Lecture 14/15 - MSK Inuries - HIP/GROIN

Question 1

What is the groin triangle made up of

Answer 1

ASIS
Pubic Tubercle
mid distance between ASIS and superior pole of patella

Question 2

Where is the Pubic clock located and what are the structures at 12, 3, 6, 9

Answer 2

Location: Pubic Tubercle

12 - (more like 11) - superficial inguinal ring - (more like 1) - rectus abdominus

3- pubic symphysis

6 - Adductor longus

9 - Inguinal lig

Question 3

What are some common causes of chronic groin pain

Answer 3

adductor related
illiopsoas related 
abdominal wall related 
pubic bone related 
hip jt

Question 4

Acute injuries of the groin are caused by (MOI

Answer 4

sudden change of direction

Question 5

What are 3 different diagnostic labels of exercise related to groin pain

Answer 5

Osteitis Pubis
Atheletic pubalgia
gilmores pain

Question 6

What are some risk factors for groin pain

Answer 6

rapid increase in training load
phx of groin injury 
loss of hip ROM 
muscle length/ strength
leg length discrepencies 
lumbopelvic stability

Question 7

Describe a Hernia

Answer 7

insidious
aggrivated by sudden motions/ coughing/sneezing
increase with resisted sit up

rehab: strength of adductors, and abdominals, avoid cutting until week 4, 2 mo return to sport

Question 8

Special tests what does it test? Squeeze test

Answer 8

Adductor strain/tendinopathy

0,60,90 degrees

Question 9

Special tests what does it test? ASLR

Answer 9

test symptoms reproduction with muscle forces acting on one side of pelvis

SIJ/motor control

Question 10

Special tests what does it test? Bilateral Adductor squeeze

Answer 10

adductor strain/tendinopathy

patient lifts leg to aslr position and resists leg adduction

Question 11

What are some tests to assess for groin pain

Answer 11

trendelenberg, balance, motor control, squats, glute bridge

Question 12

What do you use for imaging for: pubic symphysis instability, stress fracture, mm tears/tendinopathies/bursitis, enthesopathies, avulsion fracture, slipped growth plate, hernia

Answer 12

XR
Bone Scan + CT 
US
MRI
XR
XR
Herniography

Question 13

Describe Hip OA

Answer 13

a degenerative condition of the articular cartilage within the hip joint, characterized by joint space narrowing, bony cysts, subchondral sclerosis

gradual onset

age >55, morning stiffness, pain on weight bearing, worsening pain with activity ,

AMT = PMT - reduced ROM
PAM restricted ROM and PAIN
IMT + pain on hip abduction and flexion

Question 14

What are some treatment options for OA

Answer 14

weight loss, improve ROM, low impact (hydrotherapy), glute strengthening

potentially THR

Question 15

What is a THR, describe it

Answer 15

total hip replacement

replacement of the femoral head and acetabulum
for postero-lateral approach avoid hip F past 90 with hip add

Birmingham implant preserves the femoral head and neck

Question 16

What are the types of Hip fracture. Describe

Answer 16

1) femoral neck - avascular necrosis, non-union, poor healing
2) intertrochanteric - excellent healing, blood supply, ORIF, early mobs
3) subtrochanteric - delayed union, ORIF,

Question 17

What are the classifications of a femoral neck fracture

Answer 17

Garden 1 - undisplaced/incomplete
Garden 2 - complete - no displacement
Garden 3 - complete with partial displacement
Garden 4 - complete with full displacement

Question 18

What are some physio managment techniques for post hip #

Answer 18

chest/breathing exercises
circulation exercises
quads/glutes
weight bear 24-48 hours

Question 19

Describe a labral injury

Answer 19

A tear of the labrum that surrounds the rim of the hip joint socket

overload injury, lifting and twisting

diffuese anterior hip pain

click/lock/catch - feeling of instability

agg by F/IR/ADD (quadrant test +)

Question 20

What percentage of athletes with groin pain have a labral tear`

Answer 20

22%

Question 21

Describe FAI

Answer 21

abnormality of the proximal femur (cam) or acetabulum (pincer) triggers damage to the acetabular labrum and articular cartilage in the hip. the mishapen bones rub abnormally and do not permit full ROM

gradual, higher pain with activity

pain with deep flexion (getting out of car)

Pain on end range flexion and IR - AMT = PMT

+ FADIR

Question 22

Describe Hip tendinopathy

Answer 22

gradual, morning pain, pain worse with activity, swelling, localized pain over tendon

PAM = NAD, AMT = Pain ++ , IMT = pain ++

Isometrics –> Ice –> eccentric + pain free exercises