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MSK > Hip > Flashcards

Hip Flashcards

1
Q

what is a clinical syndrome
based on the presence of symptoms over the greater
trochanter of the hip, including bursitis, gluteal tendinopathy, and iliotibial band (ITB) pathology.

A

GREATER TROCHANTERIC BURSITIS

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2
Q

what are the three common greater troch burse?

A

gluteus minimums bursa
sub gluteus medius bursa
subgluteus maximus bursa

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3
Q

what is the most common age for trochanteric pain?

A

middle aged women (40s) and elderly (60s)

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4
Q

Originally, the most assumed cause of pain for the lateral hip region was the ___________. Now other pathologies have been found to be just as prevalent including____________________.

A
  • subgluteus maximus bursa
  • gluteal tendinopathy and atrophy and tensor fasciae latae tendinopathy
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5
Q

what is the most commonly cound pathological structure in lateral hip pain?

A

glute med (but it is prob in conjunction with other things)

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6
Q

what are theories of greater troch bursitis?

A
  • ITB rubbing over glute med tendon
  • direct trauma/strain
  • repetitive micro trauma
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7
Q

what is the initial cause of bursisits or tendon pain? and what occurs over time?

A
  • inflammatory reaction
  • oxidative stress and apoptosis
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8
Q

___________is theorized to
stimulate nociceptors.

A

Anoxia

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9
Q

__________________ results from
infiltration of vascular and neuronal tissue, which can be accompanied by adrenergic
involvement

A

Chronic pain

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10
Q

MOI for greater trochanter bursitis

A
  • hyperabduction of the hip
  • trauma
  • direct blow or fall
  • overuse and microtrauma (more common)
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11
Q

contributing factors to greater troch hip bursitis are…

A
  • poor walking mechanics
  • prolonged sitting/standing
  • lumbar/sacral pathology
  • LLD
  • poor multifidus/transverse abdominis
  • tight flexors, adductors, and hammys
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12
Q

signs of greater trochanter bursitis

A
  • pain on posteriolateral hip and buttock (can go down lateral thigh, rarely extends beyond the knee and into the poterior thigh )
  • numbness and snapping at the greater troch
  • L2-L4 nerve roots (thigh)
  • L5 dermatome (lat thigh)
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13
Q

aggravating activities for greater troch bursitis

A
  • ipsilateral side lying, prolonged standing, crossing the legs. rising from a chair and climbing activities.
  • Climbing and descending stairs or walking uphill.
  • Hip external rotation and abduction movements.
  • Running and jumping.
  • All these activities create increased stress or pressure on the hip joint, requiring more
    stabilization from muscle-tendon units and their surrounding structures.
  • Running, jumping, and climbing all require a high level of gluteal muscle contraction with both
    concentric and eccentric control
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14
Q

what are easing activities of greater troch hip bursitis

A
  • Rest from aggravating activities.
  • Antiinflammatory medications.
  • Lying supine.
  • Contralateral side lying with pillow between knees.
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15
Q

surgical options for greater troch bursitis

A
  • steroid shots
  • bursal sac calcification and excision
  • ITB release
  • tendon anchor repair
  • trochanteric reduction osteotomy
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16
Q

what is the goal of rehab for greater troch bursitis

A
  • decrease further injury, inflam, and regain ROM
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17
Q

once inflam has decreased in greater troch bursitis what should the focus be on?

A

ID the factors that contribute to the greater troch pain

exercises to promote hip ROM and strength

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18
Q

what exercises are good for greater troch bursitis to help restore ROM and strength?

A

eccentric gluteal exercises
dynamic pelvic stability

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19
Q

when treating greater troch bursitis _________________ are important for healing.

A

Trunk and pelvic strength and stability

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20
Q

what are 3 injury prevention techniques for greater troch bursitis?

A
  • modification of running to avoid crossing midline
  • stability and shock absorption
  • correction of LLD
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21
Q

acute vs chronic hamstring tendinopathy

A

acute- overstretch with microtears and inflam
chronic - degeneration and cellular/collagen abnormalities

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22
Q

what is a grade 1 muscle strain

A

Grade I is defined by pain with
minimal or no strength and ROM
loss. Very minimal tissue disruption
has occurred.

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23
Q

what is a grade 2 muscle strain

A

Grade II is defined by tissue damage
that results in decreased muscle
strength and function. Muscle fiber
disruption has occurred.

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24
Q

what is a grade III muscle strain

A

Grade III is defined by complete
muscle disruption resulting in
complete strength and functional
losses.

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25
Q

what is a common cause for hamstring strain?

A
  • strong eccentric load (noncontact)
  • sprints
  • over stretch ROM
  • fall, jump, kick, lung
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26
Q

T o F: the hamstring is the most common strained muscle

A

T (biceps femoris at the musculotendinous junction)

27
Q

what happens with degenerative changes of a hamstring strain

A

because of poor blood supply, there is a weakening and thickening of the tendon and this restricts healing leading to chronic tendinopathy or tendinosis

28
Q

what are contributing factors to a hamstring strain?

