HIP STI 2 Flashcards
Symptoms of deep gluteal syndrome
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
when patient suffer from deep gluteal syndrome how is pain eased
with pillow between knees in SL
Special tests for deep gluteal syndrome
FAIR (Flex/Add/IR) – practical class
Active Piriformis Stretch test -practical class
Seated Piriformis Stretch test-practical class
Beatty test
Freiberg sign
how is seated piriformis stretch test conducted
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
How is active piriformis test conducted
patient in supine , on side
patient pushes heel down, abducts w/ER against resistance
palpate at level of piriformis
FAIR
Hip flexion/add/IR
compression of sciatic nerve
FAIR test causes compression of what nerve
sciatic nerve
Beatty test
lie on unaffected side, knee and hip flexed
Abduct thigh and examiner applies resistance
2 types of cause of deep gluteal syndrome
non-discogenic
extrapelvic entrapment of sciatic nerve
deep gluteal syndrome is also known as
piriformis syndrome
aetiology of deep gluteal syndrome
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
differential diagnosis of deep gluteal syndrome
Lumbar spine nerve root compression (radiculopathy) Spinal stenosis Facet joint Pelvic tumours SIJ dysfunction
how is deep gluteal syndrome differential diagnosis outruled
CT, MRI, EMG, Ultrasound
management of deep gluteal syndrome depends on what
cause;
articular
myofascial
management of deep gluteal syndrome
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
procedures may take place to treat deep gluteal syndrome
Injection of local anaesthetic or botulinum neurotoxin (Waseem et al, 2011)
Surgical Release /Decompression
why should you be cautious when muscle stretchinig for deep gluteal syndrome
nerve sensitivity
ischiofemoral impingement
Impingement of Quadratus Femoris muscle between lesser trochanter and ischium.
aetiology of ischiofemoral impingement
Coxa Valgus Prominent lesser tuberosity Inter-trochanteric fracture Post THR Hip OA
ischiofemoral impingement is the narrowing space of
femur and ischium
ischiofemoral impingement means reduction in what movement
Hip;
Ext, Add, ER
contributing factors of ischiofemoral impingement
leg Length discrepancy, Weak hip Abductors
ischiofemoral impingement symptoms
Buttock pain lateral to ischium \+/- post thigh pain \+/- saddle pain Can mimic Sciatic Nerve pain Pain aggravated by single leg loading activities
what to conduct for ischiofemoral impingement physical examination
long stride walking - +ive posterior pain made during extension, relieved w/ short strides
patient in SL - passive put patient in hip ext and add,
management of ischiofemoral impingement
Address any leg length dysfunction
Address any gluteal muscle weakness
Correct faulty habitual posture: hip ext/Add/ER
proximal hamstrings tendinopathy
Insertional tendinopathy at the ischial tuberosity
typical patients who have proximal hamstrings tendinopathy
Common in distance runners, athletes involved in sagittal plane activities ( sprinting/hurdling) or change of direction activities ( football, hockey
aetiology of proximal hamstrings tendinopathy
compression of the tendon during hip flexion/adduction
intrinsic factors related to proximal hamstrings tendinopathy
age
increased BMI
Metabolic issues
extrinsic factors related to proximal hamstrings tendinopathy
Training errors- increasing training load too quickly
symptoms of proximal hamstrings tendinopathy
Deep localised pain in the region of the ischial tuberosity
worse in am, eases w/ activity worse afterwards
proximal hamstrings tendinopathy aggravated by
running ( high speed or uphill), Deep hip flexion (lunging, deep squat), sitting on hard surface, Hams stretches ( eg Yoga down-dog)
tests for proximal hamstrings tendinopathy
Pain with stretch’ (tensile load) tests
Puranen-Ovrava test
Bent- Knee Stretch test
Modified Bent Knee Stretch Test
how is puranen ovrava test conducted for what STI
hip flexed 90
knee extended
foot supported
for proximal hamstring tendinopathy
Explain bent knee stretch test and for what STI
supine
affected knee and hip max. flexed
passively slowly stretch knee
for proximal hamstring tendinopathy
explain modified bent knee stretch test for what STI
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
signs of proximal hamstring tendinopathy
Pain with contraction E.g. single leg bridge (A) Long-lever bridge (B) Arabesque (C ) pain on palpation at insertion
management of proximal hamstring tendinopathy
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)
lateral hip pain may be indicative of
greater trochanter pain syndrome
greater trochanter pain syndrome
Chronic lateral hip pain commonly due to pathology in the tendons
Gluteus medius/ minimus
Tensor fascia lata
what type of condition is greater trochanter pain syndrome
Degenerative condition
signs of greater trochanter pain syndrome
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
management of GTPS management
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
LEAP protocol to treat greater trochanter pain syndrome
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
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?
Deep gluteal syndrome FAIR - Flex/Add/IR Active pififormis stretch test Seated piriformis stretch Beatty test Freiberg sign
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?
IFI test - side lying
extension and adduction
deep localised pain in the region of the ischial tuberosity worse in am, running ( high speed or uphill), Deep hip flexion (lunging, deep squat)
Pain with stretch’ (tensile load) tests
Puranen-Ovrava test
Bent- Knee Stretch test
Modified Bent Knee Stretch Test
lateral hip pain
aggravated - sleeping on affected side, weight bearing(walking - single leg stance)
pain on palpation
what tests will be conducted
FABER/Patrick test
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?
FADDIR
Scour/Quadrant
Painful flexion and IR
