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NMSK 2 > HIP STI 2 > Flashcards

HIP STI 2 Flashcards

1
Q

Symptoms of deep gluteal syndrome

A

Buttock pain +/- posterior thigh pain
+/- P+N’s or Numbness
Symptoms aggravated by prolonged sitting (worse on hard surface), sit to stand, lifting, flexing forward or walking, side-lying at night ( if in FAIR position
Pain w/ bowel movements

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2
Q

when patient suffer from deep gluteal syndrome how is pain eased

A

with pillow between knees in SL

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3
Q

Special tests for deep gluteal syndrome

A

FAIR (Flex/Add/IR) – practical class
Active Piriformis Stretch test -practical class
Seated Piriformis Stretch test-practical class
Beatty test
Freiberg sign

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4
Q

how is seated piriformis stretch test conducted

A

patient seated in 90 degree hip flexion
examiner extends knee, move hip in adduction w/ IR
Palpate 1cm lateral to ischium and proximally at sciatic notch

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5
Q

How is active piriformis test conducted

A

patient in supine , on side
patient pushes heel down, abducts w/ER against resistance
palpate at level of piriformis

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6
Q

FAIR

A

Hip flexion/add/IR

compression of sciatic nerve

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7
Q

FAIR test causes compression of what nerve

A

sciatic nerve

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8
Q

Beatty test

A

lie on unaffected side, knee and hip flexed

Abduct thigh and examiner applies resistance

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9
Q

2 types of cause of deep gluteal syndrome

A

non-discogenic

extrapelvic entrapment of sciatic nerve

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10
Q

deep gluteal syndrome is also known as

A

piriformis syndrome

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11
Q

aetiology of deep gluteal syndrome

A

Piriformis Syndrome-hypertrophy/ increased tone/protective spasm. Trauma e.g. fall onto buttock
Quadratus Femoris and Ischiofemoral impingement (IFI)– narrowing of ischiofemoral space
Hamstring problems: avulsion fracture, muscle strain, contusions over origin

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12
Q

differential diagnosis of deep gluteal syndrome

A 
Lumbar spine nerve root compression (radiculopathy)
Spinal stenosis 
Facet joint
Pelvic tumours
SIJ dysfunction
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13
Q

how is deep gluteal syndrome differential diagnosis outruled

A

CT, MRI, EMG, Ultrasound

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14
Q

management of deep gluteal syndrome depends on what

A

cause;
articular
myofascial

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15
Q

management of deep gluteal syndrome

A

Soft tissue mobilisation
Trigger point release
Gentle sciatic nerve mobilisation ( to be covered in 2nd year)
Strengthen weakened muscles e.g. gluteals
Correct faulty movement patterns

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16
Q

procedures may take place to treat deep gluteal syndrome

A

Injection of local anaesthetic or botulinum neurotoxin (Waseem et al, 2011)
Surgical Release /Decompression

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17
Q

why should you be cautious when muscle stretchinig for deep gluteal syndrome

A

nerve sensitivity

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18
Q

ischiofemoral impingement

A

Impingement of Quadratus Femoris muscle between lesser trochanter and ischium.

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19
Q

aetiology of ischiofemoral impingement

A 
Coxa Valgus
Prominent lesser tuberosity
Inter-trochanteric fracture
Post THR
Hip OA
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20
Q

ischiofemoral impingement is the narrowing space of

A

femur and ischium

21
Q

ischiofemoral impingement means reduction in what movement

A

Hip;

Ext, Add, ER

22
Q

contributing factors of ischiofemoral impingement

A

leg Length discrepancy, Weak hip Abductors

23
Q

ischiofemoral impingement symptoms

A 
Buttock pain lateral to ischium 
\+/- post thigh pain 
\+/- saddle pain
Can mimic Sciatic Nerve pain
Pain aggravated by single leg loading activities
24
Q

what to conduct for ischiofemoral impingement physical examination

A

long stride walking - +ive posterior pain made during extension, relieved w/ short strides
patient in SL - passive put patient in hip ext and add,

25
Q

management of ischiofemoral impingement

A

Address any leg length dysfunction
Address any gluteal muscle weakness
Correct faulty habitual posture: hip ext/Add/ER

26
Q

proximal hamstrings tendinopathy

A

Insertional tendinopathy at the ischial tuberosity

27
Q

typical patients who have proximal hamstrings tendinopathy

A

Common in distance runners, athletes involved in sagittal plane activities ( sprinting/hurdling) or change of direction activities ( football, hockey

