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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
When can lying irritate gluteal tendinopathy?
- particularly on the involved side - possibly when on uninvolved side > fix w pillow between knees to prevent the adductiobn
26
What are some alleviating factors for gluteal tendinopathy?
- rest
27
What are some other symptoms we can see with gluteal tendinopathy?
possible lumbar hypermoblity/instability symptoms
28
What are some signs you may observe with gluteal tendinopathy?
- possible antalgic and/or trendelenburg gait - impaired LE control
29
What can we do to test LE control with gluteal tendinopathy?
- pain and/or weakness with 30 second single limb stance - may need to assess higher level ADLs like running / jumping
30
What ROM changes can we see with gluteal tendinopathy?
- 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
31
What could be some resisted/MMT findings with gluteal tendinopathy?
- 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
What are some special tests for gluteal tendinopathy?
- positive GTPS test with ER and horizontal adduction in 90 degree sfleixon - possible positive obers
33
What are some things we can find through palpation with gluteal tendinopathy?
- TTP over bursa (hallmark sign) > glut med
34
What are some other signs (of another condition) that we can see with gluteal tendinopathy?
- lumbar hypermobility/instability signs
35
What patient education can we do with gluteal tendinopathy?
- soreness rule - load management - movement cues for LE machanics - avoid providing positons - pillow between knees when on uninvolved side
36
What is okay with the soreness with tendinopathy that is different from DOMS?
- mild symptoms okay up to 24 hours after so long as doesnt change how you move with tendinopathy
37
What are providing positions we should instruct our patients with gluteal tendinopathy to avoid?
- prolonged sitting, especially crossing legs and in low seats - lying on involved side
38
What is the PT rx for gluteal tendinopathy?
- POLICED - modalities such as shock wave therapy are proposed but NOT substantiated in reseatch
39
What PT rx is NOT recommended with gluteal tendinopathy?
STRETCHING - lengthening tissues, creates more tension and compression
40
What are the primary purposes of MET with gluteal tendinopathy?
- tendon proliferation and stabilization (hip and lumbar)
41
What is the tendinosis prescription for MET?
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
What are the MET progressions for gluteal tendinopathy?
- 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
What are some examples of isotonic loading with compression from lengthening?
- abduction from an adducted position - lunge with dumbbell in opposite hand
44
What are some examples of isometric loading in weight bearing?
- CC hip abduciton, ER and ext
45
What should we know about corticosteroids for gluteal tendinopathy?
- inflammation is NOT the primary issue - mainly acts as an analgesic - may hinder tendon from responding to optimal loading
46
What should we know about other injections for gluteal tendinopathy?
- platelet rich and other "regenerative" injection lack sufficient support for ALL soft tissue injuries
47
What is hamstring tendinopathy?
Buttock pain that is more often a tendinopathy (-osis)
48
What is the prevalence of hamstring tendinopathy?
- uncommon in general public - common among athletes
49
What are risk factors for hamstring tendinopathy?
- Prior injury - regional interdependance - advanced age > less pliable tissue equals greater tension/compression
50
What about regional interdependence can contribute to hamstring tendinopathy?
- L4-S1 lumbar hypermobility/instability - excessive hip flexor recruitment leads to anterior tilt of pelvis and adds to excessive tension / compression
51
What are risk factors for hamstring tendinopathy?
- muscle imbalances - inadequate Ham: Quad ratio
52
What muscle imbalances can cause hamstring tendinopathy?
- weak glut max, glut med, and/or adductors
53
What are the goals for hamstring to quad ratio?
- Males: Hams > 66% of quad activity - Females: Hams > 75% of quad activity - if not hamstrings can oppose as well and get overworked
54
What are the structures involved with hamstring tendinopathy?
- hamstring proximal tendon - adductor Magnus - ischial bursa - rarely sciatic nerve (possible adhered if tendinosis)
55
What does the adductor Magnus play a role in hamstring tendinopathy?
shared origin and fascial connections with hamstrings
56
What is the primary driver to tendinosis in terms of hamstring tendinopathy?
abnormal mechanical loading on the tendon
57
What are some etiologies and path-mechanics of hamstring tendinopathy?
- prior injury - muscle imbalances - repetitive hamstring action with hip in flexion - excessive prolonged stretcihng - sedentary lifestyle
58
What are some repetitive hamstring actions with the hip in flexion that can contribute to hamstring tendinopathy?
- running and jumping - training errors such as overuse, springs, hills and plyometrics
59
Why can a sedentary lifestyle contribute to hamstring tendinopathy?
- sitting on the tendon!!!!
60
What are symptoms of hamstring tendinopathy?
- 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
What will we see in our observation with hamstring tendinopathy?
- possible atrophy if long standing
62
What will we find in our functional tests with hamstring tendinopathy?
pain with activity involving lengthening WITH muscle action - such as squat, lunge, running, etc.
63
What will we find with ROM with hamstring tendinopathy?
- possible limitations and pain with hip flexion and knee extension, especially if combined
64
What will we see with resisted/MMT testing with hamstring tendinopathy?
- possible weakness and pain with hip extension and knee flexion, especially in a lengthened position
65
What will we find in our neuro testing with hamstring tendinopathy?
- possible positive SLR and slump tests if sciatic nerve involved
66
What special tests can we do with hamstring tendinopathy?
- bent knee stretch test - shortened muscle length test
67
What is the bent knee stretch test for hamstring tendinopathy?
- hip and knee flexed - PT slowly straightens knee - moderate to high reliability
68
What will we find with palpation with hamstring tendinopathy?
- TTP over proximal tendon and bursa at iscial tuberosity
69
What other signs can we see (other condition) with hamstring tendinopathy?
Possible lumbar hypermobility/instability signs
70
What is the PT rx for hamstring tendinopathy?
- follow general principles of glut tendinosis plus.... > education > dry needling > neural mobilizations
71
What is our patient education for hamstring tendinopathy?
- stand > sit - avoid low seats and prolonged sitting
72
What should we know about dry needling for hamstring tendinopathy?
- limited support
73
When would we do neural mobilizations with hamstring tendinopathy?
- if sciatic nerve involved
74
What is the MET for hamstring tendinopathy?
- Eccentric training reduces pain and injury - lumbopelvic stabilization to improve hamstring activity that supports regional interdependence
75
What is the prognosis for hamstring tendinopathy?
Good out to at least 6 month with 8-10 weeks of pT
76
What is the MD RX for hamstring tendinopathy regarding corticosteroids?
- 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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