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MSK 3 Fall 2024 > Hip Unit 2 > Flashcards

Hip Unit 2 Flashcards

1
Q

OA/DJD Exam Findings

A

Clinical Criteria
- hip pain
- IR <15
- Flexion <115
- >age 50
- morning stiffness <60 minutes

Predictors of Success from PT
- Unilateral hip pain
- Age <58
- Pain >6/10 on NPRS
- 40m SPWT value <25.9 seconds
- Symptoms duration <1 yr

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2
Q

OA/DJD Intervention

A
  • Aerobic, balance, strength
  • patient education/ activity modification/ unloading of joints
  • Manual therapy
  • Gait training
  • THA if severe enough
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3
Q

Femoro-acetabular Impingement (FAI)
Common Symptoms
(non arthritic hip joint pain)

A
  • Most common cause of OA
  • Athletic/middle aged/young
    -Pincer Impingement = acetabular rim hits the head/neck of femur with full flexion
  • Cam impingement= abnormal femoral head alignment into acetabulum with flexion (pistol grip deformity)
  • Groin pain with sports
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4
Q

Femoro-acetabular Impingement (FAI)
Exam Findings

A
  • Aggravated with prolonged sitting/walking
  • (+) F-AD-IR
  • (+) Hip scour
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5
Q

Femoro-acetabular Impingement (FAI)
Interventions

A
  • rest
  • activity mod
  • NSAIDs
  • surgery if severe
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6
Q

CAM Impingement

A

Abnormal femoral head alignment into acetabulum with flexion
- pistol grip deformity

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7
Q

Pincer Impingement

A

Acetabular rim hits the head/neck of femur with full flexion

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8
Q

Labral tears
Common Symptoms

A
  • Labral Detachment in 88% >30 yrs
  • 86% anterior quadrant
  • associated chondral lesion
  • MOI: repetitive pivoting, twisting, trauma , extension + LR w/FH anterior
  • Associated with FAI, capsular laxity, dysplasia trauma
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9
Q

Labral Tears Exam Findings

A
  • Increased pain with flexion
  • May have sharp and dull groin pain/anterior thigh
  • CLICKING/CATCHING/GIVING WAY
  • Restricted ROM
  • (+) FADIR
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10
Q

Labral Tears Interventions

A

Arthroscopy

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11
Q

Trochanteric Bursitis
Common symptoms

A
  • Lateral hip pain
  • involved bursa (between greater trochanter and mm): sub glute max, sub glute med, sub glute min
  • woman more common than men (ages 40-60 years)
  • Increased risk with arthritis, fibromyalgia, leg length discrepancy
  • Most common soft tissue pathology of hip
  • MOI= Fall on lateral hip, friction of ITB over GT during flexion/extension, poor pelvic control
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12
Q

Trochanteric Bursitis
Exam Findings

A
  • Aching pain
  • tenderness over greater trochanter

1 of the following:
- pain at extreme of FABER
- Pain with resisted ABD
- Pseudo radiculopathy (lateral thigh)

Leg length

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13
Q

Trochanteric Bursitis
Interventions

A
  • address causative factors
  • Correct mm imbalance and deficiencies: eccentric mm strength, glutes, pelvic floor, abdominals
  • Muscle length deficits: ITB and hip flexors
  • positional faults or leg length discrepancy
  • walking program
  • manual therapy
  • avoid aggravating factors
  • NSAIDS/corticosteroid injections
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14
Q

Hip Tendinitis/osis
Common Symptoms

A
  • Lateral pain
  • tendinosis more common
    MOI= overuse, collagen degeneration due to:
  • inadequate pelvic control
  • increased load of SLS
  • Chicken and egg with bursitis vs tendinosis

Iliopsoas:
- most common in runners

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15
Q

Hip Tendonitis/osis
Exam Findings

A
  • Tenderness over Greater Trochanter
    -(+) Trendelenburg
  • Trendelenburg gait /compensated
    -(+) FABER
  • leg length - true leg length or weber Barstow
  • Hip abduction weakness with pain

Iliopsoas:
- complains of snapping in hip
- Pain with eccentric loading from flexion into extension
- TTP at femoral triangle and psoas belly

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16
Q

Hip Tendinitis/osis
Interventions

A
  • address causative factors
  • Correct muscle imbalance and deficiencies: eccentric muscle strength, glutes, pelvic floor, abdominals
  • Muscle length deficits: ITB and hip flexors
  • Lumbopelvic stabilization (iliopsoas)
  • positional faults or leg length discrepancy
  • walking program
  • manual therapy
  • Avoid aggravating factors
  • NSAIDS/corticosteroid injections
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17
Q

Iliotibial Band Syndrome
Common Symptoms

A

MOI= results from friction of ITB on sub gluteal medial bursa
- excessive femoral IR
- Leg length discrepancy
- Fall onto lateral hip

