Hip/Thigh

Question 1

What could be the possible causes of groin pain? (13)

Answer 1

•Muscle strain - thigh or rectus abdominus

Referred pain from L-spine or SI

• Osteitis pubis / pubic symphysitis
• Trochanteric bursitis / Gluteal tendinopathy
• Obturator nerve entrapmentIliopsoas strain
• Stress fracture of the femoral neck
• Athletic Pubalgia / Sports hernia
• Labral tear / FAI
• Avulsion fracture
• Slipped capital femoral epiphysis
• Legg-Calve’ Perthes disease
• Bursitis

Question 2

What is the most common MSK cause of chronic groin pain?

Answer 2

An adductor muscle strain

Question 3

Which muscle is most frequently involved in an adductor muscle strain?

Answer 3

Adductor longus

Question 4

What are the clinical signs/symptoms of an adductor muscle strain?

Answer 4

localized pain (i.e. muscle belly, musculoskeletal junction, origin on pubic bone), tender to palpation, pain with resisted adduction, and pain with passive stretch

Question 5

How do you manage an acute adductor muscle strain?

Answer 5

Imaging to rule out avulsion fracture, PRICE (elastic wrap or compression shorts), NSAID’s, pain free ROM, progressive stretching and strengthening, and then sport specific training

Question 6

What is a hip pointer and what muscle is it commonly over?

Answer 6

It’s a contusion to the iliac crest, commonly over the TFL with associated hematoma

Question 7

Describe the Grades I-III of a Hip Pointer.

Answer 7

• Grade I: normal gait and posture, slight pain with palpation, little or no swelling, and full trunk ROM
• Grade II: athlete flexed to side of injury, gait abnormal, debilitating pain and tenderness, return to activity 5-14 days
• Grade III: sever pain and swelling, gait is slow and deliberate, sever tilt to side of injury, trunk ROM is limited in all directions, return in 14-21 days

Question 8

What is the most common type of Snapping Hip Syndrome?

Answer 8

ITB snapping over greater trochanter (i.e. external)

Question 9

What are the less two common types of Snapping Hip Syndrome?

Answer 9

(1) Iliopsoas tendon over iliopectineal eminence
(2) Iliofemoral ligament over femoral head

Question 10

What else can cause Snapping Hip Syndrome instead of a tendon or a ligament?

Answer 10

loose bodies (inter-articular), subluxation of the hip, or labrum

Question 11

What are the interventions for treating Snapping Hip Syndrome?

Answer 11

stretching, strengthening, training modifications, and surgery

Question 12

What would a patient usually report when they have a femoral neck stress fracture?

Answer 12

They have gradual onset of groin pain that increases with activity and is better with rest

Question 13

What is the difference between tension-type and compression-type femoral neck stress fractures?

Answer 13

tension-type = fractures of the superior aspect of the femoral neck

compression-type = fractures on the inferior aspect of the femoral neck

Question 14

Why does a tension-type femoral neck stress fracture have a poorer prognosis than a compression-type?

Answer 14

It has the possibility of advancing to full fracture with potential to compromise blood supply to femoral head

Question 15

What other injuries is Femoroacetabular Impingement (FAI) associated with?

Answer 15

cartilage damage, labral tears, early hip arthritis, hyperlaxity, sports hernias, and LBP

Question 16

What occurs with movement in FAI?

Answer 16

Abnormal contact between the femoral head and acetabular rim occurs with hip flexion, adduction, and IR with impingement of the anterior-superior labrum occurring

Question 17

What are the signs and symptoms of symptomatic acetabular labrum tear?

Answer 17

anterior groin pain worse with prolonged periods of standing, sitting, and walking

Question 18

A combination of what 2 hip movements causes the greatest strain on the labrum?

Answer 18

flexion and adduction

Question 19

What is the “crossover sign” or “figure of 8”?

Answer 19

A sign that indicates acetabular retroversion/pincer type FAI

Question 20

What does the alpha angle measure?

Answer 20

It measures the extent to which the femoral head deviates from spherical (cam type FAI)

Question 21

What might rehab for FAI include?

Answer 21

ROM/modalities (i.e. ice, compression), muscle restoration with dynamic hip control, core/gluteal muscles, and muscle balance (lumbar-pelvic-hip complex)

Question 22

What portion of the labrum tears most frequently?

Answer 22

The anterosuperior part

Question 23

In what athletes are labral tears more common?

Answer 23

Those who perform twisting and pivoting in flexed, weight bearing positions (repetitive microtrauma)

Question 24

How do you differentiate a traumatic avulsion from apophysitis?

Answer 24

Apophysitis = typically low grade inflammatory pain that comes on over time (may not even prevent participation in activity)

Traumatic Avulsion = fragment of bone pulled away at ligamentous or tendinous attachment due to a sudden violent muscle contraction

Question 25

What is Osteitis Pubis?

Answer 25

It is an inflammatory lesion of bone adjacent to the symphysis pubis that is characterized by pelvic pain and local tenderness over the pubic symphysis (pain may radiate down groin and medial thigh)

Question 26

What radiographic changes are seen with Osteitis Pubis?

Answer 26

widening of the symphysis, resorption of the medial aspect of the pubic bones, and sclerosis along the pubic rami

Question 27

What are the interventions for Osteitis Pubis?

Answer 27

RICE, NSAID’s, followed by stretching and strengthening of the adductors (maybe a corticosteroid injection)

Question 28

Why is a traumatic subluxation or dislocation of the hip a medical emergency?

Answer 28

The lateral circumflex artery may be compromised which can lead to AVN of the femoral head (it needs to be reduced as soon as possible)

Question 29

How far out from subluxation/dislocation of the hip may AVN appear?

Answer 29

6-24 months

Question 30

What is Athletic Pubalgia/Sports Hernia?

Answer 30

It is a strain or tear of any soft tissue

Question 31

What is Transient Synovitis of Hip?

Answer 31

Most common hip disorder causing a limp in children that causes pain with walking and movement, non-specific inflammation of the synovium, and resolves over several weeks

Question 32

What is Legg-Calve’ Perthes Disease?

Answer 32

AVN of the femoral head which may result in flattening of weight bearing surface and painful limp made worse with activity and better with rest (4-8 years old)

Question 33

What is Slipped Capital Femoral Epihysis?

Answer 33

Pain in groin, hip, thigh, or knee (10-15 year old males that are obese)

Question 34

What two things occur in a quadriceps contusion?

Answer 34

(1) bleeding occurs secondary to broken blood vessels
(2) muscle is crushed

Question 35

What are signs and symptoms of a quadricep contusion?

Answer 35

thigh progressively stiffer, quadricep progressively unresponsive, possible swelling, and progressive loss of knee flexion

Question 36

What are the early and late complications that might occur with a quadricep contusion?

Answer 36

early = prolonged recovery with stiffness, poor quad activation, and muscle wasting

late = myositis ossificans

Question 37

What’s the criteria to return after a quadriceps contusion?

Answer 37

full ROM compared to unaffected leg, equal power/strength/endurance, minimal/no tenderness return with protective padding covering affected area

Question 38

What is the most frequently strained muscle in the body?

Answer 38

hamstrings