Week 8 - Conditions of the hip and groin Flashcards
1
Q
List specific conditions to the hip and groin. (6)
A
LAB FIT
- Femoroacetabular impingement
- Tendinopathy/tendonitis
- Instability
- Arthritis
- Bursitis
- Labral tears
2
Q
What is the percentage of co-existing pathologies
A
> 50%
3
Q
What structures interact in hip pathologies (4)
A
- Psoas
- Adductors
- Pubic bone
- Abdominal wall
4
Q
List the Superficial muscles of the groin area (8)
A
Super RIGS RITE
- Rectus abdominis
- External oblique
- Inguinal ligament
- Tensor fascia latae
- Gracilis
- Sartorius
- Rectus femoris
- Iliotibial band
5
Q
List the Deep muscles of the groin area (9)
A
Deep TAAAP GIVV
- Transversus abdominis
- Iliopsoas
- Gluteus medius
- Pectineus
- Adductor longus
- Adductor brevis
- Adductor magnus
- Vastus lateralis
- Vastus medialis
6
Q
List the groin adductors (5)
A
PAAAG
- Pectineus
- Add brevis
- Add longs
- Add magnus
- Gracilis
7
Q
Describe the pubic clock
A
- Superficial inguinal ring (11:30)
- Rectus abdominis (12:30)
- Pubic symphysis (3:00)
- Adductor longus (6:00)
- Inguinal ligament (9:00)
8
Q
List Acute groin injuries (3)
A
- Adductor strains
- Tears
- Avulsions
9
Q
What is the most common adductor muscle involved in acute groin injuries?
A
Adductor longus
10
Q
List the risk factors for groin pain (5)
A
RIPLD
- Rapid increase/changes in training load
- Deconditioned on RTS
- PHx of groin injury
- Muscle length/strength imbalances
- Loss of hip ROM
11
Q
What are the common related causes of chronic groin pain? (5)
A
HIPAA
- Adductor related
- Iliopsoas related
- Abdominal wall related
- Pubic bone related
- hip joint
12
Q
List the adductor related conditions
A
- Musculotendinous injuries - add muscle tears, tendinopathy, enthesopathy
- hip flexor tears, bursitis, avulsion
13
Q
List the iliopsoas related conditions (4)
A
- bursitis
- tendiopathy
- Lumbar spine abnormalities leading to postural changes
- Neuromyofascial tightness
14
Q
Lis the abdominal wall related conditions (4)
A
- Post. inguinal wall weakness
- Conjoint tendon tear
- Ext. oblique aponeurosis tear
- Rectus abdominus tears or tendinopathy
15
Q
List Pubic bone/pelvis related conditions (4)
A
- Stress reaction/fracture of pubic bone
- Rectus abdominus and adductor muscle imbalance
- SIJ
- Pubic symphysis instability
16
Q
List Hip joint related conditions (5)
A
- Ligamentum teres of hip pathology
- ROM
- Hip mm strength
- Chondral lesion
- Labral tear
17
Q
List and describe the Specific tests for the groin (4)
A
- Sqeeze test (PBU)
- ASLR - active straight leg
- Bilateral adductor squeeze
- Resisted sit-up (bulge = hernia)
18
Q
List causative factors of chronic groin pain (3)
A
- Leg length discrepancies
- analysis of gait/technique
- Lumbopelvic stability
19
Q
List general treatment principles for groin pain
A
- relative rest from aggravating activities
- reduce load
- Aim for asymptomatic loading
- Technique analysis
- Refer possible technique issues to right person with right equipment (coach)
- Maintain fitness and stability
- Order scans for specific pathologies
20
Q
List specific hip conditions (4)
A
FOLI
- Hip osteoarthritis
- Traumatic fracture of neck of femur
- Labral injury
- Femoro-acetabular impingement (FAI)
21
Q
Explain Hip OA
A
Wear and tear or intra-articular injury leads to cartilage loss and exposed bone. Exposed sub-chondral bone is sensitive and produces pain during force transmission (ie. weight bearing)
22
Q
What causes hip OA? (5)
A
GAPCA
- Past hip injury (intra-articular)
- Changes to alignment or contact forces (FAI)
- Genetics
- Congenital hip problems (Dysplasia)
- Avascular necrosis (AVN)
23
Q
What is a sign of OA?
A
Osteophytes
24
Q
List conservative interventions for hip OA (7)
A
- Weight loss
- Flexibility
- Activity modification
- Strengthen weak muscles
- Address poor patterns of movement
- NSAIDs
- Joint supplements (glucosomine)
25
Describe the process and rehabilitation involved post total hip replacement
1. most instructed to WBAT
2. Regain steady and confident walking (takes time)
3. Rehab admission may be required
4. Physiotherapy begins straight away
5. Posterolateral approach - avoid hip flexion past 90 deg with hip adduction
6. fx restrictions - sleep with pillow between legs , no crossing legs
7. Discharge usually 5/7 after surgery
8. many attend rehab hospital - intense therapy
26
List aetiology and epidemiology of hip fractures (6)
1. common
2. often elderly
3. female > male
4. osteoporosis contributing factor
5. presented with - shortened externally rotated leg
27
list the four classifications of femoral neck fractures (4)
1. Garden 1 - undisplaced/incomplete
2. Garden 2 - Complete without displacement
3. Garden 3 - Complete with partial displacement
4. Garden 4 - Complete with full displacement
28
List the physiotherapy Mx post hip fractures (6)
1. chest/breathing exercises
2. Circulation exercises
3. static quads and gluts exercises
4. assisted board exercises usually flexion and abduction
5. weight bearing within 24-48 hours
6. coordinate multidisciplinary Mx (co-morbidities, delirium, reconditioning, living arrangement)
29
define avascular necrosis
Loss of blood supply causes damage to the femoral head.
- bone softens and collapses resulting in deformity of femoral head and separation of overlying cartilage
- in late stages, progressive damage to hip joint results in early OA
30
List symptoms of hip labral injury (4)
1. painful click +/- residual ache
2. Agg by positions with combination of flex/IR/add depending on location of tear
3. inability to recall specific MOI/trauma
4. Typically groin pain
31
List the functions of the labrum (5)
FDSCV
1. Fibrocartilaginous
2. Deepens socket
3. increases contact area
4. Maintains intra-articular pressure, decreasing contact stresses
5. Outer 1/3 vascularized
32
What test would you perform when Labral tear suspected?
Quandrant test (aka FADIR, Hip ant. impingement test) - flexion, adduction, internal rotation, passively move into flexion.
33
List the most common causes of Labral tears (5)
TILDD
1. Trauma (twisting or pivoting with weight)
2. Hip dysplasia
3. joint degeneration
4. capsular laxity
5. femoro-acetabular impingement (FAI)
34
What causes Femoroacetabular impingement (FAI) and what condition can it lead to?
occurs wen an asseous abnormality of the proximal femur (cam) or acetabulum (pincer) triggers damage to the ace tabular labrum and articular cartilage in the hip.
- leading cause of OA
35
What are the different types of impingements (2)
1. Cam
| 2. Pincer
