Hip pain, Hip internal rotation ROM 50

Hip Flashcards by Kyle Zbornik

4 areas that refer pain to the hip

Lumbar spine
SI joint
Knee
Foot and ankle

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What is the most common area to refer pain to the hip?

Lumbar spine

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Identify 5 areas the hip refers pain to

Knee
Thigh
Can refer to lumbar
SI
Foot, ankle UNCOMMONLY

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For MSK issues at the knee, MUST LOOK AT ________.

Hip

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What diagnosis is the following question targeting? “Have you ever had a medical practitioner tell you that you have a problem with the blood circulation in your hips?”

Avascular necrosis (AVN)

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5 colon cancer red flags

Age >50 years
Bowel disturbances
Unexplained weight loss
History of colon cancer in immediate family
Pain unchanged by positions or movement

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4 red flags for pathological fracture of the femoral neck

Older women (>70) with hip, groin, or thigh pain
Hx of fall from standing position
Severe, constant pain worse with movement
A shortened and externally rotated LE

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Identify 5 red flags for BSI - femoral neck stress fracture

Younger age
Hormonal changes
Nutritional changes
High volume of training relative to recovery
Pain with WBing worsening with time

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If a BSI is confirmed, what is required?

Requires differential diagnostic imaging followed by NWB order.

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Identify 3 red flags for osteonecrosis of the femoral head

Hx of long term corticosteroid use
Hx of avascular necrosis of contralateral hip
Trauma

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What Functional assessment is most often used after a THA?

Harris hip rating

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What functional assessment is used to assess hip and groin disability in young patients?

Copenhagen Hip and Groin Outcome Score

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The “C” sign is a strong predictor of what type of pathology?

Intraarticular

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Hip flexion clinical norm

120 degrees

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Hip extension clinical norm

15-30 degrees

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Hip abduction clinical norm

45 degrees

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Hip adduction clinical norm

20-30 degrees

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Hip internal rotation clinical norm

30-45 degrees

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Hip external rotation clinical norm

45-60 degrees

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Test for piriformis syndrome

FAIR test

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Test for stress fracture of femoral shaft

Fulcrum test

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Test used if suspicion of occult hip fracture

Auscultatory patellar-pubic percussion test

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What test is used to assess for intraarticular pathology at the hip?

Quadrant (Scour) test

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Test for ligamentous laxity

Log roll test

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Test to help differentiate between hip, back, and SI pain

Resisted SLR

Test for posterior labral tear

Fitzgerald test - posterior

Test for anterior labral tear

Fitzgerald test - anterior

Screening test for early hip dysplasia

Flexion-adduction test

Test to assess femoral anteversion/retroversion

Craig test

Test to assess closed chain muscle function

Lateral step down

Hip OA cluster 2

Hip pain, Hip internal rotation ROM <15 degrees, Pain with IR, Morning stiffness <60 minutes, Age >50

Hip OA cluster one

Hip pain Hip IR <15 deg Hip flexion ROM <115 deg

Differential diagnosis clues - possible causes: Dull, deep, aching

Arthritis Paget's disease

Differential diagnosis clues - possible causes: Sharp, intense, sudden, associated with weight bearing

Fracture

Differential diagnosis clues - possible causes: Tingling that radiates

Radiculopathy Spinal stenosis Meralgia Paresthetica

Differential diagnosis clues - possible causes: Increased pain while sitting with affected leg crossed

Trochanteric bursitis

Differential diagnosis clues - possible causes: Pain at sitting, legs not crossed

Ischiogluteal bursitis

Differential diagnosis clues - possible causes: Pain after standing, walking

Hip arthrosis (OA)

Differential diagnosis clues - possible causes: Pain on attempted weight bearing

Occult fracture Severe arthrosis

Differential diagnosis clues - possible causes: Unremitting, long duration

Paget's disease Metastatic carcinoma Severe arthrosis (occasionally)

T/F Hip OA is one of the most common causes of pain in older adults.

True

S/S of hip OA (3)

Morning stiffness <60 min Insidious onset of pain Decreased ROM

What muscle group is particularly prone to weakness with hip OA?

Hip abductors

Identify 3 predictors for hip OA

Obesity Previous injury to hip and/or knee Occupational risks Women > Men

CPR for Hip OA (5)

Pain aggravated with squatting Lateral or anterior hip pain with scour tests Active hip flexion causing lateral pain Pain with active hip extension Passive range of hip IR <25 deg

No restriction of mobility has an Sn of ____ to rule out hip OA.

1.0

Acetabular labral tears are a COMMON/UNCOMMON cause for hip/groin pain.

Common

S/Sx of acetabular labral tears (4)

Pain Clicking, catching, locking Painful PROM Confirmed with MRI

Management of Acetabular labral tears (4)

Rest Protection NSAIDS Surgical -> arthroscopic resection repair

MOST acetabular labrum tears are _____________ or ______________.

