
what happens to bones as a result oif the increase tension on the ligaments and capsule due to OA
increase tension leads to stress on bone and it will try to heal itself; as such osteophytes will form and lead to deformity
what are the most common risk factors associated w/ OA
- females
- age
- stress/abnormal loadingh
- overuse
- previous injury to the joint
- obesity
- joint misalignment
- underloading
how does OA compare to RA
OA tends to be assymetrical
characteristics of OA
pt > 50 asymmetrical pain am stiffness < 30 min swellinh loss ROM weak surrounding ms
how to assess for hip OA?
- presence of pain in the hip and
IR hip < 15 degrees and ESR less or equal to 45 degree mm/H OR hip IR greater or equal to 15 degreres and am stiffness less than 60 min and over 50 yo
where is the pain site for hip OA
Groin deep Buttocks Anterior thigh Knee (referred) Pain site will be asymmetrical
what is the MOI for hip OA
insidious onset
progressive disease
what is the pain pattern for hip OA
initially c/o pain
over time c/o stiffness and decreased ROM
w/ hip OA what is generally the first mvmt to be limited?
flexion
what muscles may be atrophied w/ hip OA?
glute med and max
what functional tests can be performed to assess for hip
unilateral WB trendelenberg proprioception pain w/ squatting gait assessment
what are the stages of OA?
- ms reaction, mvmt reaction
- contracture
- bone ankylosing, osteophytes
what happens to ROM in the first stage of OA?
reduced IR especially w/ hip extended, decreased flexion, add, decreased FABER
decreased extensioon, abd, ir in CPP
how is the hip EF w/ OA in the first stage?
hypertonicity
how is EF in 2nd stage of hip OA?
early Capsular
loss of IR > flexion, abd > extension
how is the EF in the 3rd stage of hip OA?
bone to bone
what is often a cause for back pain in pts?
hip problems
how is risom in pts w/ hip OA?
weakness or inhibition w/o pain often due to glute weakness
how is palpation in pt w/ hip OA?>
pain around ms joint
ms may have increased tone and tension
what are some hip OA questionnaires that can be used?
WOMAC
LEFS
HHS
what conservative Rx can be used for OA
- pt education on lifestyle modifications
- pain management and self management
- weight control
What can be used to treat for pain of oa?
ice
tens
ifc
how can hypertonicity be reduced in oa?
static distraction traction compression massage STT dry needling
how to improve flexibility w/ hip OA?
HEP
massage
how to improve ROM w/ hip OA?
AROM/PROM
passive acessory glides of the hip
how can traction be helpful to joints w/ oa?
improves cartilage nutrition and lubrification
how to improve str?
w/ reduced pain go from NWB to WB
what is the GLAD program?
clinical guidelines for Rx of the hip and knee OA in order to proved high quality care
what is the purpose of GLAD?
Reduce pain Reduce med intakes Improve physical function and physical activity Improve QoL Reduce number of patients on sick leave
what data from GLAD was obtained from danemark?
-pain improved (not clincially sign ificant)
important physical function and act at 3 months
-decreased use of painkillers
less pts on sickleave after 1 year
better response in knee > hip OA
what data from GLAD was obtained from canada`
improved pain (cvlinically significant difference) improved function and QoL no change in med intake decrease BMI
myofascial imbalances are caused by what?
stiff muscles and weak muscles
what are common muscles to be stiff in the hip that may lead to myofascial imbalances?
iliopsoas erector spinae TFL adductors rectus femoris hamstrings External rotators
what are common muscles to be weak in the hip that may lead to myofascial imbalances?
glute max
glute med/min
quads
abductors
what ms is most commonly affected by adductor ms strain?
adductor longus
what are risk factors associated to add ms strain?
previous groin injury
higher level of play
decrease add STR of the hip
lower level of sports specific training
what is the pain site of adductor ms strain?
groin pain
anterior hip pain
pain at mT junction
what is the MOI of add ms strain?
sudden onset
ms contraction when ms is stretched often associated w/ sudden changes in direction or rapid accelertation/decceleration
what is the pain pattern associated w/ add ms strain?
