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Clinic - Common Conditions Overview > Hip, Pelvis, Groin & SIJ > Flashcards

Hip, Pelvis, Groin & SIJ Flashcards

1
Q

What are the 9 serious conditions that need to be considered in a presentation of hip, pelvis, groin and/or SIJ pain?

A 
Vascular claudication
Avascular necrosis of femoral head
Neoplasia
Osteoid osteoma
Osteomyelitis
Septic arthritis
Abdo / pelvic infection
Pelvic / gynaecological pathology
Fracture
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2
Q

What are the 5 most common pathologies in anterior hip pain?

A 
Hip OA (most common)
FAI
Labral tear
Groin pathology
Ligamentum teres tear
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3
Q

What are the 3 most common pathologies in lateral hip pain?

A 
Gluteal tendinopathy (most common)
Gluteal tear
Greater trochanteric pain syndrome
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4
Q

What are the 3 most common pathologies in groin pain?

A

Adductor pathology (most common)
Ilipsoas pathology
Osteitis pubis

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5
Q

What are PROMs that can be used in a hip / pelvis pathology?

A

HOOS (hip disability and osteoarthritis score)

LEFS (lower extremity functional scale)

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6
Q

Describe the presentation of vascular claudication in the buttock

A
  • unilateral exertional pain in buttock
  • relieved within 10-15 mins rest
    (caused by occlusion of internal iliac artery or branches; risk factors: surgery involving internal iliac artery)
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7
Q

Describe the presentation and risk factors for avascular necrosis of the femoral head

A
  • insidious onset pain with walking
  • pain on pressure over bone

Risk factors:

  • CVD risk factors
  • hip dislocation
  • alcoholism
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8
Q

Describe the presentation of septic arthritis

A

Infectious SSX:

  • fever / chills
  • sweating
  • malaise
  • nausea / vomiting

Specific to septic arthritis:

  • severe pain in joint agg. by movement
  • oedema of joint
  • inability to move limb

Populations:
- most common in infants and elderly

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9
Q

What signs and symptoms may indicate ovarian, bladder or uterine cancer in a case of hip or pelvis pain?

A 
Urinary frequency / urgency
Irregular bleeding
Discharge
Abdo distension / bloating
Dyspepsia / nausea
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10
Q

Which signs and symptoms may indicate an abdominal or pelvic infection?

A

Infectious SSX:

  • fever / chills
  • sweating
  • malaise
  • nausea / vomiting

Other:

  • GIT disturbance
  • urinary disturbance
  • discharge
  • sexual dysfunction
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11
Q

Describe the condition of osteoid osteoma

A
  • benign bone tumour usually affecting bones in leg
  • typical age children and young adults

Presentation:

  • insidious onset pain becoming constant and progressive
  • dull pain more severe at night
  • limping
  • local oedema
  • may have a palpable mass
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12
Q

Describe the condition of Hip FAI including presentation, types of FAI, findings and treatment

A

Types:

  • pincer: acetabulum projection
  • CAM: femoral projection
  • Mixed: both

Presentation:

  • hip and groin pain with movement
  • agg by squating, sitting, climbing stairs
  • particularly painful with ER
  • decreased ROM
  • locking, popping, clicking, sense of catching or giving way with movement

Findings:

  • decreased single leg strength (hop, jump, gait, single leg raise)
  • pain and crepitus with hip ROM esp. IR

Tests:

  • FADDIR
  • FABER
  • Thomas
  • Thigh thrust

Treatment:

  • conservative including strengthening of deep hip mm
  • resolution would require surgery (greatly increases risk of hip OA)
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13
Q

What are the types of hip FAI?

A

Pincer - acetabular overgrowth
CAM - femoral head / neck overgrowth
Mixed - combination of both

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14
Q

Describe the condition of a labral tear including mechanism, risk factors, presentation, findings

A

Mechanism:
- acute or insidious, caused by excessive forces at hip joint, shearing (twisting / pivoting), ER in hyperextension, hyperabduction, direct trauma, underlying pathology (FAI, OA, dysplasia)

Risk factors:
- women, running, sports w/ ER and / or hypertextension (dancing, gymnastics, soccer, golf), FAI or hip displasia

Presentation:

  • anterior hip and groin pain
  • dull and aching
  • acute or insidious onset becoming persistent
  • crepitus
  • sense of catching or hip giving way
  • decreased ROM

Agg by:

  • running / walking
  • climbing stairs
  • IR and ER

Findings:
(hard to differentiate from hip FAI w/o imaging)
- gait disturbance (avoiding hip extension)
- decreased ROM, crepitus w/ ROM

Tests;

  • FADDIR
  • FABER
  • may have pain with straight leg raise

Treatment:

  • conservative goals to manage pain and strengthen area
  • surgery needed to repair labrum
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15
Q

Which tests can be used in cases of suspected hip FAI / labral tear?

