Readings - Hip Flashcards
If a pt does not have painful clicking, what can we mostly rule out ?
Labral tear
List 6 common causes of anterior hip pain
- Labral tear
- Chondropathy
- OA
- Synovitis
- Groin related pain
- Ligamentum Teres tear
List 4 not to be missed causes of anterior hip pain
- Avascular necrosis of femoral head
- Synovial chondromatosis
- Slipped capital femoral epiphysis
- Perthes disease
Most common cause of lateral hip pain
- Glute med. tear or tendinopathy
List 3 not to be missed causes of lateral hip pain
- Tumour
- Nerve root compression
- NOF #
What is a highly sensitive test for a labral tear ?
FADIR
List two PROMs for hip pathology
- Copenhagen hip and groin outcome score
2. Hip dysfunction and OA outcome score
List two highly sensitive tests when testing OA
- Passive internal rotation less than 25 degrees
2. Pain with active hip extension
Pain and reduced range on a Thomas test can confidently indicate what?
Non-specific Intrarticular pathology and length of hip flexors
What is the close-packed position of the hip joint ?
Extension, adduction and IR
Femoral retro version might limit what movement ?
Internal rotation
Acetabular retroversion may limit what movement
Internal rotation
How might foot probation impact the hip?
Lead to internal tibial rotation, in turn leading to overload on the ITB. Increased ITB tension adds further compressive force on the greater trochanter, potentially cause tendinopathy or bursitis.
Internal tibial rotation may also lead to femoral internal rotation, adding further joint reaction force to the acetabular
Define a CAM Femoral-acetabular impingement
- morphological abnormality on the head-neck junction of femur
Define a Pincer Femoral-acetabular impingement
Morphological abnormality on the acetabulum
What movements are problematic in Pincer FAI
Hip flexion
What movements are problematic in CAM FAI
Hip flexion and internal rotation
What should those with FAI be instructed to avoid ?
The position of impingement
What is the position of impingement in FAI
Flexion, IR and adduction
For sports, what activity modifications should be made for a pt with FAI
- reduce COD and getting low (extreme flexion) where possible
- positional change ?
What two disorders of the hip can increase risk of Labral tear
- Cam-type FAI
2. Developmental dysplasia of the hip
Patients with labral tears are 40% more likely to have coexisting what?
Chondropathy
How might a damaged labrum lead to hip chondropathy
- Reduced chondral nutrition via synovial fluid
2. Reduced load bearing capacity in damaged labrum - force therefore transmitted to the bony surfaces
What position and degree of movement in gait puts greater stress on the anterior soft tissue in the hip
Last 20-30% of stance phase, which consists of 5 degrees hip extension
What gait retraining can be done for a labral pathology
- minimising hip extension at the end of stance phase
Ligamentum Teres tears commonly occur with what injuries
- FAI
- Dysplasia
- Synovitis
Ligamentum Teres tear management is mostly managed similarly to labral pathology, with a particular emphasis on what two exercise principles ?
- Regaining neuromotor control
2. Proprioception at the hip
What other pathologies increase chondropathy and ultimately OA of the hip ?
- FAI
- Decreased acetabular anteversion
- Labral pathology
- DDH
What 3 pathologies are associated with hip instability ?
- Cam-type FAI
- Ligamentum Teres tears
- Excessive anteversion
What are the most provocative loading positions for someone with hip pathologies to be avoided ?
- Rotational loads
- Loading at EOR
- Overload in the impingement position
Should the glute max be retrained in intra-articular hip pathology and if so why?
What position is best to begin retraining ?
- Yes
- it provides hip stabilisation by resisting anterior hip forces
- prone isometric external rotation against minimal resistance
Thickening of the ITB and bursae is an adaptive response to what?
And how does this affect
- repetitive compressive forces
- thickening leads to reduced tensile loading capacity
What joint positions strongly influences lateral soft tissue compressive loading of the hip joint ?
Adduction
Lateral hip pain with lack of tenderness palpated over the lateral hip would indicate what?
- other more remote conditions should be considered rather than lateral hip pain causing pathology
In lateral hip pathology, what FABER result would you expect ?
- normal or minimally limited range but reproduction of lateral hip pain
List 1 test with good sensitivity and specificity for detecting a gluteal tendinopathy in lateral hip pain
- SLS and reproduction of pain over the GT within 30 seconds of standing
What positional habits should be avoided in lateral hip pain
- Sitting with knees crossed or together
- Hip hanging whilst standing
- Side lying
In runners with lateral hip pain, what education should be given
- run on flat surface, mostly straight line running
- hill running avoided
List one early hip exercise for lateral hip pain
- Isometric hip abduction to minimise compression
Use of Clams in lateral hip pain?
May be provocative and should be avoided
What does the Ober’s test tell us ?
Assess tightness in the TFL and therefore tightness of the ITB
Reducing step length should be considered for what to injuries ?
- tib ant tendinopathy
- GTPS
