hip pathophysiology Flashcards
Males are XX times more likely to experience groin pain?
2.5x more likely than females
This statistic highlights the gender disparity in the incidence of groin pain.
List three risk factors for developing groin injuries.
- Previous groin injury
- Higher level of play
- Reduced hip adduction strength
What factors are associated with hip and groin pain?
- Pain and lower levels of adductor strength
- Reduced hip internal rotation
- Reduced bent knee fall out
What MRI findings are commonly associated with chronic groin pain?
- Degenerative changes at the symphyseal joint
- Adductor insertion pathology
- Pubic bone marrow oedema
- Secondary cleft signs
how to you determine adductor-related groin pain
tenderness over the adductors and pain reproduction with resisted adduction
What is the definition of Femoroacetabular Impingement Syndrome (FAIS)?
A motion-related clinical disorder with symptomatic premature contact between femur and acetabulum.
What symptoms are associated with FAIS?
- Motion related or position related hip or groin pain
- Symptoms may also be felt in buttock, back, and thigh
- Clicking, locking, catching, stiffness, and giving way
how would you assess an x-ray to determine FAIS?
- Plain X-ray to begin (AP and lateral views)
Cam morphology - looking at alpha angle
Generally 55-60deg is commonly used.
Pincer - lateral centre edge -normal 25-40deg.
>40deg = pincer
<20-25 = dysplasia
Tonnis angle - normal 0-10deg,
dysplasia >10deg
What are the normal ROM for the hip
IR at 90deg flex = 25-40deg
ER at 90deg = 30-45 deg
bent knee fall out = mean 13cm
abduction = mean 50deg
What are the normal strength values for the hip?
Ecc Adduction = 3 Nm/kg
Ecc abduction = 2.5Nm/kg
Isometric flexion = 2.0Nm/kg
What is the typical age range for the occurrence of pubic apophysitis?
typically athletes aged 16-21yrs
(apophysis closure doesn’t occur before 21)
What are the treatment principles for pubic apophysitis, and how does it differ to adductor-related groin pain
it should be rehab’s in the absence of pain.
the first goal should be to eliminate pain, then gradual reload/re-intro of sport specific skills
What biomechanical differences were found between men and women with hip pain?
Men walk and jump with less anterior pelvic tilt than women, although this is the same in pain-free people
Men with hip pain tend to use calves more with jumping
what are the biomechanical differences with footballers with/without hip pain
those with hip pain exhibited less hip extension with walking - maybe to reduce load on anterior hip structures
they also have lower hip adduction moment - maybe from weak hip abductors, or to offload medial hip structures
What is the role of the adductor magnus during movement?
More active with hip extension than adduction; although adductor minimus may help stabilize the hip.
What is the significance of the alpha angle in assessing cam deformity?
Cam deformity is indicated by an alpha angle greater than 60 degrees.
Although griffen et al (warwick) could not determine a “cut-off value”
What is the average age of soccer athletes presenting with gradual onset groin pain due to pubic apophysitis?
Average age is 15 years.
What clinical entity responds well to immediate loading?
Adductor related groin pain.
What is the preferred method of measuring physical activity in clinical settings?
Using objective measures like Fitbit and activity trackers.
What is the clinical significance of measuring patient expectations regarding return to physical activity?
Patients can be overly optimistic about their expectations.
how do you determine iliopsoas related groin pain
Local tenderness on iliopsoas.
also more likely with pain on resisted hip flexion or stretch
At what age does the femoral head/neck physis typically close in males?
The physis closes between 13-16 years in males.
At what age does the physis typically close in females?
The physis closes between 11-12 years in females.
How do sports engagement levels relate to alpha angles?
Those engaged in sport had on average greater alpha angles.
At what age does cartilage alpha angle increase, indicating soft-tissue hypertrophy?
Cartilage alpha angles increased as early as 10 years.
What does reduced internal rotation indicate in relation to cam morphology?
Internal rotation indicates impingement of the femoral head and acetabulum. It may decrease prior changes in bone morphology because Cam’s are cartilaginous before ossifying
What is the odds ratio (OR) of developing osteoarthritis (OA) with an alpha angle greater than 60 degrees?
OR of 3.67
(Agricola)
What is the OR of developing OA with an alpha angle greater than 83 degrees?
OR of 9.66 for alpha angle
(Agricola)
What OR indicates a risk of developing OA with internal rotation less than 20 degrees?
OR of 7.13 for internal rotation
(Agricola)
What combination of factors has an OR of 25 for developing OA?
Combination of alpha angle >83° and internal rotation <20°.
What does hip internal rotation less than 20 degrees indicate?
It may indicate impingement.
normal Hip IR is on ave = 30deg (25-40deg)
How is the alpha angle measured?
By measuring the angle where the surface of the femoral head/neck junction deviates from a circle of best fit.
What is considered a pathological cam angle?
A pathological cam angle is 78 degrees.
(Agricola)
What is the significance of the CHECK cohort study in relation to cam morphology?
It establishes that cam morphology leads to hip osteoarthritis.
What clinical implications arise from the presence of cam morphology?
Cam morphology is associated with an increased risk of developing hip OA.
What is the effect of physical activity during adolescence on cam morphology?
Physical activity during adolescence is linked to the development of cam morphology.
What is the minimum age for initiating cam prevention strategies?
Cam prevention strategies should commence before the age of 10.