A

FADDIR (sensitive but not specific)
FABER
Thomas Test (FAI)
Thigh thrust (FAI)

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16
Q

Which 4 bursa can become inflamed in the hip and groin?

A

Greater trochanteric (most common)
Iliopsoas
Gluteal
Ischial

17
Q

What is the healing timeframe for bursitis?

A

typically self-limiting within 3-7 days, oral or injected steroids can be used to decrease inflammation or surgery for severe cases

18
Q

Describe the condition of osteitis pubis including pathology, mechanism and risk factors, presentation and findings, and treatment

A

Pathology:
- inflammation of pubic symphysis and surrounding mm insertions, chronic cases can cause bone spurs and degeneration of articular cartilage

Mechanism:
- overuse injury of adductor and/or abdo mm; typically caused by underlying pelvic instability, agg. by assymetrical loads (kicking, running, single leg etc)

Risk factors:
- pelvic instability and poor lumbopelvic control, kicking sports, single leg sports, SIJ dysfunction

Presentation and findings:

  • pain over pubic symphisis (insidious becoming constant)
  • pain on palpation of pubic symphysis and SIJ
  • pain agg by coughing, sneezing, situps, resisted isometric hip abduction and flexion

Prognosis:
- full recovery can take 3-6 months (SSX reduction 2-4 weeks)

19
Q

Describe the condition of piriformis syndrome including pathology, mechanism and risk factors, presentation, findings and prognosis

A

Pathology:
- compression / irritation of sciatic nerve caused by an abnormality of piriformis

Mechanism:
- overuse of piriformis, shortening of piriformis, direct trauma or compression

Risk factors:
- female, long distance walking / running, sitting on wallet or uneven surface, short / tight piriformis, abnormality of sciatic nerve (split or going through piriformis)

Presentation:

  • buttock / hip pain maybe radiating to LBP, posterior thigh and leg
  • pain agg. by sitting, squatting, standing, hip adduction and IR
  • may have assoc. paraesthesia, numbness and difficulty walking

Findings:

  • difficulty walking / limp
  • may have sensory / motor disturbance of sciatic nerve (not spinal nerve)
  • pain on palpation of piriformis, SIJ, sciatic notch
  • HT piriformis

Tests:

  • SLR
  • FAIR (flexion, adduction, IR)

Prognosis:
- recovery 2-6 weeks if underlying biomechanics addressed

20
Q

What are the risk factors for greater trochanteric pain syndrome?

A
  • female
  • overuse / tightness of hip adductors
  • overuse / tightness of ITB
  • long distance running
  • sudden increase in volume
  • biomechanical errors: cross foot gait, pes planus, knee valgus, hip IR
  • obesity / pregnancy
21
Q

Describe the condition of greater trochanteric pain syndrome including definition, pathology, mechanism, presentation and treatment

A

Definition:
- umbrella term for chronic regional pain over greater trochanter

Pathology:
- typically caused by a combination of gluteal tendinopathy (inflammation / degeneration) and trochanteric bursitis (inflammation of gluteal tendons causes secondary inflammation of bursa)

Mechanism:

  • acute (trauma) or insidious (prolonged pressure to hip area caused by repetitive movements
  • gluteal tendinopathy: repetitive microtrauma of gluteal tendons assoc w combination of compression (under ITB) and load

Presentation:

  • insidious onset pain over greater trochanter
  • intermittent pain becoming constant
  • agg by activity, single leg loading, lying on affected side, hip extension

Findings:

  • biomechanical gait erros
  • pain on palpation of greater trochanter (typically severe)
  • may have a palpable mass over trochanteric bursa
  • pain with hip IR (passive and active) and ER (active)

Tests:

  • FADER (puts glute tendons under ITB tension against trochanter)
  • FABER
  • single leg stance (30 seconds reproduces pain)
  • may have Trendelenburg

Treatment:

  • SSX reduction 2-6 weeks
  • recovery and return to activity 2-6 months
22
Q

Which condition is typically present in a case of greater trochanteric pain syndrome?

