OA, Extra Articular Pain Flashcards by Ryan Sewell

What percent change on the Womack to prevent surgery?

20-25%

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Criteria for hip OA dx

Age over 50
Moderate anterior and/or lateral hip pain with WB activities
Hip ROM <24* or hip IR and flexion 15 less than other side
Hip pain provoked with passive IR

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What X-ray view for hip OA

AP and Lowenstein view

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Womack higher score means more or less disability? What the MCID?

More disability
MCID = 12-22%

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HOOS and LEFS higher or lower score better? And what is the LEFS MCID?

Higher score means better function
LEFS MCID is 9

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BERG balance test score cut offs; what score for fall risk, and at what score is an AD required?

50 or below is fall risk
40 and below need an AD

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What interventions should we use for hip OA?

A level - manual therapy: thrust, non-thrust and STM, exercise- flexibility strength and endurance exercise

B level - education on activity modification, exercise, weight reduction, US at 1mhz, 1.0 W/cm2

C level - functional gait and balance using correct AD and weight loss collaboration

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What’s the most common reason for hip pain with limp or NWB with limited PROM in children <10 yo

Transient synovitis

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LCPD is most common for this age group?

4-8 yo

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SCFE is most common to this age group? What is associated with SCFE

8-14 yo, associated with obesity

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What is Drehmann sign?

Hip abduction and ER with passive flexion

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What is the Tx for SCFE?

NWB with referral immediately to surgeon or ER

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What is the Tx for LCPD?

Non-emergent referral to pediatric orthopedist

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Dx for activity dependent anterior hip and with weak/painful hip flexion, tenderness to palpation over anterior hip in 12-25 yo

ASIS apophysitis

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Dx for anterior hip pain in a 12-25 yo after a sudden forceful movement, might have a snap, hip flexion weakness, difficulty with walking

ASIS avulsion

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Tx for high fever in 10 YO who is unable to bear weight

Septic arthritis, send for aspiration or MRI

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ASIS avulsion tx

Radiographs, rest, protected WB with crutches. Depending on severity for ORIF

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ASIS apophysitis tx

Rest and load management followed by progressive strengthening

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This dx looks like hip OA but will affect 30-50 yo with hx of corticosteroid use. Insidious onset with no change in symptoms over 6 weeks

Avascular necrosis

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Risk factors for stress fx (2)

Female sex and previous stress fx

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What is the female athlete triad?

Abnormal menstrual cycle
Low bone mineral density/ low bmi
Inadequate fueling/nutrition

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Hip stress fx hallmark sign

Pain with load and relief with rest, patellar-pubic percusssion test

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Dx for younger adult with C-sign pain, might have catching and clicking, positive FADIR test

FAIS (femoracetabular impingement syndrome)

This dx is aggravated by repetitive or end range movements especially flexion like sitting in a low chair, bending forward with sitting and have shortened hip flexors

FAIS

Clicking and locking with fadir and fai signs

Labral tears

Hyper mobility plus pain and apprehension. Usually younger population with c sign. Aggravates with ER and extension

Microinstability

What is the cluster for micro instability?

Ab-heer, prone hip instability test and HEER

FAIS and labral issues with pain/tightness as key finding

Pain/tightness key finding: then activity mod to reduce repetitive/prolonged flexion along with flexibility exercises and joint mobs

FAIS and labral issues with weakness /control key findings

Strength, endurance and control exercises

Anterior snapping hip occurs when the illiopsoas snaps over what 2 structures?

Femoral head and anterior capsule

What is the cluster for a sports hernia?

Deep groin pain, pain increases with exertion and decrease at rest, tender along pubic rim, pain with resisted hip adduction and resisted abdominal crunch

This dx comes with sharp burning pain near pubic symphysis. Typically seen in cyclists in 30-40 yo

Osteitis pubis

Hamstring injuries are usually caused by…

Forced hip flexion while knee extended. Repetitive injuries

What’s the biggest risk factor for a HS injury?

Previous HS injury, neural tension test is common

This grade for HS strain has minimal strength loss, AKE test less then 15 degree deficit

Grade I

This grade for HS strain will have weakness, possible bruising, limited ability to walk for 24-48 hours, and 17-25* deficit with AKE test

Grade II

This HS grade will have a palpable mass of muscle, extreme difficulty or inability to walk and 26-35* AKE deficit

Grade 3

What three things predict a longer recovery period for HS strains?

Greater percentage of the HS is tender, older age, more proximal pain

What is the best prevention for HS strains?

Nordic HS exercise along with warm up, strength and stretching exercises

What is the sign for ischiofemoral impingement?

Posterior pain at end range of extension

How do you differentiate between HS and ischiofemoral impingement?

Passive hip extension would be IFI

Acute HS strain tx (early before symmetrical ROM and painless sub max exercises)

Rice, STM, ROM, submax strengthening, gait training.

Subacute HS strain tx (normal amb, symmetrical HS ROM)

Progress to end range, eccentric exercises, flexibility, endurance, motor control

HS strain late/return to sport phase (symmetrical HS strength, adequate control, pain-free jogging)

Lengthened strength/plyo, high velocity, perturbation, reactive strength. Progress to sport when no apprehension on H test

What pain level should you keep HS rehab to?

Less than or equal to 4/10

This is sensory changes/pain down lateral thigh aggravated by tight clothes, heavy belt.

What are the two most common sources of greater trochanters pain syndrome?

Compression of tissues over greater trochanter or glute tendinopathy or tear

What will you see with compression of tissues over the greater trochanter?

TFL hypertrophy, weak abductors, trendelenberg.

How to treat compression over the greater troch?

Reduce SLS, hip adduction, reduce inflammation, improve hip abductor strength without TFL involvement

How do you treat a glute tear or tendinopathy?

Reduce irritating behaviors, load the tendon usually submax with progression to heavy loads.

What is the tx For hip flexor/adductor strains and injuries

Activity modification, normalize ROM, strengthen as tissues heal. In hip adductor injuries, adduction strength to should be >80% hip abductor strength

This neuropathy would have weak quads, possibly hip flexors, depressed or absent patellar reflex, symptoms aggravated by hip extension, decreased sensation at anterior thigh

Femoral neuropathy

This neuropathy is medial knee, medial lower leg to 1st MTP but will have no weakness

Saphenous neuropathy

This neuropathy will have decreased sensation of medial thigh and will have weakness of adductors after exercise and will be aggravated by hip extension and adductor stretch

Obtuator neuropathy

This neuropathy will have decreased sensation to lateral thigh, no weakness and a positive tinel at ASIS. What causes this?

Lateral femoral cutaneous neuropathy or meralgia parenthetical Caused by tight clothes, heavy belts, or seat belts