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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
Athletica Pubalgia (Sports Hernia) Common symptoms
MOI= repeated forced hip hyperextension with rotation - Injury to external oblique, rectus abdominis, transversalis fascia - fascia continuous with adductor muscle - Males>Females, athletes
26
Athletica Pubalgia (Sports Hernia) Exam Findings
- Presents as lower abdomen and groin pain - Exacerbated by trunk flexion ( sit ups), rotation, hip adduction (resisted) - TTP at inguinal ring
27
Athletica Pubalgia (Sports Hernia) Interventions
- relative rest - functional hip evaluation - Pelvic floor and abdominal stabilization and strength - Eccentric adduction and external obliques - Functional movements, sports specific
28
Osteitis Pubis Common Symptoms
- Collective term for all disorders that cause chronic pain in region of pubic tubercle - chronic inflammatory and overuse condition of pubic symphysis (microtrauma)
29
Osteitis Pubis Exam Finding
Tests: - bilateral resisted adductor (gapping) - Pain with passive flexion - TTP Pain with adductor stretching and sit to stands
30
Proximal Hamstring Strain Common Symptoms
- 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 2. Tendonitis/Tendinosis (Overuse) - Repetitive hip flexion/extension - W/knee extension - TTP at ischial tuberosity
31
Proximal Hamstring Strain Exam Findings
- Ecchymosis acutely - (+) resisted hip extension and or knee flexion - Altered muscle integrity - Poor motor control - (+) SLR(+) 90/90
32
Proximal Hamstring Strain Interventions
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
Hip Femoral Nerve entrapment Exam Findings
- Loss of quadriceps DTR - Weakness in hip flexors and knee extensors - (+) femoral nerve tension test
33
Hip Femoral Nerve entrapment Interventions
- 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
Hip Femoral Nerve entrapment Common symptoms
MOI= Anterior hip dislocation
34
Piriformis Syndrome Common Symptoms
- 30-40 yrs - associated trauma, anatomical configuration - also think about hamstrings syndrome
35
Piriformis Syndrome Exam Findings
- 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
Piriformis Syndrome Interventions
- manual therapy - Therex= stretching/strengthening - promote normal muscle balance and stability of lumbopelvic region - orthotics- small heel lift - education- rest, aggravating activities
37
Femoral nerve is what root
L2-L4
38
Sciatic nerve root is?
L4-S3
39
Sciatic Nerve Common Symptoms
- most common nerve injury in LE - injured pelvis fractures, posterior hip dislocations , piriformis region
40
Sciatic nerve Exam findings
- decreased strength in hams, calves, peroneals, toes - altered sensation of posterior thigh and leg - Altered reflexes of hams and Achilles
41
Sciatic Nerve Interventions
- 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
Superior Gluteal Nerve root
L4-S1
43
Superior Gluteal Nerve Common Symptoms
- compressed as passes between piriformis and glute min - passes through greater sciatic notch
44
Superior Gluteal Nerve Exam findings
- Increased pain with ambulation - weak hip abduction and IR - TTP just lateral to greater sciatic notchSuperior Gluteal Nerve
45
Superior Gluteal Nerve Interventions
- 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
Obturator nerve root
L2-L4
47
Obturator Nerve Common Symptoms
- Compressed as it leaves pelvis through obturator tunnel
48
Obturator Nerve Exam Findings
- Weak hip adduction, knee flexion, hip ERs
49
Obturator Nerve Interventions
- 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
Hip Stress Fractures Common Symptoms
MOI= running, jumping, hiking - commonly the femoral neck Risk Factors: - female -Smoking - amenorrhea - steroid use Can be compression or tension sided
51
Stress Fracture Exam Findings
- 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
Stress Fractures Interventions
SEND FOR IMAGING - protected weight bearing - maintain strength
53
Hip Fracture Common Symptoms
- Proximal 1/3rd of femur MOI= low energy falls Risk Factors - falls - advanced age - Female - Caucasian - institutionalization - Comorbidities
54
Hip Fracture Exam Findings
- Groin or lateral thigh pain - TTP - Difficulty walking or bearing weight - shortened and externally rotated limb - pain with rotation and flexion - ecchymosis
55
Hip fracture Interventions
- WB restrictions - early mobilization - strengthen - gait training - balance training - transfers
56
Peds: Congenital or Developmental Hip Dysplasia DHD Common symptoms
- femoral head subluxed or dislocated from acetabulum
57
Peds: Congenital or Developmental Hip Dysplasia DHD Exam Findings
(+) ortolani's (+) barlows
58
Peds: Congenital or Developmental Hip Dysplasia DHD Interventions
- Harness/Splint - surgery/cast/bracing - improve muscle strength - improve ROM - Treat gait deviations
59
Legg-Calve Perthes Disease Common symptoms
- Idiopathic osteonecrosis of femoral head - Children age 4-10
60
Legg-Calve Perthes Disease Exam Findings
- unilateral - knee and thigh pain - limp - reduced abduction, rotation, and poss flexion contracture
61
Legg-Calve Perthes Disease Interventions
- WB bracing - maintain ROM and femoral head reduced in acetabulum - address weakness - treat gait deviations - surgery
62
Slipped Capital Femoral Epiphysis Common symptoms
- Displacement of femoral head through physis - pain with activity in groin, thigh, or knee
63
Slipped Capital Femoral Epiphysis Exam findings
- Decreased IR, abduction, flexion - may have shortening of leg
64
Slipped Capital Femoral Epiphysis Interventions
- surgery if displaced - conservative if not

MSK 3 Fall 2024 (8 decks)

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