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Sports and Exercise Medicine iBSc > Hip and Groin > Flashcards

Hip and Groin Flashcards

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1
Q

Football

A

Prevalence 12-16%

Account for 11-16% of all FB injuries

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2
Q

hockey

A

20 GI/100 players/year
Increasing rate of 1.32/100 players/year
3rd most common injury
8% of all injuries

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3
Q

Australian football

A

GI incidence failed to decrease since 2002
Prevalence 2nd highest after H/S
Highest recurrence rate

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4
Q

Rugby

A

3.29/1000 player hours (training)
0.1/1000 player hours (match)
101/25 absence days (training/match)
Ranked 4th most severe injuries
23% risk of sustaining GI in RB

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5
Q

history

A

Gilmore’s groin
Hockey’s groin
Sportsman’s hernia
Adductor-related groin pain

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6
Q

Hip joint anatomy

A

V stable and robust
Subject to high loads through many movements
Joint supported by v powerful muscles
Functionally, muscles act like slings- abdominal muscles connected to adductor muscles

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7
Q

Contributor factors- Load

A

Complex loading through pelvis/groin region
Sudden dynamic changes of load in sports specific movements
Lack of functional training for changing load

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8
Q

Contributing factors- other

A

Age
Lack of adequate training- less training hours in pre-season is a RF
Other injuries
Lack of proper conditioning
Hamstring + adductor muscles injuries seem to be well correlated

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9
Q

Hip anatomy recab

A

Multiple muscle attachments

Potentially natural deficits in abdo wall e.g. hernias

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10
Q

Hip biomechanics

A

Important biomechanical associations
Spine, pelvis, hip etc all meet at pubic symphysis
Central –> lateral loading distribution
Muscle (im)balance

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11
Q

Groin triangle- Superiorly

A

Pubic Symphysis
Abdo Wall
Hernias

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12
Q

Groin triangle- Medial

A

Adductor muscles

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13
Q

Groin triangle- Within

A

Iliopsoas
Rectus Femoris
Nerves

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14
Q

Groin triangle- Lateral

A

Femoral acetabular joint
Tensor fascia lata
Hip joint

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15
Q

Pubic tubercle- adductor tendon enthesopathy

A

Insidious onset, warms up with onset
Guarding on passive abduction, weakness
Pubic clock 6-8

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16
Q

Pubic tubercle- rectus abdominis enthesopathy

A

Well localised to insertion, acute or insidious onset
Pain from resisted sit up
Pubic clock 12

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17
Q

Pubic tubercle- pubic bone stress injury

A

Non-specific diminished athletic performance, loss of propulsive power
Bone tenderness predominates
Diagnosis of exclusion

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18
Q

Medial to triangle- Adductor/gracilis enthesopathy

A 
Insidious onset
Diminished performance
Warms up
Proximal adductor pain, at enthesis
Guarding, weakness
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19
Q

Medial to triangle- Adductor longus pathology at musculotendinous junction

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A

Acute onset, worse during exercise
Pain in proximal adductor
(2-4cm distal to enthesis), guarding, weakness

20
Q

Medial to triangle- Pubic bone stress injury

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A

Pain primarily at pubis radiating to proximal thigh
Bone tenderness
Lack of point muscular tenderness

21
Q

Superior to base- rectus abdominis tendinopathy

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A

Well localised to insertion, acute or insidious onset
Pain from resisted sit-up
Pubic clock 12

22
Q

Lateral to triangle- Impingement/labral pathology, femoro-acetabular joint

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A

Mechanical signs
Clicking in joint and/or catching
Impingement test

23
Q

Lateral to triangle- Osteoarthritis/chondral damage, femoro-acetabular joint

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A

History of traumatic/congenital insult
Older age group
Persistent lateral hip pain worse on lying on affected side
Limited ROM
Pain on weight bearing
Pain on transition between lying/standing

24
Q

Lateral to triangle- Iliotibial band friction syndrome

Study These Flashcards
A

External snapping and/or lateral knee pain
Re-create snapping
Ober’s test

25
Within- Iliopsoas syndrome
Pain above and below inguinal ligament- associated snapping at hip joint Thomas test, modified
26
Adductor related pathologies
Palpation + resisted adduction
27
Iliopsoas related pathologies
Palpation + resisted flexion OR extension stretch
28
Inguinal related pathologies
Palpation
29
Pubic related pthologies
Palpation
30
Hip related pathologies
``` Passive ROM (PROM) Flexion adduction internal rotation (FADIR) Flexion abduction external rotation (FABER) ```
31
Neural
Ilioinguinal nerve | Genitofemoral
32
True hernia
Cough sign
33
Pelvis sign
Warning signs of acute pathology Morning pain + stiffness Feeling of warmth and fullness Swelling
34
Acute hip
Majority of studies using 4-6 weeks Sharp, obvious pain in groin Big haemorrhage Instant loss of balance and performance
35
What injuries account for majority of acute groin injuries
Adductor injuries
36
What other injuries common for acute
Proximal rectus femoris and iliopsoas
37
More than --- injuries showed no imaging signs of acute injuries
1 in 5
38
Clinically diagnosed adductor injuries often confirmed on
Imaging
39
Iliopsoas + rectus femoris injuries showed
a different radiological injury location in more than 1/3 of cases
40
Acute - 0-48 hours
RICE Gentle stretching to P1 Active pain-free ex Phys mod (TENS, laser)
41
Acute- after 1st 48 hours
Gradually increase stretching Gradually increase strengthening (act abd/add, add/flex against resistance, stabilizing exs) Functional strengthening Sport-specific skills
42
Movement patterns
Groin/hip pain usually multi-structural, multi-planar and multi-directional A number of research without stringent inclusion/exclusion criteria found strong associations Still high incidence, still high recurrence, still no reliable treatment strategy
43
Treatment
* Active rehab with manual elements * Including mainly the adductor and abdominal muscle * Regardless of evidence, not all discovered elements are present in exercise programmes * Common: abdominal, adductor work * Missing: sport specific rehab, other muscle groups (adductors? Hip ROM?)
44
Prehab groin
Adductors + trunk flexors + glutes | Functional work
45
Hip pathologies
Labral tears | FAI (morphology, not pathology)
46
Hip pathologies- treatment
o Usual patient: M/F, active (loading activities) professional o Treatment: usually good and quick improvement (to the point) with intense gluteal exercises (off-loading) and temporary avoiding painful activities o Some further improvement (usually including increase of strength and stability) o Recovery either plateaus, or go back to square 1 with going back to sports o Loading management o Injection o Surgery

Sports and Exercise Medicine iBSc (13 decks)

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