wk 8- Hip, pelvis, lumbar

Question 1

Red flags (10)

Answer 1

-high speed impact/history of trauma
-fever
-constant pain
-unwell
-unexplained weight loss
-bowel/bladder dysfunction (painful urination, incontinence, retention)
-myotomal muscle weakness
-gait alteration
-saddle paraesthesia
-history of cancer (esp breast, prostate, reproductive)

Question 2

why are red flags important

Answer 2

indicators of possible serious pathology such as
inflammatory/neurological conditions
MSK damage or disorders
circulatory problems
suspected infections
tumours
systemic conditons

Question 3

groin pain is common in?

Answer 3

males more than females and athletes

sports:
-ice hockey/football
-mode of injury: kicking, change of direction, sprinting

Question 4

risk factors for groin pain

Answer 4

-previous history
-higher level of play
-reduced hip adduction strength (adductor squeeze test)
-lower level of sports specific training
-reduced hip internal rotation and bent knee fall out range
-altered trunk muscle function

Question 5

common findings in athletes with long standing adductor groin pain

Answer 5

• degenerative change. of symphyseal joint
  -adductor muscle insertion
  pubic bone marrow oedema
  -secondary cleft signs

Question 6

clinical criteria for adductor groin pain

Answer 6

adductor tenderness and pain on resisted testing

Question 7

clinical criteria for iliospoasis groin pain

Answer 7

liopsoas tenderness
Pain on resisted hip flexion AND/OR pain on
stretch

Question 8

clinical criteria for inguinal groin pain

Answer 8

Pain location in the inguinal region AND
tenderness of the inguinal canal.

No palpable hernia.

Pain aggravated with resistance testing of the
abdominal muscles OR on Valsalva/cough/sneeze

Question 9

doha agreement is

Answer 9

how different types of groin pain is classified

Question 10

clinical criteria of pubic groin pain

Answer 10

Local tenderness of the pubic symphysis and
the immediately adjacent bone.

No particular resistance test that could be
used in conjunction with palpation

Question 11

clinical crtieria of hip groin pain

Answer 11

History (onset, nature, location, mechanical
symptoms e.g. catching, locking, clicking or
giving way)

PROM tests and special tests: FABER, FADIR).

Question 12

adductor muscles and types of injuries that occur

Answer 12

adductor magnus, longus, brevis and pectineus helps with movements

1. adductor muscle strain
2. adductor tendinopathy/ enthesopathy

Question 13

tests for adductor related groin pain

Answer 13

palpation (adductor longus, pectineus, gracillus)

resistance (squeeze test with hip in neutral and long lever, or with hip and knee flexion, or outer range adduction)

stretch (passive adductor stretch, FABER test)

80-81% probability of MRI adductor lesion with 3 tests positive

Question 14

iliopsoas related groin pain

Answer 14

poor correlation between clinical tests and imaging, MRI needed to assist diagnosis

hip flexor injuries account for 1/3 of acute groin injuries

Question 15

inguinal related groin pain (excluding inguinal hernia) diagnosis/injuries (4)

Answer 15

1. posterios wall bulge
2. ilioinguinal nerve adhesions
3. ilioinguinal nerve entrapment
4. enestheopathy at insertion

Question 16

pubic related groinpain injuries (4)

Answer 16

1. pubic symphysis joint (older athletes)
2. pubic apopysitis (younger athlete)
3. superior/inferior pubic rami bone stress injury
4. abdominal tendonopathy/enthesopathy

Question 17

causes of hip pan can be what?

Answer 17

anterior
lateral
posterior

diagnosis for all different areas

Question 18

femoroacetabular impingement syndome

Answer 18

need 3 things for diangosis

symptoms:
-pain in motion or position
-pain can be felt in back, butt or thigh

clinical signs:
FADIR- sensitive test
limited ROM of hip flexion and restricted internal rotation in flexion

imaging findings:
- pincer (cover coverage of femoral head by acetabular) or cam morphology (flattening of the femoral head)

Question 19

what can femoroacetabular impingement syndrome lead to

Answer 19

chondral and labral pathology

cam morphology is associated in osteoarthritis

-common in elite athletes and active indiviudals

Question 20

what is acetabular labral tear due to

Answer 20

labrum exposed to higher loads
-hip dysplasia and cam/pincer morphologies

can be asymptomatic and an incidental finding

symptomatic will report
* Clicking hip
* Pain in the groin region, anterior or lateral hip (c-sign)
* Pain with deep squatting/pivoting
* Aching with sitting or prolonged driving
* Pain at rest/after activity
* Altered gait/limp

Question 21

common Hip injuries/pathology of anterior hip (not including developmental injuries)

