NMS 3: Hip Flashcards
Forces acting across hip joint
Body weight, abductor muscles force, joint reaction force
Abductors
Gluteus minimus/medius, TFL
Hip Fracture
-Elderly
-Unable to bear weight (not always)
-History of fall on hip (95%)
-Most commonly caused by: Osteoporosis
-350,000 cases per year
-81% of cases are >75 years old
-Women experience 3/4 of all hip fractures (fall more, more often have osteoporosis-hormonal)
Types of Hip Fracture
-Intracapsular: twice as common/more likely to develop complications
-Extracapsular: Refer out
Stress Fractures
-Cause: Repetitive Stress
-Young and Active/Pain worse with weight bearing/anterior and deep
Types of Stress Fracture
-Transverse: Potentially unstable; superior cortex
-Compression: Stable/Rest and elastic support for 2 weeks, then non-weight bearing exercise for 4-6 weeks; inferior cortex
Congenital Hip Dislocation
-Newborn or child prior to walking-sometimes missed and presents as a non-painful limp
-Cause: Acetabular deformities and capsular tightness
-Evaulation: Ortolani’s Click test and Barlow
-May appear normal until 4-6 weeks of age
Barlow Maneuver
Push the hip down and out, positive test will have the hip pop out
Ortolani Maneuver
Meant to push the hip back into place
Treatment of Hip Dislocation
-Pavlik Harness for infants to 6 months
-6-15 months-Spica Cast
-Surgery
Traumatic Hip Dislocations
-Posterior: 90% of sports-related hip dislocations, forced in into a flexed/abducted hip
-Anterior: Forced into an extended/externally rotated leg
-Management: Relocation under anesthesia; rest and gradual return to non-weightbearing (not done in chiro office)
Slipped Capital Epiphysis
-Most common hip condition in adolescents
-Overweight child OR rapidly growing adolescent with traumatic history
-Acute or chronic slippage
-May only present as knee pain
-Causes: Traumatic (50%), hormonal or in fast-growing adolescents
Legg-Calve-Perthes Disease
-Male predominace of 4 or 5:1
-80% between 4-9 yeats
-Mid hip pain and associated limp with insidious onset
-Cause: Disruption of the vascular supply of femoral head, avascular necrosis-steroid use, alcoholism, pancreatitis…
-Evaluation: Positive Trendelenburg…
-Management: Monitor/Conservative care for 18 months, PT/Traction, Surgery (Femoral/Acetabular osteotomy with internal fixation)
Trochanteric Bursitis
-40-60 years
-Subgluteus medius: Superior to greater troachanter
-Subgluteus maximus: Posterior to greater trochanter
-Gluteus minimus: Less often involved
-Well-localized lateral hip pain
Causes of Trochanteric Bursitis
Anything that alters hip mechanics-LBP, leg length discrepancy, arthritic conditions, surgery, neurologic conditions with paresis
Management of Trochanteric Bursitis
-Correction of abnormal biomechanics and appropriate adjustments, stretching of hip abductors, anti-inflammatory…
Iliopectineal & Iliopsoas Bursitis
-Severe, acute anterior hip pain or groin pain with an antalgic gait
-May radiate down anterior aspect of the leg due to femoral nerve pressure
-May assume position of flexion and external rotation to alleviate pain
-Cause: Hip flexor tightness and repetitive activity
Evaluation of Iliopectineal & Iliopsoas Bursitis
-Located 1-2cm below middle third of inguinal ligament
-Resisted hip flexion and iliopsoas
-Managment: Myofascial release of iliopsoas
Ischial bursitis
-Weavers bottom or tailors seat
-Sitting for long periods on hard surfaces
-May have referral down posterior leg mimicking sciatica
-Cause: Direct blow to bursa or prolonged irritation, chronic hamstring strains, occasionally prolonged standing
Evaluation & Management of Ischial bursitis
Lean toward affected side with accompanying shortened stride length
-Padding/pillow or donut/Avoidance of activity
Snapping Hip Syndrome
-Hip snapping (many w/o pain)
-If trauma, consider acetabular labrum tear
-Cause: tendons that snap over bony prominences or bursae
-Passes over the femoral head and hip capsule to a more medial position with hip extension
Snapping Hip Syndrome Evaluation (By location)
