Hip

Question 1

• Deep buttock and lateral thigh pain
• MOI: overuse
• (-) sitting, walking up stairs
• ROM (-) AROM - hip flexion & RROM - Knee flexion
• +/- radicular symptoms into LE
• Management

Answer 1

Hamstring strain

Test: SLR, Bent knee stretch test

Education (grade, avoidance, proper warm-up) >

Question 2

• 30’s peak age, F, athletes
• MOI: hip flexion (eps in External rotation)
• Intermittent groin pain (-) with activity, (+) rest
• Audible “clicking” or “catching”
• Radiating pain ant thigh to above the knee
• Prom - pain with hip ext, Arom pain with hip flex/LR

Answer 2

Iliopsoas strain
AKA: “Dancers Hip” or “Jumpers Hip”

Test:
Thomas test
Management:
Activity modification > rest > myofascial > stretch (antagonists) > strengthen (flexors)

Question 3

• MOI: kicking, sprinting, change of direction
• Anterior hip pain
• A/Rrom - pain with hip flex + knee ext, Prom - hip ext
• Management?

Answer 3

Quadriceps strain

Test:
- Muscle testing
* hip flex = quads * hip flex + ER = iliopsoas

• PRICE > positioning (knee flex) > stretch > isometric > isotonic

Question 4

• MOI: sudden change in direction (soccer)
• Groin pain
• pain with A/Rrom adduction + flexion
• ## pain with direct palpation of groin muscle

Answer 4

Adductor Strain

• Adductor Squeeze Test
• Passive Abduction

PRICE > PRROM > Isometric > isotonic

Question 5

• Weak hip abductors
• Lateral knee pain
• LONG DISTANCE + DOWNHILL running aggravates
• Management?

Answer 5

ITB syndrome

Test: Nobel’s + Ober

• Rest > Modalities > glut med/min strengthening

Question 6

• 15-40, F
• Extension -> flexion (Iliopsoas)
• IR -> ER (TFL, Glut max)
• +/- pain
• Weak abs and hamstrings
• Imaging?
• Management?

Answer 6

Snapping hip Syndrome

Dx Ultrasound

• Stretching + strengthening
• if painful, rule out labral tear

Question 7

• F, unilateral hip pain
• Post/lateral thigh pain can radiate above the knee
• POINT TENDERNESS
• Pain sleeping on side
• RROM pain - abduction

Answer 7

Trochanteric bursitis
“GTPS”

Gluteal - Rrom Ext
Iliopsoas - Rrom Flex

Question 8

• Sharp, localized groin pain
• Worse after a heavy meal or extended standing
• Lifting, coughing, bending aggravate
• Management?

Answer 8

Inguinal hernia

GP > surgery > post op core strengthening

Question 9

• 30-40, M
• Pain lateral hip and radiates down to knee
• Overweight, Diabetic
• (-) walking, standing
• Management?

Answer 9

Meralgia Parasthetica

• Education (weight loss > loose clothing)

Question 10

• Groin pain made worse with activity
• (-) hip adduction
• Childbirth, rugby/soccer, urological surgery

Answer 10

Osteitis Pubis

Question 11

• F, < 1
• Asymmetric skin folds (uni flat buttock)
• Tight hip adductors
• Decreased AROM - Abduction
• Sleepless nights, avoiding walking/crawling
• Imaging?

Answer 11

Hip Dysplasia

Tets:
Ortalani - “in”, Abd + distraction
Barlow - “out”, Add + compression

Xray - putts triad
(shallow acetabulum, small femoral head, dislocation sup/lat)

Question 12

• 20-30, F
• Pain, stiffness in the groin
• Swollen, red
• +/- pain with thigh extension
• Hint?
• Management?

Answer 12

Myositis Ossificans
Hint - post traumatic

• Imaging - xray (post 3 weeks)
• Management - rest > US, PFROM

Question 13

• 40-50, M (6:1)
• Obese
• BILATERAL gradual onset of dull, achy groin pain
• May refer down into the knees
• +/- A & Prom restricted and painful. RROM wnl
• Imaging?
• Management?

Answer 13

Avascular Necrosis (AN)

Imaging
- MRI (GS)
- Xray (WNL early stages)

Ortho, manual = contraindicated until complete recovery and pain free

• LCP in children 3-12 (hip and knee pain)

Question 14

• 3-12, M (4:1)
• Insidious onset hip, knee, or groin pain
• (-) leg movement
• Antalgic gate
• +/- pain felt in KNEES or UNAFFECTED HIP
• Flexion and adduction contractures
• Limited ABD + IR

Answer 14

Legg-Calve-Perthes