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Sportsmed > wk 8- Hip, pelvis, lumbar > Flashcards

wk 8- Hip, pelvis, lumbar Flashcards

1
Q

Red flags (10)

A

-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)

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2
Q

why are red flags important

A

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

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3
Q

groin pain is common in?

A

males more than females and athletes

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

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4
Q

risk factors for groin pain

A

-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

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5
Q

common findings in athletes with long standing adductor groin pain

A
  • degenerative change. of symphyseal joint
    -adductor muscle insertion
    pubic bone marrow oedema
    -secondary cleft signs
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6
Q

clinical criteria for adductor groin pain

A

adductor tenderness and pain on resisted testing

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7
Q

clinical criteria for iliospoasis groin pain

A

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

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8
Q

clinical criteria for inguinal groin pain

A

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

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9
Q

doha agreement is

A

how different types of groin pain is classified

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10
Q

clinical criteria of pubic groin pain

A

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

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

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11
Q

clinical crtieria of hip groin pain

A

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

PROM tests and special tests: FABER, FADIR).

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12
Q

adductor muscles and types of injuries that occur

A

adductor magnus, longus, brevis and pectineus helps with movements

  1. adductor muscle strain
  2. adductor tendinopathy/ enthesopathy
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13
Q

tests for adductor related groin pain

A

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

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14
Q

iliopsoas related groin pain

A

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

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

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15
Q

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

A
  1. posterios wall bulge
  2. ilioinguinal nerve adhesions
  3. ilioinguinal nerve entrapment
  4. enestheopathy at insertion
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16
Q

pubic related groinpain injuries (4)

A
  1. pubic symphysis joint (older athletes)
  2. pubic apopysitis (younger athlete)
  3. superior/inferior pubic rami bone stress injury
  4. abdominal tendonopathy/enthesopathy
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17
Q

causes of hip pan can be what?

A

anterior
lateral
posterior

diagnosis for all different areas

18
Q

femoroacetabular impingement syndome

A

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)

19
Q

what can femoroacetabular impingement syndrome lead to

A

chondral and labral pathology

cam morphology is associated in osteoarthritis

-common in elite athletes and active indiviudals

20
Q

what is acetabular labral tear due to

A

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

21
Q

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

A
  1. femoroacetabular impingement syndrome
  2. acetabular labrum tear
  3. ligamentum teres tears
  4. osteoarthritis
  5. bone stress injury of fermoral neck or shaft
22
Q

osteoarthritis

A

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

23
Q

developmental causes of hip pain (4)

A

perthes disease

slipped capital femoral epiphysis

apophysitis/avulsion fracture

dysplasia

24
Q

perthes disease

A

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

25
Q

slipped capital femoral epiphysis

A

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

26
Q

dysplasia

A

altered development of the hip joint- reduced weight bearing areas in the joint

risks:
-female
-premature
- family history
- breech position

27
Q

apophysitis/ apophyseal avulsion fractures

A

peads/adolescent sporting population

multiple sites it can occur at

apophysitis: overload of apophysis

avulsion: tensile forces lead to detachment

28
Q

bone stress injuries is

A

imbalance between bone resorption and formation (osteoblasts and osteoclasts)

29
Q

bone strain

A

imaging of bone stress without symptoms

does not limit ability

unclear if management is required

change of MRI and nuclear only

30
Q

bone stress

A

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

31
Q

stress fracture

A

positive imaging and symptoms and presence of fracture line

may be visible on xray

unloading needed for healing

32
Q

femoral neck stress fracture

A

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

33
Q

femoral shaft stress fracture

A

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

34
Q

greater trochanter pain syndrome

A

-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

35
Q

clinical tests for GTPS

A

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

36
Q

lateral hip injuries

A

greater trochanteris pain syndrome

37
Q

Posterior hip injuries (5)

A
  1. proximal hamstring tendinopathy
  2. muscle pain
  3. ischiofemoral impingement
  4. sciatic nerve entrapemnt
  5. deep gluteal and piriformis syndrome
38
Q

proximal hamstring tendinopathy

A

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

39
Q

lumbar spine pain

A

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

40
Q

lumbar bone stress injury

A

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

41
Q

spondylolisthesis

A

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

42
Q

disc injuries and acute radicular pain

A

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

Sportsmed (11 decks)

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