-Lateral Hip: IT band snapping at greater trochanter
-Anterior Hip: Iliopsoas tendon or iliofeoral ligament over r joint capsule
-Posterior Hip: Biceps femoris tendon over ischial tuberosity
Management
Usually benign and position dependent
-Strengthening rather than stretching the involved muscle is often helpful
Transient Synovitis
-Child <10 years old complains of acute or gradual onset of inguinal pain with difficulty bearing weight
-Often a prior viral infection
-Evaluation: Decreased internal rotation, bone scan, ultrasound may have fluid in the joint
-Management: Non-weight bearing followed by crutch
Adductor Strain
-Most common strain: Adductor longus
-Usually an athlete involved in kicking, sprinting or jumping
-Evaulation: Tenderness in adductor muscle group or at pubic attachement/resisted adduction painful
-Management: Elastic figure-of-eight strapping with hip in slight extension, gentle stretching
Hamstring Strain
-Sudden pull or pop in posterior thigh after forceful knee extension
-Cause: Overcontraction of hamstrings when in a position of stretch, avulsion of ischial apophysis possible in young adults
Hamstring Strain Recovery Timelines
-1st degree strain: within a couple of weeks
-2nd degree: 4-6 weeks
-3rd degree: 3-4 months
-Long-term goal: Re-strengthening when 75% of normal ROM returns
-Focus on prevention
Quadriceps Strain
-Sudden pulling pain in anterior thigh after: attempting to sprint, missing a kick, sudden stop
-Cause: Sudden contraction of quads; Could be predisposed to tight quads/lack of strethcing, short leg
-Evaulation: Pain w/ knee extension, possible rupture
-Management: Ice, neoprene or elastic support wrap, crutches, stretching, surgery
Meralgia Paresthetica
-Numbness or tingling in the lateral thing
-Compression of the lateral femoral cutaneous nerve at or slightly below inguinal ligament (d/t prolonged sitting, overweight, carries keys in front pockets)
-Diabetes
-Policeman who wear guns on belts, construction workers, soldiers
-Skinny jeans
Meralgia Paresthetica Evaluation
-Mechanical/non-diabetic: Passive hip extension/flexion
-Anterolateral thigh area
-Management: Diabetic co-management, pregnancy, mechanical/non-diabetic: avoid prolonged sitting, lose weight if factor, empty pockets
Femoroacetabular Impingement
-Deep hip and groin pain in front of hip
-Restricted range of hip motion
-Can be acute following an injury…
Types of FAI
CAM (thickening of femoral neck)
Pincer (thickening/elongation of hip joint)
Causes of FAI
-Injury as youth leading to malformation of hip bones or degenerative process
-Possible labral damage that cause extra bone formation
-More common in young and middle age patients
FADIR test
Flex hip 90, Adduct hip, Internal Rotation
FAI Treatment
-Adjust, mobilize hip joint, stretch any tight structures, improve soft tissue flexibility and length
-Strengthen deep, intermediate, superficial hip muscles
-Proprioception
-If not, surgery
Hip Pointer
-Impact of attachment point of gluteus maximus
-Either a contusion to the iliac creast or from separation of the muscle fibers
-Hockey/Football players
-Management: Ice, different padding to protect,
Soft Ball
-Can involve unicameral bone cyst
Medial border of the femoral triangle
Adductor longus
Lateral border of femoral triangle
Sartorius
Psoas muscle is deep to the _________ pulse
Femoral
Psoas bursa is deep to _________ to joint capsule fibers
Psoas anterior
Gluteus medius inserts into the _________ portion of the trochanter
Upper lateral
Hip Flexor
Iliopsoas, sartorius, rectus femoris
Hip Extensor
Gluteus maximus, hamstrings
Hip Abductor
Gluteus medius, gluteus minimus, TFL
Hip adductor
Adductor longus, adductor brevis, adductor magnus, pectineus, gracilis
Hip Ext Rotation
Obturator internus, obturator externus, gemelli, quadratus femoris, piriformis
Hip Internal Rotation
Gluteus medius, gluteus minimus, TFL
Hip Flexion ROM
A: 120/P: 140
Hip Extension
A: 15-20/P: 20-30
Hip Abduction ROM
A: 45/P: 50
Hip Adduction
A+P: 20-40 degrees
