L3 Hip Conditions

Question 1

Instability

Answer 1

excessive mobility that causes pain with or without the symptom of hip joint unsteadiness

can be dysplasia, subluxation, dislocation

Question 2

Causes of instability

Answer 2

traumatic
atraumatic

Question 3

Traumatic instability

Answer 3

MVA or other high energy event is the cause

Question 4

Atraumatic Instability

Answer 4

repetitve axial loading and rotation in the presence of anatomic variation

Question 5

RF for Atraumatic Instability

Answer 5

golfers, gymnastics, football, hockey, figure skating, ballet, adolescent athletes with mobility

acetabular dysplasia
soft tissue hypermobility
ligamentum teres tear

Question 6

Instability S/S

Answer 6

pain in groin or anterior thigh
popping, locking, snapping
worsening pain with sitting, walking, running
limping, weakness, sensation of dead leg
unable to perform strenuous activities

Question 7

Instability Imaging

Answer 7

Center edge angle can be altered
can develop labral hypertrophy to stabilize
can progress to labral tears and OA in adulthood

Question 8

Center Edge angle

Answer 8

femoral head and acetabulum
<25° dysplasia
>39° over-coverage/pincer type FAI

Question 9

PT management of instability

Answer 9

1. Patient Ed
2. Postural re-education
3. Avoiding long lever hip flexion and high impact
4. Strengthening of rotators, abductors, extensors, adductors
5. Neuromuscular training/Proprioceptive

Should have PT for 8-12 weeks before considering surgery

Question 10

Pericetabular Osteotomy

Answer 10

-for pts <40 and have failed with PT
-may delay or avoid need for THA in future
-high rate of complications
-NWB for 6-8 weeks
-return to school in 12 weeks, sport in 6-12 mo

Question 11

Dysplasia

Answer 11

(the acetabulum is too shallow)

reduces joint stability, but joint can be unstable without having it
left untreated will lead to labral tears and OA

dysplasia + OA = need for THA

Question 12

Femoracetabular Impingement

Answer 12

abnormal contact between femoral head/neck and acetabular margin from structural variations in proximal femur and/or acetabulum

may result in labral tears, chondral damage, OA

Question 13

CAM structure

Answer 13

non-spherical shape of the femoral head, protrusion of the head-neck junction
thickening

Question 14

PINCER structure

Answer 14

deeper acetabular socket, associated with acetabular retroversion
increased center edge angle

Question 15

MIXED Structure

Answer 15

combination of cam and pincer, most common category of impingement

Question 16

Epidemiology of FAI

Answer 16

10-15% of population
CAM = young, male athletes
Pincer = active middle aged women

most likely to be symptomatic with high speed, high impact rotational sports

Question 17

FAI Clinical Exam

Answer 17

Hx = anterior groin pain, C sign, clicking, giving away
Obs = pelvic tilt
ROM = decreased flexion and IR, tight ilioposoas and joint
overall weakness

gait will show a slower cadence and limited hip extension. Squats will have limited motion

Question 18

FAI and muscle weakness

Answer 18

not a strong correlation between FAI and specific muscle weakness

global hip muscle weakness moderate predictor of whether FAI was symptomatic

Question 19

Does FAI mean automatic pain?

Answer 19

asymptomatic individuals is 29%
20-40s are most likely to have pain that is ONLY FAI. vs older will have OA w/FAI

self-efficacy and psychologic factors are more present in pts with pain and weakness

Question 20

PT Management for FAI

Answer 20

activity modifcation
patient ed
manual therapy
avoid end range stretching
progressive pain-free strengthening
neuro re-education
squat variations

Question 21

Labral Tear Epidemiology

Answer 21

most common in 4th decade, more women vs men
22-55% of patients with hip or groin pain
74% have no clear MOI

Question 22

Traumatic Labral Tear

Answer 22

acute, rapid twisting, hyperabduction, falling
compression from MVA

Question 23

Atraumatic Labral tear

Answer 23

combo of anatomic variants with repetitive forces

Question 24

RF for Labral tears

Answer 24

female
FAI
higher BMI
capsular laxity
hip dysplasia
illiopsoas overactivity
degeneration of surrounding tissues

Question 25

Subjective Labral Tear

Answer 25

sharp, deep, intermittent pain anterior hip/groin pain associated clicking or catching in hip end of range pain with flexion or extension

Question 26

Labral Tear Exam

Answer 26

possible anterior or posterior pelvic tilt flexed knee gait pattern, decreased stance time and stride length special tests = none with high spin or snout

Question 27

Labral Tear and FABER/FADIR

Answer 27

FADIR will be + if its anterior FABER will be + if its posterior

Question 28

PT Management for Labral Tear

Answer 28

sit in a higher chair increase cadence to shorten stride consider muscle imbalances optimize mechanics avoid loaded, rapid pivoting/twisting manual therapy --> low grade joint mob for pain

Question 29

Medical Management Labral Tear

Answer 29

injection to relieve pain surgery (successful if patient fails PT, low age, interest in surgery) 1/5 pts having surgery for labral will need another surgery

Question 30

Labral and surgery

Answer 30

most labral tears are asymptomatic; the decision to do surgery should be with caution and after conservative treatment has failed. Labral tears have a low chance of developing symptoms if asymptomatic

Question 31

Gluteal Tendinopathy

Answer 31

most prevalent of all LE tendinopathies possible association with future development of OA usually have concurrent LBP takes between 3 wks to 1 year to heal

Question 32

Trochanteric Bursitis

Answer 32

true bursal inflammation may result from either chronic microtrauma, regional muscle dysfunction, overuse or acute injury

Question 33

Mechanisms and Pathophys of GT

Answer 33

chronic progressive tendon irritation from combination of compressive and tensile loading compressive load increases naturally with increasing hip adduction; 40° of adduction has 106 N of force

Question 34

Epidemiology of GT

Answer 34

3 F vs 1 M 1 in 4 women over the age of 50 will be diganosed

Question 35

RF for GT

Answer 35

non-modifiable, female >40 y/o abnormal biomechanics, plyometric overload, training error

Question 36

S/S of Gluteal Tendinopathy

Answer 36

lateral, posterolateral hip pain that can refer down lateral thigh achy, dull or sharp trendelenburg sign aggravates: side-sleeping, WB activities, standing after prolonged sitting Eases: bell curve of activity, mid range postures palpation tenderness

Question 37

Imaging for GT

Answer 37

Question 38

PT Management GT

Answer 38

conservative treatment has high success rate over 6-12 weeks relative rest reduce intensity, duration, frequency of training avoid sidelying sleeping, asymmetric standing, crossed legged sitting minimize stretching address any other deficits isometrics massage taping

Question 39

Patient Ed for GT

Answer 39

patients often catastrophize, have depression, low self-efficacy, higher BMI condition will be exacerbated with psychologic factors

Question 40

Medical Management for GT

Answer 40

injections of cortizone (only provided relief for about 3 mo) surgery = irresponsive or grade 3-4 tears, does have good outcomes