A
  • poor warm up
  • imbalance of strength of quad and hammys
  • hypermobility of hip lumbar and pelvis
  • muscle fatigue
  • poor activation of back and abs
    -tight hip flexors, erector spinae, and hamstrings
  • poor running technique and biomechanics
  • neural tension
29
Q

signs and symptoms of hamstring strain

A
  • “pop” tearing
  • tenderness with passive stretch and palpation
  • posterior thigh pain that gets worse with resisted knee flexion
  • glute pain and point tenderness
30
Q

aggravating factors of a hamstring strain

A
  • quick increase in velocity
  • lengthening of hamstrings
  • decelerate knee extension, (eccentric action)
  • dance yoga and MMA
31
Q

easing activities of hamstring strain

A
  • slow walking
  • anti-inflam meds
  • rest
  • neutral hip and knee flexion with post pelvic tilt and lumbar spine flexion
  • slow level walking
  • positioning the hip and knee to avoid excessive stretch
32
Q

Rehab ideas for hamstring strain

A
  • isometric followed by concentric and eccentric pain-free exercises
  • stretching
  • joint mobilization
  • proper mechanics
33
Q

prevention of recurrence of hamstring strain includes…

A
  • strength and endurance
  • abs, lumbar, pelvic, and glute strengthening
  • regular hamstring stretching
34
Q

there is a higher prevalence of labral tears in athletes who have ________. approx ___%

A
  • groin pain
  • 25
35
Q

there is a greater chance of pathology in the labrum with _____________ and ___________

A

structural abnormalities
previous hip path

36
Q

what type of individual experiences labral tears

A

highly active individuals that are 20-40 years old (females)
- if it occurs older than 60 it is prob bc of degenerative changes

37
Q

what tears occur between the acetabulum and the femoral head

A

hip dysplasia, capsular laxity, or femoroacetabular
impingement (FAI)

38
Q

Radial flap tear

A

Most common type, disruption of the free margin of the labrum

39
Q

radial fibrillation tear

A

Fraying of the free margin, associated with degenerative joint
disease

40
Q

abnormally mobile tears

A

Detached labrum, similar to a Bankart lesion of the shoulder

41
Q

longitudinal peripheral tear

A

Least common type, tear in longitudinal direction in the
peripheral aspect of the labrum

42
Q

92% of the time labreal tears are _____________ of the inner aspect of the labrum

A

anterior and anterosuperior location

43
Q

MOI for labral tear

A
  • subluxation or disrupt of cartilage
  • activities with sudden twisting
  • repetitive micro trauma = wear and tear
  • none
44
Q

contributing factors to a labral tear

A
  • FAI (decreased joint clearance and a degenerative process)
  • capsular laxity
  • dysplasia
  • articular cartilage degeneration
45
Q

common signs and symptoms of a labral tear

A
  • lock and click and catch
  • pain in groin
  • hip stiffness
  • giving way
    -limited ROM
  • hip path
  • anterior groin, buttock, greater T, thigh, medial knee
46
Q

aggravating activities of labral tear

A

Pivoting or twisting
 Deep squatting
 Crossing legs (e.g., to tie shoes)
 Walking
 Climbing or descending stairs
 Sitting

47
Q

easing activities of labral tear

A
  • open pack
  • hip distraction
  • anti-inflam
48
Q

rehab for labral tear is to __________ and ____________. then ID contributing factors.

A

decrease pain and inflam

49
Q

what is piriformis syndrome

A

Piriformis syndrome is a condition of the piriformis muscle causing local pain in the
buttocks with or without referred
symptoms into the lower extremity caused by compression of the sciatic
nerve.

50
Q

_________________ occurs from local trauma that causes hematoma formation followed
by adhesion formation, which irritates the piriformis muscle

A

myofascial pain

51
Q

____________________ of the sciatic nerve from trauma may occur; this is due to
the inflammation that causes chemical irritation of the sciatic nerve

A

compression or irritation

52
Q

what restricts muscle mobility after a strain?

A

scar tissue

53
Q

Nerve entrapment/impingement occurs in cases in which the sciatic nerve ___________________, creating neural irritation and inflammation of the sciatic nerve when the piriformis muscle is compressed

A

pierces through the piriformis muscle

54
Q

what is primary piriformis syndrome

A

All pathology intrinsic to the piriformis muscle secondary to
an inciting event such as trauma is included.

55
Q

what is secondary piriformis pathology

A

All other causes in which the symptoms of posterior buttock pain with or without radiation down the leg depend on the location of the pathology in relation to the structures adjacent to the sciatic notch, provided that spinal pathology is excluded

56
Q

what are MOI of piriformis syndrome

A
  • falling on butt/trauma
  • prolonged sitting
  • excessive strain of the muscle
  • pregnancy
  • insidious onset
57
Q

what are contributing factors to piriformis syndrome

A
  • weak glutes
  • weak core
  • increased lumbar lordosis
  • fibrosis caused by trauma
  • partial or total nerve anatomical abnormalities
  • jobs that you sit or drive a lot for
58
Q

common signs and symptoms of piriformis syndrome

A
  • pain in butt, and difficulty walking
  • pain with stooping or lifting
  • palpable spindle or sausage shaped mass in the ass
  • positive Lasegue’s sign
  • glute atropy
  • pain with pooping
  • dyspareunia (painful intercourse)
  • radicular-type symptoms into the lower extremity posterior thigh and calf following the sciatic nerve pattern in cases with nerve irritation: “Wallet sign”
59
Q

aggravating factors of piriformis syndrome

A
  • sit
  • put shoe on
  • crossed leg sitting
  • squat
  • lung
  • going DOWN stairs
  • hip ADD and IR
60
Q

easing activities of piriformis syndrome

A
  • not stretching it (supine and ER of LE)
  • standing from seated pos
  • traction
  • standing with LE ER
61
Q

The focus of PT for piriformis syndrome is for ___________________________________

A

impairments leading to the piriformis syndrome and
restore function.

62
Q

____________ improves mobility of the sciatic nerve to prevent further entrapment

A

neural mobilization

63
Q

__________________ of abnormal movement patterns and functional exercises are goals with piriformis syndrome

A

correction and reeducation

64
Q

in piriformis syndrome ___________________________ are required before fully returning to prior level of function activities.

A

pain free activities without neurological symptoms

MSK (19 decks)

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