Hip Theory (Manual) Flashcards
Describe the etiology of FAI and describe the types.
Abnormal contact between the femoral neck and rim of acetabulum.
i) Pincer: more common in middle-aged and females. Related to abnormal bony growth of acetabulum encroaching on femoral neck.
ii) CAM: more common in younger males. Related to thickening/abnormal shape of femoral neck nd/or head and poor fit in acetabulum.
Thought to be related to repeated flexion IR activities damaging labrum over time.
Describe how hip biomechanics can contribute to FAI.
i) posterior capsule tension and anterior capsule laxity can contribute to anterior glide in flexion
ii) TFL dominance over iliopsoas as IR will automatically occur along w/ hip flexion
iii) weak lengthened iliopsoas (has fibres to anterior capsule which prevents capsular impingement when working properly)
iv) ? APT dynamically contributing to impingement
Describe common subjective complaints in the case of FAI.
i) pain with prolonged sitting or sitting in low chairs
ii) Active/athletic history
iii) insidious onset anterior hip/groin pain, intermittent or constant, may radiate
iv) aggravated by cycling
v) walking/running generally well tolerated
vi) aggravated by flex/IR/ADD
v) may have pop/catch/click if labral tear present
Describe common objective findings in the case of FAI.
i) Gait: may have reduced hip ext, ADD or IR in stance
ii) ROM: may have reduced flex, ADD, IR but more pronounced when the three are combined
iii) reduced posterior glide of the hip
iv) positive impingement sign: (flex/ADD/IR) quadrant
v) dominant tight TFL, weak and lengthened iliopsoas, weak glute max, weak glute med
vi) functional tests may show pain w/ IR/twist/pivot as well as squat. May use L/sp flex dominance to avoid hip flex.
Describe key treatment components in the case of FAI.
i) Edu re: avoiding excessive hip flexion (raise seats), pivoting, aggravating sports, crossing legs, prolonged sitting
ii) stretching/mobilizing hip ABD and ER in both flex and ext positions
iii) mobilizing into F/ADD/IR w/ belt distraction or posterior glide just prior to point of aggravation
iv) MWM for flex/IR at 90 deg
v) Exercise: strengthen iliopsoas, glute max and med. WBing hip flex w/ band to avoid ADD/IR (ex. squat w/ band), lumbopelvic core strengthening, wall pushes/step down functional movements
vi) Bracing taping w/ S.E.R.F (stability through ER of the femur)
Describe the etiology of greater trochanteric pain syndrome.
Localized inflammatory condition of bursae and gluteal tendons on insertion near GT. Note glute tendinopathy and partial tears are more frequently causative of pain, bursae may be involved but not in isolation. Often resultnt of compression over gluteal tendons from ITB. Large psychosocial effect on pain severity.
Describe common causes of greater trochanteric pain syndrome.
i) excessive ADD in gait/functional activities
ii) weak abductors with tight ITB tensioners (ie. TFL and glute max)
iii) insufficient tensile loading or intolerance to compression in tendons
iv) coxa vara/femoral anteversion
Describe common assessment findings for greater trochanteric pain syndrome.
i) Gait/functinal: Trendelenberg, increased adduction, Px in SLS
ii) May have full ROM or pain in EoR ABD (impingement) or flex/ER (compression)
iii) weak glute med/min, dominant TFL, short ITB glute max tensioning ITB
v) Special Test cluster: Px on palpation and 1 other positive from below..
- Gluteal derotation test
- 30s leg stand test
- Passive Adduction and resistance
- FABER w/ lat hip pain
- Trendeleberg
Describe key features of treatment for greater trochanteric pain synrome.
i) AVOID (unload) aggressive stretching, crossing legs, laying on that side, hip poke out, high level activity
ii) begin with isometrics for ABD and IR for glutes
iii) progress to WBing ABD strength
iv) dynamic control activities in SLS (ex. step downs lateral, SL squat,
Can use .. corticosteroid injection, dry needling, shock wave, surgery
Describe the etiology of ischiofemoral impingement syndrome.
Narrowing of the space between the lateral aspect of the ischial tuberosity and lesser trochanter of the femur. Structures that can be impinged are quadratus femoris (most common), hamstringss, iliopsoas tendon and sciatic n.
What are common congenita causes of IFI?
i) DHD
ii) prominent lesser trochanter or later PCSA
iii) wider femal pelvic anatomy (IT further apart)
iv) femoral anteversion
v) coxa valga
vi) lower pubic ischial ramus
Describe common acquired causes of IFI?
i) gait: increased ADD/ER from weak ABD
ii) chronic psoas or hamstring irritation (may also be a symptom of this)
iii) Hx of fracture/OA/LCP affecting bony integrity
Describe common subjective findings with IFI.
i) Pain in posterior buttock and prox thigh, may also have groin pain, may radiate down thigh
ii) snapping of hip with extreme extension ex. running
iii) may coexist w/ LBP
Describe common objective findings with IFI.
i) +ve IFI test (sidelying ext ADD aggravating and ABD should relieve)
ii) Long Stride Walk Test (shortening stride and some ABD should reduce Px)
iii) +ve Trendelenberg
Outline the typical treatment components for IFI
i) limit aggravating activities
ii) strengthening abductors
iii) gait training (incr BOS and shorten stride length)
iv) orthotics for overpronation causing excessive hip IR
v) lumbopelvic stability/core strengthening
Surgery and corticosteroids are also options
Describe etiology of hip dysplasia.
Abnormalities of acetabulum of femoral head during development (utero, infancy or childhood), causing a separation of the joint surfaces or incomplete containment resulting in instability, subluxation or dislocation.
List risk factors for developing hip dysplasia.
i) swaddling
ii) female
iii) breech birth
iv) fam Hx
v) radiation/amniocentesis
vi) postural deformity/oligohydramnios
Describe common objective findings with hip dysplasia.
i) leg length discrepancy
ii) asymmetric gluteal folds
iii) waddling/limping gait, trendelenberg
iv) weakness/reduced mobility
v) pain in ABDs and iliopsoas
vi) +ve Ortolani and Barlow tests
What is the treatment for hip dysplasia?
i) Pavlik harness for containment (6 months and older) in flex/ABD
ii) surgery closed reduction
iii) hippotherapy
iv) non-impact strengthening (ie cycling, swimming, AROM)
What are the positions for a posterior hip dislocation, superior anterior and inferior anterior?
i) posterior: hip is flex, ADD and IR
ii) superior anterior: hips is in ext, ABD and ER
iii) inferior anterior: hip is in flex, ABD an ER
What are the precautions for a posterior hip dislocation?
i) toe touch WBing 4 weeks
ii) WBAT next 4 weeks
iii) avoid distraction
Focus on gait, passive pendulum, hip girdle exercise
Describe the etiology of a SCFE?
Disruption of proximal femoral epiphysis, most commonly in adolescents. Epiphysis moves posteriorly causing the metaphysis to move anterior and superior causing impingement and damage to labrum and acetabular rim. More common with retroversion, obesity and other common health issues.
Describe common objective findings with a SCFE?
i) Pain in groin, thigh, knee, buttock
ii) leg in ER and antalgic gait
iii) reduced flexion, ABD, IR
iv) increased ADD and ER (hip will fall into ER > 90 deg flex)
What does conservative Rx of SCFE entail?
i) spica casting
ii) ROM
iii) hydrotherapy
iv) coordination/proprio
May be surgical
