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Hip CPGs > Non- arthritic hip joint pain > Flashcards

Non- arthritic hip joint pain Flashcards

1
Q

What are the best diagnostic criteria to rule in/ out a specific hip condition?

A

Combo of imaging and clinical fundings- no consensus on diagnostic criteria

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2
Q

What is the normal angle of inclination?

A

120-125

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3
Q

What is normal anteversion of the demur?

A

14-18

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4
Q

Name the ligaments supporting the hip, as well as other passive structures that help provide its stability

A

Iliofemoral, ischiofemoral, pubofemoral
Labrum and joint capsule
Ligamentum Teres

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5
Q

Describe the musculatures role in hip stabilization

A

Glute med- primary dynamic stabilizer
Iliopsoas- anterior stability
Hip rotators- more critical when labrum is torn

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6
Q

Describe femoroacetabular impingement

A

Abnormal contact between the femoral head/ neck and the acetabular margin
Has been associated with labral and chondral damage

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7
Q

Describe the 3 classifications of FAI

A

Cam- result of asphericity of the femoral head, often related to SCFE or protrusion of head/ neck junction
Pincer- result of acetabular abnormalities (protrusia/ retroversion)
Combination- Cam and pincer

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8
Q

What can FAI contribute to?

A

Labral lesions, cartilage damage, secondary hip joint OA

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9
Q

Describe the gender differences for cam/ pincer lesions

A

Cam- 2X prevalence in males

Pincer- middle aged active women

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10
Q

Describe hip instability and its causes

A

Extraphysiological hip motion that causes pain
Traumatic, nontraumatic, or due to bony/ soft tissue abnormality (shallow acetabulum or excessive anteversion, neck shaft > 140)
Can lead to labral tears

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11
Q

Differentiate between anteversion and retroversion

A

Anteversion- increased femoral IR, limited ER
Retroversion- increased ER, decreased IR
Both can increase risk for OA/ labral injury

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12
Q

What is the function of the labrum?

A

deepens the hip socket, decreases forces transmitted to the articular cartilage

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13
Q

Describe the MOI for labral tears

A
  • Traumatic- rapid twisting, pivoting, falling motions, forceful rotation with hyperextension
  • Insidious
  • Due to anatomical variants
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14
Q

What are the 4 classifications for labral tears?

A
  1. Radial flap- Most common, free margin of labrum is disrupted
  2. Radial fibrillated- fraying of the free margin
  3. Abnormally mobile- partially detached from labral surface
  4. Longitudinal peripheral- tear along acetabular labral junction
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15
Q

Describe attachment points for the ligamentum teres

A

Edges of the acetabular notch and transverse acetabular ligament and attaches at the fovea capitus of the femoral head

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16
Q

What is the role of the ligamentum teres?

A

Stabilization particularly when hip is ER in flexion or IR in extension

17
Q

What have anterior/ superior condral lesions been associated with?

A

Dysplasia
Anterior joint laxity
FAI
Traumatic- blow to greater trochanter

18
Q

Why might you see loose bodies in the hip joint

A

Single- Dislocation/ Osteochondritis dissecans

Multiple fragments- Synovial chondromatosis

19
Q

Describe the clinical findings associated with FAI- subjective and objective

A

Pain in anterior hip/ groin, and/ or lateral hip/ trochanter
Aching/ sharp
Agg by sitting
Mechanical symptoms- popping/ locking snapping
+ FADIR
Hip IR < 20
Flexion/ abduction also limited

20
Q

What are the radiographic findings with FAI

A
  1. Cam impingement- increased femoral neck diameter
  2. Pincer impingement- increased acetabular depth
  3. Decreased acetabular inclination- tonnis angle < 0
  4. Acetabular retroversion- ischial spine projects into pelvis, crossover sign
21
Q

Describe the clinical findings with structural instability of the hip- subjective/ objective/ imaging

A

Anterior groin, lateral hip, generalized hip pain
Mechanical symptoms
+ Hip apprehension sign (Hyperextension/ ER test)
+ FADIR/ FABER
Hip IR > 30
Radiographic- increased acetabular inclination
Tonnis angle > 10
Decreased femoral head coverage