Anterior or anterosuperior

Etiology of acetabular labrum tears (2)

Trauma Degenerative (dysplastic or idiopathic)

Most common type of acetabular labrum tear

Radial flap

Clinical presentation of acetabular labrum tears (6)

Pain deep in groin - "C" sign Hip instability Buckling, catching, twinges, clicking, locking Worse with weight bearing or twisting Pain may occur w/ climbing stairs Pain may occur getting in/out of car

Conservative interventions for acetabular labrum tears (4)

Rest Work on impairments NSAIDS Modify functional activities

Surgical management of acetabular labrum tears (2)

Arthroscopy Debridement of labrum

This special test has been found to correspond to dynamic impingement and labral lesions.

FADIR

This special test is designed to provoke FAI at posterior aspect of the acetabulum.

Posterior impingement test

If angle of the greater trochanter is >8-15 degrees into IR, the femur is considered to be in __________.

Anteversion

If a patient can tolerate FAIR, flex-add axial compression, flex-IR test, impingement test, Fitzgerald what can be ruled out?

Labral tear

Identify: Abnormal contact between the femoral head and acetabular rim.

FAI

Identify three types of FAI:

CAM Pincer Mixed (most common)

What type of FAI is pictured?

CAM

What type of FAI is pictured?

Pincer

What type of FAI is pictured?

Mixed

What type of FAI is most common?

Mixed

Provocative test for a CAM impingement

FADIR

Provocative test for Pincer impingement

Hip extension, ER

FAI type: Bony overgrowth of the femoral neck

CAM

FAI type: Bony abnormality of the acetabulum due to increased size of the acetabular rim.

Pincer

Based on the following clinical presentation, identify the likely pathology: "C" sign pain, Pain, aching, or sharp anterior hip/groin or lateral hip region, Pain with walking, pivoting and recreational exercise, Mechanical symptoms such as popping, locking, or snapping of hip, Loss of certain ranges of motion, Pain with squatting often accompanies, Patients will hold hip in resting position.

FAI

Functional assessment cluster for FAI:

Squat vs low squat SLS/LSD Bridge + SLR Hopping (DL, SL)

For FAI would FADIR or FABER rule in?

FADIR

What might you expect with MMT of a patient with FAI?

Hip flexor weakness Gluteal muscle fatigue

What is the goal of Warwick's Agreement?

To reach an international and multidisciplinary agreement on the diagnosis and treatment of FAI syndrome.

What test is generally VERY provocative with FAI?

Scours (if high SINS, not a good idea)

Often FAI is accompanied by _________.

Labral tears

Gluteus medius weakness is associated with ____.

With a gluteus medius tear, what should be avoided INITIALLY? Why?

Hip abduction strengthening as it provokes tendinopathy.

What type of contraction will commonly tear the adductors?

Eccentric (slipping with foot planted)

How might a concentric strain of the adductors occur?

Forceful contraction in a fully elongated position

Two risk factors for an adductor tear:

* Imbalance between strength and flexibility * Imbalance between ABD and ADD strength

Two signs of an adductor strain:

Twinging or stabbing pain in groin, Pain with passive ABD (stretch on injured tissue)

Body position for an eccentric strain of the rectus femoris:

Hip extension Knee flexion

Mechanism for concentric rectus femoris strain:

Forceful or repetitive hip flexion

Two signs of a rectus femoris strain:

C/O local pain and tenderness in anterior thigh Pain with resisted knee extension and passive stretching

Mechanism for eccentric strain of the Iliopsoas

Forced hip extension (foot planted, pelvis hit from behind)

Mechanism for concentric strain of the Iliopsoas:

Forceful, repetitive hip flexion

5 treatment options for piriformis syndrome:

* Hip - joint mobilization * ROM, stretching * PRE * Neurodynamics * Single leg progression (SLS, step ups, carries, frontal plane hip abduction off step, lateral taps)

With the leg extended, the piriformis is mainly a hip _________. With the leg flexed, the piriformis is a hip ___________.

External rotator; abductor

Two recommended tests for discerning piriformis syndrome:

FAIR, Freiberg

What is the most commonly strained muscle(s) of the hip?

Hamstring

Special test for hamstring strains with a Sn of 1.0 and a Sp of 1.0.

Taking off the shoe

Which adductors are commonly involved in an adductor strain?

Adductor longus, Gracilis

Timeline for phase 1 of hamstring strain rehab

0-4 weeks

Two goals for phase 1 of hamstring strain rehab

Protection and healing Minimize swelling, edema and pain

4 areas to focus on during phase 1 of hamstring strain rehabilitation:

Isometrics Single limb stance IASTM AROM PRE (avoiding eccentrics)

What is the criteria to advance from phase 1 to phase 2 of hamstring strain rehabilitation?

Hip flexion >70 degrees with 90 degrees of knee flexion - pain free Walking program, progressing to walk - glide

Timeline for phase 2 of hamstring strain rehabilitation

5-8 weeks

What is the goal of phase 2 of hamstring strain rehabilitation

Normalization of gait, mobility

2 areas to focus on during phase 2 of hamstring strain rehabilitation

* Lumbopelvic static and dynamic stability * Initiation of bridging (isometric -> concentric)

4 criteria to advance from phase 2 hamstring strain rehabilitation to phase 3

Normalization of gait, <20% different involved to uninvolved - hamstring mobility, >50% isometric hamstring strength - involved to uninvolved Tolerance to conservative jog/run (fwd/bwd)

Timeline for phase 3 of hamstring strain rehabilitation

8-12 weeks

What is the goal of phase 3 of hamstring strain rehabilitation?