A

Gluteal tendinopathy
- inflammation of gluteal tendons (can be caused by micro-trauma / overload / compression under ITB) causes secondary inflammation of trochanteric bursa

23
Q

Which tests can be used in a case of greater trochanteric pain syndrome and/or gluteal tendinopathy?

A

FABER
FADER
Single Leg Stance (30 seconds)
Trendelenburg

24
Q

What is the difference between neurogenic and vascular claudication, and how can you differentiate between the two conditions?

A

Neurogenic:
- compression / ischaemia of lumbosacral nerve roots

Vascular:
- occlusion of blood supply to lower limb

Differentiating:

  • neurogenic will be relieved by Lx flexion and agg. by Lx extension (vascular unchanged by these movements)
  • vascular is related to exercise onset and relieved by rest (30 mins), neurogenic unrelated to activity
25
Q

Describe the condition of neurogenic claudication including mechanism, risk factors, presentation and treatment

A

Mechanism:

  • compression and/or ischaemia of lumbosacral nerve roots
  • typically secondary to spinal stenosis, osteophytes, disc herniation or fibrosis

Risk factors:
- age, OA, DJD, disc herniation, congenital

Presentation:

  • pain in glutes, thighs, calves
  • radicular pain quality
  • may have radiculopathy / weakness

Pattern:

  • pain agg. by Lx extension and relieved by flexion
  • pain agg by walking, prolonged sitting, standing

Findings:
- LL motor and sensory changes, reflex changes

Treatment:

  • conservative (stretching / strengthening)
  • surgery if indicated for severe cases (test with nerve conduction first)
26
Q

Describe the condition of vascular claudication including pathology, risk factors, presentation, findings and management

A

Pathology:

  • occlusion of blood supply to lower limb
  • often caused by atherosclerosis (PVD) or thrombus

Risk factors:
- CVD, atherosclerosis, HTN, diabetes, obesity, sedentary (DVT), tobacco

Presentation:

  • pain in glues, thighs and calves
  • cramping, heaviness, fatigue in LL
  • pain begins distally and progresses proximally
  • pain related to activity (relieved within 10-30 mins of stopping activity)
  • pain unrelated to Lx ROM

Findings:
- peripheral CV exam (coldness, peripheral bruits, skin changes, decreased capillary refill, decreased or absent radial pulse)

Treatment:

  • referral and monitoring
  • reduce underlying CVD risk factors
27
Q

Describe the mechanism, presentation, findings and prognosis for hamstring and adductor strains

A

Mechanism:

  • acute: rapid extensive contraction or extreme stretch, knee hyperextension (hamstring)
  • insidious (overload)

Risk factors:

  • dynamic sports requiring sprinting, jumping, twisting, kicking
  • quad dominance, weak glutes and adductors, limited hamstring flexibility (hamstring)

Presentation:

  • acute onset
  • popping or tearing sensation with onset
  • oedema and bruising within hours-days
  • agg by: sitting and walking (hamstring); stretching (adductors)

Findings:

  • grade 1: mild pain w/ walking, mod pain w/running and on stretch
  • grade 2: pain and weakness of resisted knee flexion and extension, altered gait, unable to run
  • grade 3: can be painless or mild pain, significant mm weakness / inability to contract / altered gait

Prognosis:

  • high recurrence (30% in first year)
  • SSX reduction 2-12 weeks
  • recovery and return to activity 3-4 months
28
Q

What is the typical healing timeframe for a hamstring or adductor strain?

A

3-4 months

high rate of recurrence (30% in first year)

29
Q

What are the spinal nerve roots for the femoral, obturator and sciatic nerves?

A

Femoral L2-4
Obturator L2-4
Sciatic L4-S3

30
Q

What are the spinal nerve roots for the sciatic nerve?

A

L4-S3

31
Q

Which facets can refer pain to the hip and groin?

A

L2-S1: buttocks

L3 - S1: groin, anterior and posterior thigh

Clinic - Common Conditions Overview (26 decks)

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