Thigh, Hip, Pelvis

Question 1

Labral tears

Answer 1

Don’t heal well

S/S:
Catching/clicking, pain, giving way
Anterior-pain moving hip into extension, IR, and add
Posterior-pain w/passive hip flexion, IR, with a post directed load

ST:
Hip scouring quadrant test-apleys

Question 2

Femoral acetabular impingement

Answer 2

Impingement of femoral head within acetabulum
Pincer-acetabulum
Cam-femur
Extra bone growth, common w/labral tears, believed to be congenital
Gets better and than worse

S/S:
Deep groin pain 
Often pain w/ABD, flexion
Possible clicking, locking, or catching 
Possible back pain 

ST:
FADDIR-flexion, Add, IR
Flexion IR test

Question 3

Athletic pubalgia

Answer 3

Sports hernia
Result of increased muscular loads on the pubic bone and public symphysis
Muscular imbalances
Often misidentified as an adductor strain-rule out everything else first

S/S:
Pain w/resisted abdominal curl up and adduction
Deep groin, hip, butt, pee
Gets better and then worse

Tx:
Herniography-surgical repair
RTP-3-4 weeks after

Question 4

Osteitis pubis

Answer 4

Gradual ossification and widening of pubic symphysis
MOI: rotational, tension, or shear forces
Most common in repetitive activities such as running, kicking, ice skating

Question 5

Snapping hip syndrome

Answer 5

External-ITB over greater trochanter, caused when hip is ADD and hip flexes/extended
Internal-ilopsoas tendon over femoral head, caused by moving from flexed, ABD, ER, to extended ADD, IR
Snapping can result in bursitis

ST:
Thomas test

Question 6

Trochanteric bursitis

Answer 6

Increased Q-angle

Question 7

Ischial bursitis

Answer 7

Rule out avulsion fx
Painful WB on ischial tuberosity
Direct blow-rupture, swelling

Question 8

Iliopsoas bursitis

Answer 8

Pain in anterior hip

Mass may be palpated around Inguinal ligament

Question 9

Hip dislocation

Answer 9

Rare-medical emergency so check sensory and vascular supply and transport

S/S:
Immediate intense pain in joint and buttock
AROM impossible

Question 10

Avulsion fx

Answer 10

Violent or explosive muscular contraction
Ischial tuberosity most common

S/S:
Pt tenderness, sudden, acute, localized pain
AROM/RROM: pain w/movement
PROM: pain w/stretching involved muscle

Question 11

Legg-calve-perthes disease

Answer 11

Avascular necrosis causing osteochondritis of proximal femoral epiphysis (kids 3-12)-causes femoral epiphysis to flatten

Question 12

Slipped capital femoral epiphysis

Answer 12

Fx across capital femoral epiphysis-SALTR Harris fx and then slips off
Most common in overweight, adolescent males (10-15 age)
Transport

S/S:
Pain may be referred to anterior groin/thigh 
Unable to IR femur or stand on one leg
Presents similar to dislocation 
Leg length discrepancy

Question 13

Hip pointer

Answer 13

Blow to iliac crest

Debilitating for obliques

Question 14

Myosotis ossificans

Answer 14

Heterotrophic ossification

Question 15

Piriformis syndrome

Answer 15

Spasm or hypertrophy of piriformis compresses sciatic nerve-mimics lumbar nerve roots compression or sciatica

S/S:
Burning, pain, numbness or paresthesia that are increased w/contraction of piriformis
Pain deep in posterior aspect of hip, radiating into buttock and down leg
Altered gait
AROM: pain w/ ER
PROM: pain w/ supine IR, better w/ER
RROM: pain w/ seated ER or hip abduxtionb

ST:
Piriformis test
Single leg raise test

Tx:
Stretching, strengthening, possible injection