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18
Q

Iliotibial Band Syndrome
Exam Findings

A
  • Similar to GT bursitis
  • “Snapping” at hip into flexion from extension
  • (+) Ober’s
  • Also check: Thomas/ Ely test
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19
Q

Snapping Hip (Coxa Sultans)
Common symptoms

A
  • Begin –> symptomatic in athletes
  • Intra articular snapping–> loose bodies, labral tear
  • Extra articular snapping–> imbalance
  • internal- iliopsoas over pelvic rim
  • external- ITB or glute max over GT
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20
Q

Snapping Hip ( coxa sultans)
Exam findings

A

Audible snap of hip with movement mainly extension

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21
Q

Snapping Hip ( coxa sultans)
Interventions

A
  • NSAIDs and ice if symptomatic ( short term)

Long Term:
- correct malalignments
- Correct muscle imbalances

Release of iliopsoas and proximal ITB (surgery)

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22
Q

Hip Meralgia Paresthetica
Common symptoms

A
  • irritation of lateral femoral cutaneous nerve

MOI= Direct trauma or compression at ASIS

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23
Q

Hip Meralgia Paresthetica
Exam Findings

A
  • Irritation at ASIS
  • Tingling, numbness, pain in sensory distribution
  • (+) Tinel’s at ASIS and inguinal ligament
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24
Q

Hip Meralgia Paresthetica
Interventions

A
  • Reduce/correct mechanical factors
  • Injections
  • Surgery
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25
Q

Athletica Pubalgia (Sports Hernia)
Common symptoms

A

MOI= repeated forced hip hyperextension with rotation
- Injury to external oblique, rectus abdominis, transversalis fascia
- fascia continuous with adductor muscle
- Males>Females, athletes

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26
Q

Athletica Pubalgia (Sports Hernia)
Exam Findings

A
  • Presents as lower abdomen and groin pain
  • Exacerbated by trunk flexion ( sit ups), rotation, hip adduction (resisted)
  • TTP at inguinal ring
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27
Q

Athletica Pubalgia (Sports Hernia)
Interventions

A
  • relative rest
  • functional hip evaluation
  • Pelvic floor and abdominal stabilization and strength
  • Eccentric adduction and external obliques
  • Functional movements, sports specific
28
Q

Osteitis Pubis
Common Symptoms

A
  • Collective term for all disorders that cause chronic pain in region of pubic tubercle
  • chronic inflammatory and overuse condition of pubic symphysis
    (microtrauma)
29
Q

Osteitis Pubis
Exam Finding

A

Tests:
- bilateral resisted adductor (gapping)
- Pain with passive flexion
- TTP

Pain with adductor stretching and sit to stands

30
Q

Proximal Hamstring Strain
Common Symptoms

A
  • Common in Athletes
    2 Types
    1. Tear strain
  • occur at musculotendinous junction or scar tissue of past injury
  • biceps femoris commonly injured
  • MOI= deceleration during sprinting, eccentric contraction
  • Increased risk w/weak glute max
  1. Tendonitis/Tendinosis (Overuse)
    - Repetitive hip flexion/extension
    - W/knee extension
    - TTP at ischial tuberosity
31
Q

Proximal Hamstring Strain
Exam Findings

A
  • Ecchymosis acutely
  • (+) resisted hip extension and or knee flexion
  • Altered muscle integrity
  • Poor motor control
  • (+) SLR(+) 90/90
32
Q

Proximal Hamstring Strain
Interventions

A

Acute Phase (2-5 days)
- PRICE-EM
- manual therapy
- therex: movements within pain free ROM ( passively, AA, Act)
- modalities for pain and edema

Subacute to Late Phase (return to sport)
- Therex, neuromuscular re-education, theract
- progressive agility and trunk stabilization
- Manual therapy ( SIJ mobs if indicated)

33
Q

Hip Femoral Nerve entrapment
Exam Findings

A
  • Loss of quadriceps DTR
  • Weakness in hip flexors and knee extensors
  • (+) femoral nerve tension test
33
Q

Hip Femoral Nerve entrapment
Interventions

A
  • education - avoid aggravating factors/rest
  • manual therapy- soft tissue mobs, joint mobs, neural mobs
  • Therex- correct muscle imbalances of strength, abdomino lumbo pelvis stabilization
  • Theract- return to sport occupation training
  • Modalities- prn for symptomatic relief
33
Q

Hip Femoral Nerve entrapment
Common symptoms

A

MOI= Anterior hip dislocation

34
Q

Piriformis Syndrome
Common Symptoms

A
  • 30-40 yrs
  • associated trauma, anatomical configuration
  • also think about hamstrings syndrome
35
Q

Piriformis Syndrome
Exam Findings

A
  • TTP of piriformis/greater sciatic notch
  • Pain in buttock with referred leg symptoms in sciatic nerve distribution
  • (+) piriformis test (FAIR)
    -(+) passive SLR
  • Aggravated by walking, stairs, trunk rotation
36
Q

Piriformis Syndrome
Interventions

A
  • manual therapy
  • Therex= stretching/strengthening
  • promote normal muscle balance and stability of lumbopelvic region
  • orthotics- small heel lift
  • education- rest, aggravating activities
37
Q

Femoral nerve is what root

A

L2-L4

38
Q

Sciatic nerve root is?