Eccentric tolerance, sport specific training

If there's no MOI, piriformis strain is LIKELY/UNLIKELY.

Unlikely. Likely something else. Usually traumatic event associated with piriformis strain.

2 areas to focus on during phase 3 hamstring strain rehabilitation

Isolated hamstring strengthening, Sport-specific drills

What is the timeline for phase 3 of hamstring strain rehabilitation?

8-12 weeks

What is the goal of phase 3 of hamstring strain rehabilitation?

Eccentric tolerance and sport specific training

What are the two areas to focus on during phase 3 hamstring strain rehabilitation?

* Isolated hamstring strengthening in lengthened state (eccentrics) * Trunk stability - dynamic

What are the criteria to advance from phase 3 hamstring strain rehabilitation?

No insecurity with H test, no palpable tenderness, 5/5 MMT at 15 degrees knee flexion, active knee extension <10 degrees with hip at 90 degrees, <10% difference - hopping, S/L bridge...

What is the timeline of phase 4 hamstring strain rehabilitation?

4-6 months

What is the goal of phase 4 hamstring strain rehabilitation?

Return to sport and prevention!

What are the four areas to focus on during phase 4 of hamstring strain rehabilitation?

Jumping and landing tasks, running, sprinting, agility

What are the three criteria to advance phase 4 of hamstring strain rehabilitation?

Advancement is return to play, complete all activities without S/Sx without hesitation, H-test!

When returning to sport, what is the timeline for the highest risk of reinjury?

First 2 weeks

What are the four modifiable risk factors for soft tissue strains?

Muscle weakness Fatigue Lack of flexibility Poor coordination

What are two immediate interventions for contractile problems (12-18 hours)?

Minimize bleeding (RICE or PRICE) and compression as able

What are five interventions after 24 hours of a contractile problem?

Anti-inflammatory modalities Heat/ice Massage Stretching Modifying activities

Once you have full, pain-free PROM after a contractile problem, what are three interventions to use?

Sub-maximal isometrics -> progress to resistive exercises Progress to full isometrics Work towards sport/work specific tasks

What are three common areas for tendinopathy?

Proximal hamstrings Rectus femoris Adductors

Reactive tendinopathy results from?

Acute overload

How does a reactive tendinopathy present and in what demographic is it common?

Swollen, may be painful to the touch. Common in younger patients.

Tendon disrepair results from?

Matrix breakdown

What is the presentation of tendon disrepair?

Tendons may appear thick. Stiffness predominates.

Degenerative tendinopathy results from?

Cell death and matrix disorganization

How does a degenerative tendinopathy present?

Focal nodular areas, general thickening, repeated bouts of tendon pain

What are two types of intervention for tendinopathy?

Eccentrics and heavy slow resistance

What are three things tendons do?

Energy storage/release Compression Friction

Energy storage occurs at this part of the tendon:

Mid-tendon

Compression occurs at which part of the tendon?

Insertion

Friction occurs at what part of the tendon?

Peritendon

For tendinopathy, should volume or intensity be prioritized?

Volume

True or False: Stretching is an important part of tendinopathy intervention.

False! Should be avoided

What are the descriptive stages for tendinopathy rehab plan?

Load, move, bounce, hop and bound

How does bursitis present?

Pain with passive movement

When considering Iliopectineal bursitis, what are two differential diagnoses to consider?

* OA (Pain with PROM and AROM) * Iliopsoas tear (pain with resisted hip flexion)

What is the 2nd most common cause of lateral hip pain?

Trochanteric bursa (GTPS)

What is the general idea with bursitis intervention?

Non-mechanical interventions: Rest, ice, NSAIDs, anti-inflammatory modalities, injection, gentle stretching, strengthening of weak muscles

Identify the borders of the femoral triangle.

Inguinal ligament Sartorius Adductor longus

What are three tests when a proximal femur fracture is suspected?

Heel strike test Fulcrum test Patellar pubic percussion

What are two signs/symptoms of loose bodies in the LE?

Sudden onset of pain with weight bearing, decreased ROM

What are two management strategies for loose bodies?

Manipulation and surgical excision

AVN of the femoral head is more common in which gender?

Male

The hip most often dislocates in which direction?

Posteriorly

What is the most common cause of meralgia paresthetica?

Entrapment at the level of the inguinal ligament.

What nerve is affected in meralgia paresthetica?

Lateral femoral cutaneous nerve

Meralgia paresthetica is exacerbated by what movement?

Hip extension

What is the PT management of meralgia paresthetica?

TENS and exercise (aerobic, flexibility, strength)

True or False: Weight loss may help treat meralgia paresthetica.

True

What are three treatment options for meralgia paresthetica?

Conservative, nerve block, surgery

What are the two types of leg length discrepancy?

True discrepancy and functional (apparent) discrepancy

Hip Flashcards

(150 cards)