Hip Theory (Manual)

Question 1

Describe the etiology of FAI and describe the types.

Answer 1

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.

Question 2

Describe how hip biomechanics can contribute to FAI.

Answer 2

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

Question 3

Describe common subjective complaints in the case of FAI.

Answer 3

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

Question 4

Describe common objective findings in the case of FAI.

Answer 4

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.

Question 5

Describe key treatment components in the case of FAI.

Answer 5

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)

Question 6

Describe the etiology of greater trochanteric pain syndrome.

Answer 6

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.

Question 7

Describe common causes of greater trochanteric pain syndrome.

Answer 7

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

Question 8

Describe common assessment findings for greater trochanteric pain syndrome.

Answer 8

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..

1. Gluteal derotation test
2. 30s leg stand test
3. Passive Adduction and resistance
4. FABER w/ lat hip pain
5. Trendeleberg

Question 9

Describe key features of treatment for greater trochanteric pain synrome.

Answer 9

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

Question 10

Describe the etiology of ischiofemoral impingement syndrome.

Answer 10

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.

Question 11

What are common congenita causes of IFI?

Answer 11

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

Question 12

Describe common acquired causes of IFI?

Answer 12

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

Question 13

Describe common subjective findings with IFI.

Answer 13

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

Question 14

Describe common objective findings with IFI.

Answer 14

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

Question 15

Outline the typical treatment components for IFI

Answer 15

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

Question 16

Describe etiology of hip dysplasia.

Answer 16

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.

Question 17

List risk factors for developing hip dysplasia.

Answer 17

i) swaddling
ii) female
iii) breech birth
iv) fam Hx
v) radiation/amniocentesis
vi) postural deformity/oligohydramnios

Question 18

Describe common objective findings with hip dysplasia.

Answer 18

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

Question 19

What is the treatment for hip dysplasia?

Answer 19

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)

Question 20

What are the positions for a posterior hip dislocation, superior anterior and inferior anterior?

Answer 20

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

Question 21

What are the precautions for a posterior hip dislocation?

Answer 21

i) toe touch WBing 4 weeks
ii) WBAT next 4 weeks
iii) avoid distraction

Focus on gait, passive pendulum, hip girdle exercise

Question 22

Describe the etiology of a SCFE?

Answer 22

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.

Question 23

Describe common objective findings with a SCFE?

Answer 23

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)

Question 24

What does conservative Rx of SCFE entail?

Answer 24

i) spica casting
ii) ROM
iii) hydrotherapy
iv) coordination/proprio

May be surgical

Question 25

Describe the etiology of Legg Calves Perthes disease.

Answer 25

Idiopathic avascular necrosis of the femoral head in childhood, ages 2-12. Cause loss of bone integrity and fracture of malformation.

Question 26

Describe the presentation of Legg Calves Perthes disease.

Answer 26

i) psoatic limb/limp
ii) reduced AROM in ext and ABD may be IR too
iii) pain worsening over the course of the day
iv) night pains
v) Trendelenberg or Duchenne gait
vi_ localized muscle atrophhy

Question 27

Describe the pathlogy/etiology of a hip loose body.

Answer 27

A loose body forms from osteoarthotic cartilagenous fronds/fragments breaking off and making their way into the joint from repetitive friction/pinching. They can also occur from an acute trauma or osteochonditis dessicans.

Question 28

Describe the presentation of a hip loose body.

Answer 28

Intermittent pain/locking/catching or instability, relieved by shaking leg. Bony end feels and limited ROM in non-capsular pattern.

Question 29

How is a hip loose body treated?

Answer 29

Loose body manipulation - maintaining strong traction and adding high velocity ER or IR. Or arthroscopy.

Question 30

List the functions of the hip labrum.

Answer 30

i) add stability
ii) provide negative pressure to resist distraction
iii) add lubrication
iv) load distribution
v) proprioception

Question 31

List the common causes of hip labral tears.

Answer 31

i) Major trauma in forced ER and ABD
ii) Microtrauma from repetitive twisting/pivoting
iii) Hx of hip dysplasia or FAI
iv) Femoroactetabular instability causing repetiive ER or ABD and ext. This causes iliofemoral ligament laxity and degredation of labrum.
v) poor lumbopelvic neuromuscular control
vi) Normal consequence of aging.

Question 32

List special test to rule/in out a hip labral tear.

Answer 32

i) hip scour
ii) FADIR
iii) Log roll test (IR to ER in supine neutral)
iv) FABER
v) 30 deg resisted SLR
vi) Apprehension test (passive ext, ER and ADD)
vii) Posterior Abutment (prone passive ext, ER and ADD)

Can also do Obers, Thomas and often will have pain or reduced ROM on hip flex

Question 33

What are the main physio objectives in treating a hip labral tear?

Answer 33

i) correction of impairments (motor control, hypertonicity, weakness, lumbopelvic core etc.)
ii) pelvic floor re-education
iii) taping SERF strap to avoid ADD and ER.
iv) focused strengthening on hip ABD and ER, secondarily glute max