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SPRING MSK II - Exam 2 > Pelvis and Hip Tendinopathies > Flashcards

Pelvis and Hip Tendinopathies Flashcards

1
Q

What is gluteal tendinopathy usually diagnosed as?

A

Greater Trochanteric bursitis

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2
Q

Where is the pain with gluteal tendinopathy?

A

Lateral hip

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3
Q

What is the primary pathology of greater trochanteric bursitis?

A

tendinopathy

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4
Q

What is the secondary cause of greater trochanteric bursitis?

A

Inflammation

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5
Q

What is happening with the tendon MOST often with gluteal tendinopathy?

A

Structural change & not firing like a tendon should

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6
Q

What is another term for Gluteal tendinopathy?

A

Greater trochanteric pain syndrome (GTPS)

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7
Q

What is the MOST prevalent LE tendinopathy?

A

Gluteal tendinopathy

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8
Q

What gender is gluteal tendinopathy most common in?

A

biological women over men

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9
Q

What age group is gluteal tendiopathy most common in?

A

> 40 years of age

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10
Q

What population type is gluteal tendinopathy most common in?

A

Sedentary > athletic individuals

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11
Q

What are risk factors for gluteal tendinopathy?

A
  • biological female
  • high BMI
  • excessive hip aDduction
  • Plyometric overuse
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12
Q

What can excessive hip aDduction cause?

A
  • weak hip aBductors
  • coxa vara - leads to genu valgus
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13
Q

What are the structures involved with gluteal tendinopathy?

A
  • greater trochanteric bursa
  • muscles and respective tendons
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14
Q

What are the muscles and tendons associated with gluteal tendinopathy?

A
  • primarily= gluteal medius and minimus
  • secondarily = TFL/IT Band and glut max
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15
Q

What muscle is at the 12 o clock positioning with gluteal tendinopathy?

A
  • glut med
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16
Q

What muscle is at the 11 o’clock positioning with gluteal tendinopathy?

A
  • piriformis
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17
Q

What muscle is at the 10 o’clock positioning with gluteal tendinopathy?

A

GOGOs
- gemelli and obturators

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18
Q

What muscle is at the 9 o’clock positioning with gluteal tendinopathy?

A

Quadratus femoris

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19
Q

What is the etiology of gluteal tendinopathy?

A
  • abnormal mechanical loading on the tendon is the primary driver to tendinosis
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20
Q

What is the pathomechanics of gluteal tendinopathy regarding compressive loads?

A
  • excessive tensile and compressive loads occur
  • particularly during the lengthened ranges
  • positionally or eccentrically
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21
Q

What is the pathomechanics of gluteal tendinopathy regarding LE control?

A
  • impaired LE control and including but NOT limited to excessive hip adduction
  • could be local from hip problems or from trunk control
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22
Q

What are symptoms of gluteal tendinopathy?

A
  • lateral hip pain and maybe lateral thigh
  • frequently a gradual and unknown onset but possible overuse/lower supply
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23
Q

What are aggravating factors of gluteal tendinopathy?

A
  • walking, running, stairs, any single leg loading
  • prolonged sitting with increased IT band tension
  • Lying = may interrupt sleep
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24
Q

When does prolonged sitting increase pain with gluteal tendinopathy?

A
  • crossing legs (adduction)
  • through Gmax lengthening, particularly in lower seat
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25
Q

When can lying irritate gluteal tendinopathy?

A
  • particularly on the involved side
  • possibly when on uninvolved side
    > fix w pillow between knees to prevent the adductiobn
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26
Q

What are some alleviating factors for gluteal tendinopathy?

A
  • rest
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27
Q

What are some other symptoms we can see with gluteal tendinopathy?

A

possible lumbar hypermoblity/instability symptoms

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28
Q

What are some signs you may observe with gluteal tendinopathy?

A
  • possible antalgic and/or trendelenburg gait
  • impaired LE control
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29
Q

What can we do to test LE control with gluteal tendinopathy?

