Hip

Question 1

T or F: a pathological hip joint may be asymptomatic

Answer 1

T: it may be a hip issue but they have pain somewhere else (knee, back)

Question 2

arthrogenic inhibition

Answer 2

joints tell the muscles to stop working

(most common at knee, but at the hip you see glute weakness)

Question 3

what does C sign signify?

Answer 3

hip joint pain
*associated with FAI and labral injury

Question 4

what are a few special tests for hip joint pain?

Answer 4

FABER
FADIR
SLR
Scouring (hip quadrant)

Question 5

when someone has hip joint pain, what will happen with SLR test?

Answer 5

they will have pain from about 0-30 degrees b/c that is where the most joint torque is created. then, it goes away as they get higher

Question 6

what kind of strengthening helps stop arthrogenic inhibition

Answer 6

isometric

Question 7

are muscle strains more common in one or two joint muscles

Answer 7

two because we put them on double the amount of stretch

Question 8

3 causes of muscle strains (overall)

Answer 8

1 - ballistic movements
2 - eccentric contractions
3 - end range motion

Question 9

what is the biggest risk factor for a hamstring injury? what are other risk factors

Answer 9

a prior hamstring injury
others: strength imbalance, insufficient warm-up, fatigue

Question 10

your pt is a 22 y.o. male baseball player presenting with pain in the bak of the leg after lunging onto 1st base. he felt a pull and immediate pain. he has difficulty running, pain is a 5/10 and is TTP along the hamstrings. what does your pt have

Answer 10

hamstring strain

Question 11

what is the best way to treat a hamstring strain?

Answer 11

don’t let it happen. strengthen them to prevent it (nordic exercise)

Question 12

what are some populations hamstring tendinopathy is common in

Answer 12

• distance runners
• saggital plane activities (springting)
• change in direction (football, hockey)
• excessive stretching (dance)

Question 13

Your pt is a 17 y.o. football player c/o pain in the back of the leg. He had no specific MOI. The pain improves once he gets through his warm-up, however, by the time he gets to the end of practice it increases again. He is TTP over the ischial tuberosity. Stretching his hamstring causes pain. What does the pt likely have? If you treat the pt and he is not improving what needs to be ruled out?

Answer 13

hamstring tendinopathy, avulsion needs to be ruled out if not improving

Question 14

stage 1 muscle strain treatment

Answer 14

isometrics

Question 15

stage 2 muscle strain treatment

Answer 15

isotonic hamstring load with minimal hip flexion
ex: bridges, prone hip extension, prone leg curls, nordic

3-4 sets every other day with isometrics in between

Question 16

stage 3 muscle strain treatment

Answer 16

isotonic exercise with increased hip flexion
ex: hip thrusts, step-ups, walking lunges, dead lift

Question 17

stage 4 muscle strain treatment

Answer 17

energy storage loading to prepare for return to sport
ex: bounding, split squats, a-skips, cutting, sprinter curls

Question 18

what are 2 common places to get muscle contusions in the LE?

Answer 18

anterior thigh
iliac crest

Question 19

what 2 interventions should you avoid for muscle contusions? why?

Answer 19

• aggressive stretching and manual therapy
• it can cause myositis ossificans

Question 20

myositis ossificans

Answer 20

bone growth into the soft tissue

Question 21

greater trochanteric bursitis encompasses what 3 disorders

Answer 21

1 - trochanteric bursitis
2 - snapping hip
3 - abductor tendinopathy

Question 22

is greater trochanteric pain syndrome more common in men or women

Answer 22

women (due to pelvis shape and q angle)

Question 23

what are 3 muscles are commonly weak in greater trochanteric pain syndrome

Answer 23

abductors, extensors, external rotators

Question 24

Your pt is a 35 y.o. female with c/o R lateral hip pain. She has pain with sidebending, trendelenberg gait, and is TTP over the greater trochanter. You also note a 2cm leg length discrepancy. What does this pt likely have?

Answer 24

greater trochanteric pain syndrome

Question 25

your pt with greater trochanteric pain syndrome c/o pain in her lateral hip when in the FADIR position. is this a positive test

Answer 25

no, it is only positive if it produces anterior joint pain

Question 26

what are 4 differential diagnoses for greater trochanteric pain syndrome

Answer 26

1 - fracture 2 - hip joint pathology 3 - lumbar spine pathology 4 - lateral femoral cutaneous nerve

Question 27

do corticosteroid injections, shock wave therapy, or home exercise help greater trochanteric pain syndrome more long-term?

Answer 27

home exercise

Question 28

T or F: there was a significant difference in using dry needling vs. corticosteroid injections for greater trochanteric pain syndrome after 6 weeks

Answer 28

F

Question 29

iliopsoas bursitis

Answer 29

- tendon snapping over ilipectineal eminence - "snapping hip"

Question 30

what are some causes of iliopsoas bursitis?