Answer 21

1. femoroacetabular impingement syndrome
2. acetabular labrum tear
3. ligamentum teres tears
4. osteoarthritis
5. bone stress injury of fermoral neck or shaft

Question 22

osteoarthritis

Answer 22

abnormal loading that exceeds tolerance of normal cartilage or secondary to impingement

labral tears are precursors to OA because of joint instability and chondral damage

presents: pain worse in morning, better with small amounts of activity, lack of hip extension

Question 23

developmental causes of hip pain (4)

Answer 23

perthes disease

slipped capital femoral epiphysis

apophysitis/avulsion fracture

dysplasia

Question 24

perthes disease

Answer 24

osteochondrosis which causes increased density and flattening of the femoral head

presents with:
-limp
-low grade ache
-reduced ROM

affects males more around 4-10years of age

Question 25

slipped capital femoral epiphysis

Answer 25

can lead to AVN of femoral head commonly anterior displacement of the mataphysis relative to the epiphysis presents: -unilateral -pain -walk with foot turned out affects males more, 10-16years

Question 26

dysplasia

Answer 26

altered development of the hip joint- reduced weight bearing areas in the joint risks: -female -premature - family history - breech position

Question 27

apophysitis/ apophyseal avulsion fractures

Answer 27

peads/adolescent sporting population multiple sites it can occur at apophysitis: overload of apophysis avulsion: tensile forces lead to detachment

Question 28

bone stress injuries is

Answer 28

imbalance between bone resorption and formation (osteoblasts and osteoclasts)

Question 29

bone strain

Answer 29

imaging of bone stress without symptoms does not limit ability unclear if management is required change of MRI and nuclear only

Question 30

bone stress

Answer 30

imaging evidence of bone stress and symptoms abscene of fracture line/breach of cortex changes on MRI of nuclear only period of unloading needed to prevent progression to stress fracture

Question 31

stress fracture

Answer 31

positive imaging and symptoms and presence of fracture line may be visible on xray unloading needed for healing

Question 32

femoral neck stress fracture

Answer 32

can be caused by compression or tensile forces, common in runners complications: - displacement/non union -AVN of femoral head lack of clinical testing that is reliable therefore imaging is recommended patella pubic percussion test

Question 33

femoral shaft stress fracture

Answer 33

repetitive overload endurance athletes vague ache anterior thigh inability to weight bear well (hop test, fulcrum test)

Question 34

greater trochanter pain syndrome

Answer 34

-lateral hip pain injury it can be gluteus medius/minimus tendinopathy or bursitis most common in menopausal women and population with low back pain presents: -pain over lateral hip -night pain with lying on the side -antalgic gait -pain during sitting -walking uphills causes pain

Question 35

clinical tests for GTPS

Answer 35

palpation single leg stance test flexion, adduction external rotation resisted (FADERR) medical imaging is sensitivte but not specific as tendon changes are common but cont correlate with pain

Question 36

lateral hip injuries

Answer 36

greater trochanteris pain syndrome

Question 37

Posterior hip injuries (5)

Answer 37

1. proximal hamstring tendinopathy 2. muscle pain 3. ischiofemoral impingement 4. sciatic nerve entrapemnt 5. deep gluteal and piriformis syndrome

Question 38

proximal hamstring tendinopathy

Answer 38

common in runners/sports with kicking or trunk flexion, menopausal women, sedentary individuals presents: -pain over lower butt -worse when sitting in low hard chairs -worse when walking/running uphill or stairs clinical tests - plapation - max hip flexion with active knee ext

Question 39

lumbar spine pain

Answer 39

85% of people affected in their life, mostly likely resolves 85% is associated with lifestyle and individual reasons 510% associated with sporting injuries -lumbar bone stress -disc protusions/ acute radicular pain imaging shows changes but poor correlation with pain and pathology

Question 40

lumbar bone stress injury

Answer 40

common in young athletes in sports with hyperextension and rotation or high axial loads (jump and land on one leg), gymnastics, javelin, high jump, cricketers long recovery time 6-8 weeks asymptomatic 10-12 stress reaction 20-30 weeks partial or complete fracture if not treated, can progress to pars defect/spondylolisthesis or increased risk of BSI on opposite side

Question 41

spondylolisthesis

Answer 41

often associated with bilateral pars defects, can develop in childhood, pars defects that result from sport rarely result in this condition, more congential usually L5 slipping on S1, graded on degree of slip

Question 42

disc injuries and acute radicular pain

Answer 42

protusion of the nucleus pulposus from the annular fibrosis which pushes on the nerve presents: cough/sneeze painful rerferred pain nerve changes difficult tolerating position for long periods tests: slump test straight leg raise test