A
  • pain and/or weakness with 30 second single limb stance
  • may need to assess higher level ADLs like running / jumping
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30
Q

What ROM changes can we see with gluteal tendinopathy?

A
  • possible lateral hip pain and limitation
  • primarily with aDduction
  • likely with horizontal adduction and ER in 90 degrees flexion (glut med and min are IRs and lengthening at this position)
  • possibly with IR and/or ER in neutral
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31
Q

What could be some resisted/MMT findings with gluteal tendinopathy?

A
  • possible weakness and pain with:
  • aBduction especially in an adducted position
  • IR and ER in neutral
  • IR and Horizontal Abduction in 90 degrees flexion
    – abductors and ERs weak and atrophied
32
Q

What are some special tests for gluteal tendinopathy?

A
  • positive GTPS test with ER and horizontal adduction in 90 degree sfleixon
  • possible positive obers
33
Q

What are some things we can find through palpation with gluteal tendinopathy?

A
  • TTP over bursa (hallmark sign) > glut med
34
Q

What are some other signs (of another condition) that we can see with gluteal tendinopathy?

A
  • lumbar hypermobility/instability signs
35
Q

What patient education can we do with gluteal tendinopathy?

A
  • soreness rule
  • load management
  • movement cues for LE machanics
  • avoid providing positons
  • pillow between knees when on uninvolved side
36
Q

What is okay with the soreness with tendinopathy that is different from DOMS?

A
  • mild symptoms okay up to 24 hours after so long as doesnt change how you move with tendinopathy
37
Q

What are providing positions we should instruct our patients with gluteal tendinopathy to avoid?

A
  • prolonged sitting, especially crossing legs and in low seats
  • lying on involved side
38
Q

What is the PT rx for gluteal tendinopathy?

A
  • POLICED
  • modalities such as shock wave therapy are proposed but NOT substantiated in reseatch
39
Q

What PT rx is NOT recommended with gluteal tendinopathy?

A

STRETCHING - lengthening tissues, creates more tension and compression

40
Q

What are the primary purposes of MET with gluteal tendinopathy?

A
  • tendon proliferation and stabilization (hip and lumbar)
41
Q

What is the tendinosis prescription for MET?

A

END GOAL
- 3 sets of 10-15 reps with a heavy load
- frequency - every other day to 3 days a week depending on patient
- shortened concentric positions 1st

42
Q

What are the MET progressions for gluteal tendinopathy?

A
  • isometric loading without compression from lengthening
  • Isotonic loading without compression from lengthening
  • Isotonic loading with compression from lengthening
    -Isometric loading in weak wearing
  • plyometric loading
43
Q

What are some examples of isotonic loading with compression from lengthening?

A
  • abduction from an adducted position
  • lunge with dumbbell in opposite hand
44
Q

What are some examples of isometric loading in weight bearing?

A
  • CC hip abduciton, ER and ext
45
Q

What should we know about corticosteroids for gluteal tendinopathy?

A
  • inflammation is NOT the primary issue
  • mainly acts as an analgesic
  • may hinder tendon from responding to optimal loading
46
Q

What should we know about other injections for gluteal tendinopathy?

A
  • platelet rich and other “regenerative” injection lack sufficient support for ALL soft tissue injuries
47
Q

What is hamstring tendinopathy?

A

Buttock pain that is more often a tendinopathy (-osis)

48
Q

What is the prevalence of hamstring tendinopathy?

A
  • uncommon in general public
  • common among athletes
49
Q

What are risk factors for hamstring tendinopathy?

A
  • Prior injury
  • regional interdependance
  • advanced age > less pliable tissue equals greater tension/compression
50
Q

What about regional interdependence can contribute to hamstring tendinopathy?

A
  • L4-S1 lumbar hypermobility/instability
  • excessive hip flexor recruitment leads to anterior tilt of pelvis and adds to excessive tension / compression
51
Q

What are risk factors for hamstring tendinopathy?

A
  • muscle imbalances
  • inadequate Ham: Quad ratio
52
Q

What muscle imbalances can cause hamstring tendinopathy?