28
Q

aetiology of proximal hamstrings tendinopathy

A

compression of the tendon during hip flexion/adduction

29
Q

intrinsic factors related to proximal hamstrings tendinopathy

A

age
increased BMI
Metabolic issues

30
Q

extrinsic factors related to proximal hamstrings tendinopathy

A

Training errors- increasing training load too quickly

31
Q

symptoms of proximal hamstrings tendinopathy

A

Deep localised pain in the region of the ischial tuberosity

worse in am, eases w/ activity worse afterwards

32
Q

proximal hamstrings tendinopathy aggravated by

A

running ( high speed or uphill), Deep hip flexion (lunging, deep squat), sitting on hard surface, Hams stretches ( eg Yoga down-dog)

33
Q

tests for proximal hamstrings tendinopathy

A

Pain with stretch’ (tensile load) tests
Puranen-Ovrava test
Bent- Knee Stretch test
Modified Bent Knee Stretch Test

34
Q

how is puranen ovrava test conducted for what STI

A

hip flexed 90
knee extended
foot supported
for proximal hamstring tendinopathy

35
Q

Explain bent knee stretch test and for what STI

A

supine
affected knee and hip max. flexed
passively slowly stretch knee
for proximal hamstring tendinopathy

36
Q

explain modified bent knee stretch test for what STI

A

supine legs extended
grasp affected leg behind heel w/ 1 hand and knee w/ other
max flex hip and knee and straighten knee
proximal hamstring tendinopathy

37
Q

signs of proximal hamstring tendinopathy

A 
Pain with contraction
E.g. single leg bridge (A)
Long-lever bridge (B)
Arabesque (C )
pain on palpation at insertion
38
Q

management of proximal hamstring tendinopathy

A

Reduce tensile and compressive loads so rest from aggravating activities,
consider cross- training
AVOID HAMSTRING STRETCHING
Start introducing loading activities when pain settles ( 0-3/10 during and for short period after exercise is acceptable)
Phase 1: Isometric Hams e.g. bridge, single leg bridge, long-lever bridge
Phase 2: Isotonic Hamstrings with minimal hip flexion
Phase 3: Isotonic Hamstrings with increased Hip Flexion (70-90)

39
Q

lateral hip pain may be indicative of

A

greater trochanter pain syndrome

40
Q

greater trochanter pain syndrome

A

Chronic lateral hip pain commonly due to pathology in the tendons
Gluteus medius/ minimus
Tensor fascia lata

41
Q

what type of condition is greater trochanter pain syndrome

A

Degenerative condition

42
Q

signs of greater trochanter pain syndrome

A

pain
location - lateral aspect of lower hip maybe below knee
aggravated - sleeping on affected side, weight bearing(walking - single leg stance), stairs
pain in resisted abduction
pain in palpation of greater trochanter

43
Q

management of GTPS management

A

strengthening exercises and load management
Load Management
Avoid Compressive positions/activities (Hip in relative ADDUCTION)
Progessive Loading through ADLs and exercise
Strengthening of Glut Med/Min

44
Q

LEAP protocol to treat greater trochanter pain syndrome

A 
low load - isometric hip abduction in supine, double leg bridge or squat
progress to offset bridge
single leg loading
standing - bilateral abduction
resisted abduction in standing
45
Q

patient is suffering pain the in the buttock
Pins and Needles / numbness
Feels worse when sitting for a long time, sitting to standing.
What tests do you do?

A 
Deep gluteal syndrome
FAIR - Flex/Add/IR
Active pififormis stretch test
Seated piriformis stretch 
Beatty test
Freiberg sign
46
Q

patient is suffering from buttock pain lateral to ischium
+/- post thigh pain
takes shorter stride as long strides causes pain in back of thigh what tests do you perform?

A

IFI test - side lying

extension and adduction

47
Q

deep localised pain in the region of the ischial tuberosity worse in am, running ( high speed or uphill), Deep hip flexion (lunging, deep squat)

A

Pain with stretch’ (tensile load) tests
Puranen-Ovrava test
Bent- Knee Stretch test
Modified Bent Knee Stretch Test

48
Q

lateral hip pain
aggravated - sleeping on affected side, weight bearing(walking - single leg stance)
pain on palpation
what tests will be conducted

A

FABER/Patrick test

49
Q

Patient with anterior groin pain also describe clicking, catching, locking, stiffness, restricted range of motion or giving way
Pain aggravated by prolonged sitting, driving, climbing stairs, sport activities,
Reduced strength and ROM of flexion and adduction what tests do you do?

A

FADDIR
Scour/Quadrant
Painful flexion and IR

NMSK 2 (8 decks)

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