22
Q

Describe the clinical findings of intra-articular injury (labral tear, osteochondral lesion, loose bodies, ligamentum teres rupture)

A

Anterior/ generalized hip pain
Mechanical symptoms of hip
Reported feelings of instability/ sensation of instability with squatting
+ FADIR/ FABER

23
Q

What are the differential diagnoses for nonarthritic hip joint pain

A

Referred pain from lumbar- facet/ disc/ stenosis
SIJ dysfunction
Pubic symphysis dysfunction
Nerve entrapment- lateral femoral cutaneous, obturator
Hip OA/ Septic Arthritis/ RA
Hernia- inguinal, athletic pubalgia
Strain- iliopsoas, adductor/ psoas abcess
Osteonecrosis, Osteomyeltis
Myositis Ossificans/ Heterotopic ossificans
Avulsion injury- Sartorius/ rectus femoris
Leg Calve Perthes
SCFE
Metabolic bone disease
Prostatitis
Neoplasm
Gynecological disorders

24
Q

What imaging studies are recommended for diagnostics of non arthritic hip joint pain

A

XR- first, can detect femoral/ acetabular abnormalities

MRA- intra-articular structures, articular cartilage integrity

25
Q

Describe the clinical course for treatment of non- arthritic hip joint pain

A

Non surgical management for 8-12 weeks- PT, medication, and U/S guided injection
Arthroscopic procedures- labral tear resection (most support)/ repair, capsular modification, osteoplasty for FAI, ligamentum teres debridement, loose- body removal

26
Q

Which validated outcome measures should you use

A

A evidence-
HOS- Hip Outcome Score
HAGOS- Copenhagen Hip and Groin Outcome Score
iHOT- 33- International Hip Outcome Tool

27
Q

What physical impairment measures should you assess

A 
Trendeleberg  
FABER/ FADIR 
Log roll test 
Passive hip IR/ ER - sitting/ prone 
Passive flexion/ abduction 
Hip Abductor/ posterior glute med muscle strength 
Hip IR/ER strength in flexion (sitting) and extension (thomas test, supine- take into end range- hold)
Hip flexor strength
28
Q

Describe a positive Trendelenberg

A

Raise non-stance pelvis as high as possible

  1. Unable to hold elevated pelvic position for 30 sec
  2. No elevation noted
  3. Stance hip adducts , allowing non stance pelvis to drop below stance leg pelvis
29
Q

Describe the log roll test

A

For determining ligamentous laxity
Passive IR/ ER in supine
+. > ER than non- involved side

30
Q

What instruction/ patient education should you provide for FAI

A

Avoid activities that create pinching

Avoid end- range flexion, IR and sometimes abduction

31
Q

What instruction/ patient education should you provide for Structural instability

A

Avoid repetitive strain on passive restraints on hip- extension and rotational loading

32
Q

What activities should you be assessing to determine if any modification should be provided?

A

Sitting- avoid low/ soft chair, changing work positions
Sit to stand
Ambulation- assistive device? increase plantar flexion at terminal stance
Stairs
Sleep positions
Flexibility routine- avoid end- range aggressive flexion/ IR stretches or hip flexor stretches

33
Q

What manual techniques are contraindicated for FAI, for structural instability?

A

FAI- end range flexion/ IR

Instability- joint mobilization (with exception of pain modulation)

34
Q

What recommendations are made for manual therapy for non- arthritic hip joint pain?

A

F evidence-
joint mobilization for capsular restriction impairing mobility
STM- for muscles impairing hip mobility

35
Q

What can be said about stretching and structural instability? For general non- arthritic hip pain?

A

Contraindicated for instability
Can use contract/ relax stretching and prolonged stretching that does increase symptoms otherwise
ASK WHAT THEYVE TRIED- usually they have tried stretching already

36
Q

Which muscle groups are important to strengthen with structural instability

A

Hip abductors and rotators

37
Q

What recommendation can be made about Neuro re-ed and hip pain

A

F- evidence
May be used to decrease movement coordination deficits
dynamic stabilization may be beneficial for those with compromised labrum

Hip CPGs (2 decks)

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