PROM: pain w/ passive abd at EOR
AROM/risom: pain w/ add and add and flexion
what may be observed w/ add ms strain?
bruising and discoloration, slightly lower that region of strain due to effect of gravity on bleeding
how to treat add ms strain in the inflammatory phase?
police to reduce pain and inflammation
discontinue activtiy and sport
how to treat add ms strain in the proliferative phase?
rehab on progressive STR (add, flexion of the hip, abd and core work) use holmich protocol proprioception STT avoid stretching
what is holmich’s protocol?
use of a criteria based protocol rather than a time based protocol
what exercises are suggested to pt in initial stages of hip add strain?
isometric ankle w/ ball or isometric add squeeze w/ crook lying
as you progress from the initial stage what exercises are suggested to pt w/ hip add strain?
side lying hip add hip add lateral slide hip add w/ elastic band or pulley copenhagen add exercise sport specific exercises
how to monitor exercise progression for hip add ms strain in rehab?
pain level before and after; dont want it to increase b yh more than 2/10
PROM hip abd immediately post exercise
how long should rehab last for hip add strain?
8-12 weeks minimum but continue specific exercises for at least 1 year
why is it important to treat add ms strain properly?
avoid longstanding groin pain
avoid risk of re-injury
what may cause pain in ITBFS
overuse where fat pads and connective tissue of the lateral femoral condyle gets compressed B/W ITB and lateral femoral condyle
what are the pathomechanics if ITBFS?
involves multiple segments causing for ms imbalances and compressive loads on the ITB at the level of femoral condyle
biomech dysfunction at the knee caused by ITBFS?
–dynmic knee valgus due to weakness of ionhibition of glute med
biomech dysfunction at the hip/pelvis caused by ITBFS?
contralateral pelvic drop due to weakness of glute med
where is the pain site for ITBFS?
lateral knee more than GT pain
how is pain described in ITBFS?
Sharp/burning pain
what is the pain pattern associated w/ ITBFS?
Often associated to repeated mvmts s/a running/cycling
initially irritted w/ knee flexion/extension ~20-30 degrees
what funcitonal tests can be performed to assess ITBFS
Trendelenberg
unilateral WB
unilat squat will notice valghus
how is rom in ITBFS
Full but the first 20-30 degrees of knee flexion/extension may be painful
how is RISOM in ITBFS?
Weakness of glute med and max is possible and also of knee flexors and extensors
what tests can be used to assess decreased flexibility of ITB/TFL
ober’s test
modified thomas test
how to treat for itbfs?
pain relief
treat biomech dyusfunction
actibvate and strengthen weak ms
decrease ms tension of ITB
what is GTPS an synonym of?
lateral hip pain
what is the MOI of GTPS
excessive loading
what may cause excessive compressive loads leading to GTPS?
- glute tendon or ITB compressed at GT
- excess static postures
- sitting w/ knees crossed
- excess dynamic postures w/ excess lateral hip tilt
- dynamic knee valgus
- friction or direct impact and activities w/ high eccentric load
what is the pain site for GTPS?
Lateral hip joint
GT area down the lateral thigh
what is the pain pattern of GTPS?
Pain when lying on affected side at nigh
pain on SL WB task
pain when leaning or touching affected area
is ROM limited in GTPS?
generally not but may have pain w/ active ABD and passive add and w/ risom
what functional tests can be performed for GTPS
30 s sustained SLS
what special tests can be performed for GTPS
FABER
resisted external derotation test
how can we treat for GTPS?
Rx generally consistent w/ insertional tendinopathy
how to treat for pain relief of GTPS if in reactive on degnerative?
Load reduction by removing provocative load, modify sleeping postures
provide isometric exercises taht target glutes more than TFl
how to treat for pain relief of GTPS if in tendon disrepair and degeneration
4 stage program
optimization of mvmt patterns
stretch into hip add
what is piriformis syndrome
controversial syndrome for buttocks pain
what is the MOI for piriformis syndrome
insidious onset
what is the pain pattern for piriformis pain syndrome?
mvmt associated w/ stretching of piriformis (flexion, add, er)
muscle hypertonic
how is ROM in piriformis syndrome
decreased ROM and pain w/ hip IR w/ hip felxion below 70
decreased rom and pain w/ hip er above hip flexion ~70
decreased rom and pain w/ combined flexion, add and er
how to treat for piriformis syndrome`
ms stretch in flexion/add/er
DTF/STT
myofasial release
STR exercises for buttock
