Hip, Pelvis, Groin & SIJ Flashcards
What are the 9 serious conditions that need to be considered in a presentation of hip, pelvis, groin and/or SIJ pain?
Vascular claudication Avascular necrosis of femoral head Neoplasia Osteoid osteoma Osteomyelitis Septic arthritis Abdo / pelvic infection Pelvic / gynaecological pathology Fracture
What are the 5 most common pathologies in anterior hip pain?
Hip OA (most common) FAI Labral tear Groin pathology Ligamentum teres tear
What are the 3 most common pathologies in lateral hip pain?
Gluteal tendinopathy (most common) Gluteal tear Greater trochanteric pain syndrome
What are the 3 most common pathologies in groin pain?
Adductor pathology (most common)
Ilipsoas pathology
Osteitis pubis
What are PROMs that can be used in a hip / pelvis pathology?
HOOS (hip disability and osteoarthritis score)
LEFS (lower extremity functional scale)
Describe the presentation of vascular claudication in the buttock
- 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)
Describe the presentation and risk factors for avascular necrosis of the femoral head
- insidious onset pain with walking
- pain on pressure over bone
Risk factors:
- CVD risk factors
- hip dislocation
- alcoholism
Describe the presentation of septic arthritis
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
What signs and symptoms may indicate ovarian, bladder or uterine cancer in a case of hip or pelvis pain?
Urinary frequency / urgency Irregular bleeding Discharge Abdo distension / bloating Dyspepsia / nausea
Which signs and symptoms may indicate an abdominal or pelvic infection?
Infectious SSX:
- fever / chills
- sweating
- malaise
- nausea / vomiting
Other:
- GIT disturbance
- urinary disturbance
- discharge
- sexual dysfunction
Describe the condition of osteoid osteoma
- 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
Describe the condition of Hip FAI including presentation, types of FAI, findings and treatment
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)
What are the types of hip FAI?
Pincer - acetabular overgrowth
CAM - femoral head / neck overgrowth
Mixed - combination of both
Describe the condition of a labral tear including mechanism, risk factors, presentation, findings
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
Which tests can be used in cases of suspected hip FAI / labral tear?
FADDIR (sensitive but not specific)
FABER
Thomas Test (FAI)
Thigh thrust (FAI)
Which 4 bursa can become inflamed in the hip and groin?
Greater trochanteric (most common)
Iliopsoas
Gluteal
Ischial
What is the healing timeframe for bursitis?
typically self-limiting within 3-7 days, oral or injected steroids can be used to decrease inflammation or surgery for severe cases
Describe the condition of osteitis pubis including pathology, mechanism and risk factors, presentation and findings, and treatment
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)
Describe the condition of piriformis syndrome including pathology, mechanism and risk factors, presentation, findings and prognosis
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
What are the risk factors for greater trochanteric pain syndrome?
- 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
Describe the condition of greater trochanteric pain syndrome including definition, pathology, mechanism, presentation and treatment
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
Which condition is typically present in a case of greater trochanteric pain syndrome?
Gluteal tendinopathy
- inflammation of gluteal tendons (can be caused by micro-trauma / overload / compression under ITB) causes secondary inflammation of trochanteric bursa
Which tests can be used in a case of greater trochanteric pain syndrome and/or gluteal tendinopathy?
FABER
FADER
Single Leg Stance (30 seconds)
Trendelenburg
What is the difference between neurogenic and vascular claudication, and how can you differentiate between the two conditions?
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
