Neuromuscular disorders of the hip joint and pelvis Flashcards
Why is activity-related groin pain so common in some sports?
-complex anatomy
-high load
high velocity
-poor rehab of past injuries
What is so special about the adductor region?
the blending of muscle fibres - no single attachment point for each muscle
Why is the femur curved in the saggital plane?
it means that the adductors can function as extensors or flexors
Where is adductor longus at the highest risk of strain injury?
during transition from hip extension to hip flexion
What is the definition of a diagnosis?
pathoanatomical source of symtoms
- type of pathology
- where, what, when
What is the classification?
the ‘why’ of the disorder, and why it developed
According to the Doha agreement, what are the terminologies for groin pain?
-adductor-related
-iliopsoas-related
-pubic-related
-inguinal-related
They are all interconnected
Adductor-related groin pain
- adductor tendonopathy/enthesopathy
- adductor tenderness and pain on resisted adduction testing
Ilio-psoas related groin pain
- iliopsoas tendinopathy or bursitis
- pain on resisted hip flexion and/or pain on stretching hip flexors
Inguinal-related groin pain
- abdominal conjoined tendinopathy
- enthesis on inguinal ligament
- pain at inguinal canal region and tenderness of inguinal canal (but no palpable hernia)
- pain on cough, sneeze, valsalva
Pubic-related groin pain
- BSI (osteitis pubis), stress # pubic rami/body of pubis
- tenderness of pubic synthesis and immediately adjacent bone
Subjective examination features of inguinal-related groin pain
Symptom behaviour: -uni/bi-lateral prox groin pain with running, kicking, change of direction -cough/sneeze provocative Activity -loss of acceleration/speed -loss of kick distance PRO -HAGOS HPC -insidious onset or acute event preceding persisting symptoms -chronic + episodic Loading history -change of position change/fluctuation in training/loading
Physical examination features of inguinal-related groin pain
Diagnostic tests
- pain on resisted trunk flexion/adductor resistance
- lower abdominal wall TOP
- Copenhagen 5 sec squeeze test
- rule out other MSK conditions FABER, FADIR, obturator nerve examination
Subjective examination features of pubic-related groin pain
Symptom behaviour -uni/bi-lateral proximal groin pain with running, kicking, changing direction -post activity/morning stiffness Activity -loss of acceleration/speed -loss of kick distance PRO -HAGOS HPC -insidious onset or acute event preceding persisting symptoms -chronic + episodic -limited/no improvement with rest in ST Loading history -change of position change/fluctuation in training/loading
Physical examination features of pubic-related groin pain
Diagnostic tests
- pain on resisted adductor resistance
- pubic bone TOP
- Copenhagen 5 sec squeeze test
- rule out other MSK conditions FABER, FADIR, obturator nerve examinatio
Subjective examination features of adductor-related groin pain
Symptom behaviour -uni/bi-lateral prox groin pain with running, kicking, change of direction -post activity/morning stiffness Activity -loss of acceleration/speed -loss of distance with long kicks -stiffness/tighness during/after activity PRO -HAGOS HPC - insidious onnset or may have acute event preceding persisting symptoms Loading history -change of position -change in training
Physical examination features of adductor-related groin pain
Diagnostic
- pain on resisted adductor resistance
- adductor TOP
- Copenhagen 5 sec squeeze
Clinical features of hip joint arthropathy
Symptom behaviour -pain with loading/WB -stiffness/pain after rest -hip joint stiffness.loss of mobility/mechanical symptoms PROs -HOS -oxford hip score -Harris hip score -WOMAC HPC -insidious onsent history of past hip trauma
Hip OA objective clinical features
Tests -FADIR -quadrant -FABER Observation -hip in open-pack position Hip ROM -impingement signs at EROM -equal loss of AROM and PROM -ROM loss in capsular pattern
What are dynamic factors affecting the hip joint?
- abnormal stress and contact between femoral head and acetabular rim
- but motion stresses are normal
- mechanical stresses can result in reactive hip pain
What is FAI?
- abnormal contact between femoral head and acetabular leading to compression/impingement +/- tearing of acetabular labrum
- likely to occur during twisting or pivoting that require a relatively large hip ROM
- variation of bony morphology
What are the two principal forms of FAI?
- pincer: caused by excessive acetabular cover
- cam: caused by non-spherical head and resultant loss of femoral head-neck offset
What is the mechanism of a cam deformity development?
- reactive bone apposition at antero-superior aspect of head neck junction
- sports activity that alter shape of growth plate