A
  • weak glut max, glut med, and/or adductors
53
Q

What are the goals for hamstring to quad ratio?

A
  • Males: Hams > 66% of quad activity
  • Females: Hams > 75% of quad activity
  • if not hamstrings can oppose as well and get overworked
54
Q

What are the structures involved with hamstring tendinopathy?

A
  • hamstring proximal tendon
  • adductor Magnus
  • ischial bursa
  • rarely sciatic nerve (possible adhered if tendinosis)
55
Q

What does the adductor Magnus play a role in hamstring tendinopathy?

A

shared origin and fascial connections with hamstrings

56
Q

What is the primary driver to tendinosis in terms of hamstring tendinopathy?

A

abnormal mechanical loading on the tendon

57
Q

What are some etiologies and path-mechanics of hamstring tendinopathy?

A
  • prior injury
  • muscle imbalances
  • repetitive hamstring action with hip in flexion
  • excessive prolonged stretcihng
  • sedentary lifestyle
58
Q

What are some repetitive hamstring actions with the hip in flexion that can contribute to hamstring tendinopathy?

A
  • running and jumping
  • training errors such as overuse, springs, hills and plyometrics
59
Q

Why can a sedentary lifestyle contribute to hamstring tendinopathy?

A
  • sitting on the tendon!!!!
60
Q

What are symptoms of hamstring tendinopathy?

A
  • posterior hip/buttock pain (a deep ache)
  • worsened with activities that lengthen hamstring with or without muscle action
  • less symptomatic with warm up
  • stiff after prolonged positioning, particularly sitting
  • possible lumbar hypermobility/instability symptoms
61
Q

What will we see in our observation with hamstring tendinopathy?

A
  • possible atrophy if long standing
62
Q

What will we find in our functional tests with hamstring tendinopathy?

A

pain with activity involving lengthening WITH muscle action
- such as squat, lunge, running, etc.

63
Q

What will we find with ROM with hamstring tendinopathy?

A
  • possible limitations and pain with hip flexion and knee extension, especially if combined
64
Q

What will we see with resisted/MMT testing with hamstring tendinopathy?

A
  • possible weakness and pain with hip extension and knee flexion, especially in a lengthened position
65
Q

What will we find in our neuro testing with hamstring tendinopathy?

A
  • possible positive SLR and slump tests if sciatic nerve involved
66
Q

What special tests can we do with hamstring tendinopathy?

A
  • bent knee stretch test
  • shortened muscle length test
67
Q

What is the bent knee stretch test for hamstring tendinopathy?

A
  • hip and knee flexed
  • PT slowly straightens knee
  • moderate to high reliability
68
Q

What will we find with palpation with hamstring tendinopathy?

A
  • TTP over proximal tendon and bursa at iscial tuberosity
69
Q

What other signs can we see (other condition) with hamstring tendinopathy?

A

Possible lumbar hypermobility/instability signs

70
Q

What is the PT rx for hamstring tendinopathy?

A
  • follow general principles of glut tendinosis plus….
    > education
    > dry needling
    > neural mobilizations
71
Q

What is our patient education for hamstring tendinopathy?

A
  • stand > sit
  • avoid low seats and prolonged sitting
72
Q

What should we know about dry needling for hamstring tendinopathy?

A
  • limited support
73
Q

When would we do neural mobilizations with hamstring tendinopathy?

A
  • if sciatic nerve involved
74
Q

What is the MET for hamstring tendinopathy?

A
  • Eccentric training reduces pain and injury
  • lumbopelvic stabilization to improve hamstring activity that supports regional interdependence
75
Q

What is the prognosis for hamstring tendinopathy?

A

Good out to at least 6 month with 8-10 weeks of pT

76
Q

What is the MD RX for hamstring tendinopathy regarding corticosteroids?

A
  • remember inflammation is NOT the primary issue
  • Mostly a degenerate tendinosis issue
  • mainly acts as a analgesic
  • may hinder tendon from responding to optimal loading

SPRING MSK II - Exam 2 (6 decks)

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