Answer 30

- growth spurt - shortened hip flexor/weak glutes - anterior pelvic tilt - overuse flex/ER

Question 31

what are some populations who commonly experience iliopsoas bursitis

Answer 31

- dances - rowers - resistance training - runners

Question 32

Your pt is a 21 y/o dancer experiencing pain in her anterior hip. She often hears a clicking sound. The pain bothers her most when she is dancing, specifically during kicks and splits. It improves with rest. She is TTP in the femoral triangle. What does she likely have?

Answer 32

iliopsoas bursitis

Question 33

what is a differential diagnosis for iliopsoas bursitis

Answer 33

hip joint pathology

Question 34

if you are treating a female who has a femoral neck stress fracture what condition should you consider?

Answer 34

female athlete triad

Question 35

female athlete triad

Answer 35

eating disorder, amenorrhea, osteopenia

Question 36

the femoral neck is a zone of weakness because it ha no overlying ____

Answer 36

trabeculae

Question 37

Your pt is a 20 y.o. female who recently c/o anterior groin pain with no MOI. She is a new runner and recently increased her mileage. It hurts more when she is running and at night. On exam, you noted that IR and ER cause pain. What does this pt likely have?

Answer 37

femoral neck stress fracture

Question 38

T or F: femoral neck stress fractures always show up on radiographs

Answer 38

F: they take at least 10-14 days to show up

Question 39

treatment for femoral neck stress fractures depends on what 3 things

Answer 39

1 - radiograph 2 - location 3 - clinical presentation

Question 40

if your pt with a femoral neck stress fracture has pain immediately upon standing what do they need to do

Answer 40

go on bed rest/offload

Question 41

two types of femoral acetabular impingement

Answer 41

cam - femoral based pincer - acetabular base

Question 42

cam impingement is more common in _______ while pincer is more common in _______

Answer 42

males females

Question 43

where do people with FAI typically have pain? what motions are restricted/painful? what special test is typically positive

Answer 43

- groin pain - flexion, IR - positive FADIR

Question 44

what are some typical physical impairments in people with FAI? (4)

Answer 44

- hip muscle weakness - lower trunk strength - poor single leg balance - lower functional task performance

Question 45

your pt had surgery for FAI where they went through the anterior capsule. what motions should you avoid

Answer 45

ER and extension

Question 46

phase 1 treatment for FAI surgery 0-4/6 weeks

Answer 46

- normalize gait - control edema - restore ROM (within limits)

Question 47

phase 2 treatment for FAI surgery 4-8 weeks or 6-12 weeks

Answer 47

-I w/ ADLs -psoas re-ed (watch for tendinitis) -continue glute activation, core stabilization -consider advanced closed chain exercises

Question 48

phase 3 treatment for FAI surgery 8-12 weeks or 12-20 weeks

Answer 48

-becoming recreationally asymptomatic -continue building strength/endurance -dynamic exercises, maybe plyometrics

Question 49

10 rep triple for advancement/return to running

Answer 49

step downs, SL squats, hip abduction

Question 50

T or F: you should change multiple training variables at once

Answer 50

F: one at a time

Question 51

Your pt is a 40 y.o. female with c/o anterior groin pain for over a year. She has painful clicking and sometimes it feels like her hip "catches". SLR, FADIR, and FABER are all painful. She also has a positive McCarthy sign. What does your pt likely have?

Answer 51

acetabular labral tear

Question 52

T or F: snapping hip and FAI can set you up for a labral tear

Answer 52

T

Question 53

T or F: complication rates are high with hip arthroscopies

Answer 53

F: only 0.5% have permanent complications

Question 54

what are 3 possible complications of hip arthroscopy

Answer 54

1 - femoral artery/nerve 2 - lateral femoral cutaneous nerve 3 - sciatic nerve

Question 55

T or F: hip arthroscopies have good return to sport rates

Answer 55

T

Question 56

are hip fractures more common in females or males? active or sedentary? caucasion or african-american

Answer 56

females sedentary caucasian

Question 57

where are intrascapular hip fractures? AKA: hip fractures?

Answer 57

femoral neck subcapital

Question 58

where are extracapsular hip fractures? AKA: femur fractures?

Answer 58

subtrochanteric trochanteric

Question 59

are intracapsular or extracapsular hip fractures more common

Answer 59

intracapsular

Question 60

your pt is a 75 y.o. female with c/o hip pain after a fall. what should you automatically be worried about

Answer 60

hip fracture consider blood loss

Question 61

Your pt is a 82 y.o. male who has decreased LE strength and hip ROM grossly. His pain his worse in the mornings and with prolonged standing. He walks with an antalgic gait. What does he likely have?

Answer 61

osteoarthritis

Question 62

T or F: in patients with OA you should focus on getting rid of their pain

Answer 62

F: you may never get rid of their pain... focus on function