A

L4-S3

39
Q

Sciatic Nerve
Common Symptoms

A
  • most common nerve injury in LE
  • injured pelvis fractures, posterior hip dislocations , piriformis region
40
Q

Sciatic nerve
Exam findings

A
  • decreased strength in hams, calves, peroneals, toes
  • altered sensation of posterior thigh and leg
  • Altered reflexes of hams and Achilles
41
Q

Sciatic Nerve
Interventions

A
  • manual therapy
  • Therex= stretching/strengthening
  • promote normal muscle balance and stability of lumbopelvic region
  • Thereact- return to sport, occupation training
  • Modalities- prn for symptomatic relief

-

42
Q

Superior Gluteal Nerve root

A

L4-S1

43
Q

Superior Gluteal Nerve
Common Symptoms

A
  • compressed as passes between piriformis and glute min
  • passes through greater sciatic notch
44
Q

Superior Gluteal Nerve
Exam findings

A
  • Increased pain with ambulation
  • weak hip abduction and IR
  • TTP just lateral to greater sciatic notchSuperior Gluteal Nerve
45
Q

Superior Gluteal Nerve
Interventions

A
  • manual therapy
  • Therex= stretching/strengthening
  • promote normal muscle balance and stability of lumbopelvic region
  • Thereact- return to sport, occupation training
  • Modalities- prn for symptomatic relief
46
Q

Obturator nerve root

A

L2-L4

47
Q

Obturator Nerve
Common Symptoms

A
  • Compressed as it leaves pelvis through obturator tunnel
48
Q

Obturator Nerve
Exam Findings

A
  • Weak hip adduction, knee flexion, hip ERs
49
Q

Obturator Nerve
Interventions

A
  • manual therapy
  • Therex= stretching/strengthening
  • promote normal muscle balance and stability of lumbopelvic region
  • Thereact- return to sport, occupation training
  • Modalities- prn for symptomatic relief
50
Q

Hip Stress Fractures
Common Symptoms

A

MOI= running, jumping, hiking
- commonly the femoral neck
Risk Factors:
- female
-Smoking
- amenorrhea
- steroid use

Can be compression or tension sided

51
Q

Stress Fracture
Exam Findings

A
  • thigh or knee pain, activity related, relieved by rest
  • local tenderness
  • pain at end range of rotation
  • pain with axial compression
  • Antalgic gait
  • (+) fulcrum test
  • Single leg hop test
52
Q

Stress Fractures
Interventions

A

SEND FOR IMAGING
- protected weight bearing
- maintain strength

53
Q

Hip Fracture
Common Symptoms

A
  • Proximal 1/3rd of femur
    MOI= low energy falls
    Risk Factors
  • falls
  • advanced age
  • Female
  • Caucasian
  • institutionalization
  • Comorbidities
54
Q

Hip Fracture
Exam Findings

A
  • Groin or lateral thigh pain
  • TTP
  • Difficulty walking or bearing weight
  • shortened and externally rotated limb
  • pain with rotation and flexion
  • ecchymosis
55
Q

Hip fracture
Interventions

A
  • WB restrictions
  • early mobilization
  • strengthen
  • gait training
  • balance training
  • transfers
56
Q

Peds: Congenital or Developmental Hip Dysplasia DHD
Common symptoms

A
  • femoral head subluxed or dislocated from acetabulum
57
Q

Peds: Congenital or Developmental Hip Dysplasia DHD
Exam Findings

A

(+) ortolani’s
(+) barlows

58
Q

Peds: Congenital or Developmental Hip Dysplasia DHD
Interventions

A
  • Harness/Splint
  • surgery/cast/bracing
  • improve muscle strength
  • improve ROM
  • Treat gait deviations
59
Q

Legg-Calve Perthes Disease
Common symptoms

A
  • Idiopathic osteonecrosis of femoral head
  • Children age 4-10
60
Q

Legg-Calve Perthes Disease
Exam Findings

A
  • unilateral
  • knee and thigh pain
  • limp
  • reduced abduction, rotation, and poss flexion contracture
61
Q

Legg-Calve Perthes Disease
Interventions

A
  • WB bracing
  • maintain ROM and femoral head reduced in acetabulum
  • address weakness
  • treat gait deviations
  • surgery
62
Q

Slipped Capital Femoral Epiphysis
Common symptoms

A
  • Displacement of femoral head through physis
  • pain with activity in groin, thigh, or knee
63
Q

Slipped Capital Femoral Epiphysis
Exam findings

A
  • Decreased IR, abduction, flexion
  • may have shortening of leg
64
Q

Slipped Capital Femoral Epiphysis
Interventions

A
  • surgery if displaced
  • conservative if not

MSK 3 Fall 2024 (8 decks)

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