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Flashcards in Hip Injuries Deck (35)
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1

Hip Flexor Strain

Presentation:
- C/O "deep groin pain"
- Pain radiate to the anterior hip or thigh
- A "limp" may occur
- Pain on deep palpation of femoral triangle, lateral to the femoral nerve and inferior to the inguinal ligament.
- It will be medial to the sartorius muscle

Provocative Maneuvers
- Extension of the hip (active or passive? Cyriax Diff Dx Findings)
- If a supine patient raises heels off the table to 15 degrees.

Differential Diagnosis
- Iliopsoas Bursa, between psoas muscle and femoral head.
- "Snapping HIp Syndrome"
- Osteitis Pubis

2

Contusion

A muscle contusion indicates a direct, blunt, compressive force to a muscle.

This results in tissue and cellular damage and bleeding deep within the muscle and between the muscle planes.

The resultant tissue necrosis and hematoma lead to inflammation.

Contusions are a very common injury in sport.

3

Contusion Management

RICE and Stretch

Initially avoid the use of any form of heat (superficial or deep heating forms) and massage.

4

Myositis Ossificans

Aberrant reparative process that causes benign heteroptopic (ie extraskeletal) ossification in soft tissue.

Two Types:
Myositis Ossificans Circunscripta
Myositis ossificans Progressiva

5

Myositis Ossificans Management

Typically treated symptomatically
Surgical removal is rare.

6

Proximal Hamstring Strain

A hamstring strain can occur during an isolated athletic activity (acute) or result from persistant repetative stress (chronic)

Risk Factors:
Improper warm-up
Fatigue
Previous Injury
Strength imbalance
Poor Flexibility

7

Hip Adductor Strain

"Most common musculoskeletal cause of groin pain in sports"
High incidence in soccer.

Pathophysiology - The miscle is stretched or overloaded beyond normal range.

Common muscles involved - adductor longus, gracilis

8

Differential Diagnosis for Hip Adductor Strains

Sports Hernia
Osteitis Pubis
Femoral Neck Stress Fracture

9

Management for Adductor Strain

Assess biomechanical causes:
-Foot and lower leg malalignment
-Leg Length Discrepancy
-Gait Abnormality

Muscular Imbalances

Management: Chronic
Stretching program
Low intensity isotonic exercise
Consider active training exercise program

10

"Snapping Hip"

The snapping sensation results from the movement of a muscle or tendon over a bony structure.

In the hip, the most common site is at the lateral side where the illiotibial band passes over the greater trocanter.

Eventually this could lead to Trochanteric Bursitis

Another tendon that could cause a snapping hip is the tendon of the iliopsoas.

11

Hip Pointer

An injury to the iliac crest caused by a direct blow, often seen in contact sports such as football.

When someone sustains a hip pointer injury, the bone and overlying muscle can be bruised.

IN more serious cases of hip pointers, the hit can be so severe that a fracture of the bone results.

12

Trochanteric Bursitis

Possible Causes:
Repetitive stress (Overuse) Injuries.
Multiple minor traumatic injuries.
Leg-length inequalities.
Excessive or prolonged pressure on the hip such as from standing too long.
An acute traumatic incident such as a fall.

Signs and Symptoms:
Aching pain is usually focused on the outside of the upper thigh, just over the point of the hip.
Pain may radiate down the outside of the thigh as far as the knee.

13

Iliopsoas Bursitis

Inflammation of the bursa that separates the Iliopsoas muscle from the underlying articular capsule of the hip.

Typically the result of "overuse"

14

Ischial Bursitis

Inflammation of the bursa that separates the gluteus maximus muscle of the buttocks from the underlying bony prominence of the bone that we sit on, the ischial tuberosity.

15

Sciatic Nerve Involvement

Sciatica - pain along the large sciatic nerve that runs from the lower back down the back of each leg.

Sciatica is usually caused by pressure on the sciatic nerve:
-Degenerative Disc Disease
-Herniated Disc
-Lumbar Spinal Stenosis
-Spondylolisthesis

16

Sciatica Presentation

Pain in the rear or leg that is worse when sitting.
Weakness, numbness or difficulty moving the leg or foot
"Radiculopathy"
-Burning or tingling down the leg
-A shooting pain that makes it difficult to stand up.

In severe cases, bladder/bowl incontinence (cauda quina syndrome)

17

Piriformis Syndrome

A neuromuscluar disorder that occurs when the piriformis muscle compresses or irritates the sciatic nerve.

Compression of the sciatic nerve causes pain-frequently described as tingling or numbness-in the buttocks and along the nerve, often down to the leg.

The pain may worsen as a result of sitting for a long period of time, climbing stairs, walking, or running.

18

Piriformis Syndrome Treatment

Generally, treatment for the disorder begins with stretching exercises and massage.

Activity Modification
-Cessation of running, bicycling or similar activities may be advised.

19

Hip Labral Tear

Can be causes by repetitive motions (running or pivoting) or can have a traumatic cause (Hip Dislocation)

Signs and Symptoms
-Catching or locking
-Limited ROM
-Symptoms radiating into the groin.

20

Femoral Neck Fracture

90% of hospitalizations for hip fractures are for people older than the age of 65.
More common in females than males.

21

Femoral Neck Fracture Presentation

Severe pain in your hip or groin.
Inability to put wieght on your injured leg.
Shorter leg on the side of your injured hip
May present with external rotation and slight abduction of the side of the injured hip.

22

Femoral Neck Fracture Acute Management

Immediate immobilization - traction splint in the position found.
Transport to the hospital - typically treated with ORIF (Open reduction, internal fixation).

23

Femoral Neck Stress Fracture

Symptoms: Groin pain or anterior thigh pain
- provoked by activity (weight bearing)
- relieved with rest

Signs
- Antalgic gait (trendelenburg gait)
- Pain on internal hip rotation

Radiology
- X-ray changes lag symptoms by 2-4 weeks
- MRI preferred over nuclear bone scan
(High test sensitivity)
(High test specificity)

24

Osteitis Pubis

Common cause of chronic groin pain in athletes

Causes:
Pregnancy
Vigorous weight bearing activity

25

Osteitis Pubis Pathophysiology

An inflammation of the pubic symphysis and surrounding muscle insertions.

Pregnancy
- Expanding pressure from growing fetus

Sports-related repetitive stress injuries
- shearing forces on pubic symphysis
- long distance running
- soccer

Traction on pelvic musculature

26

Osteitis Pubis Predisposing factors in sports

Limited internal hip rotation
Sacroiliac joint fixation
Lower limb biomechanical abnormalities
Leg length Discrepancy
Over-Pronation
Genu Varum
Genu Valgum

27

Osteitis Pubis Signs and Symptoms

Tenderness to palpation of pubic symphysis

Provocative maneuvers
-Active adduction (distal symphysis involvment)
- Sit-ups (proximal symphysis involvement)

Pain localized over the symphysis and radiating outward

Adductor pain or lower abdominal pain that then localizes to the pubic area (often unilaterally)

Pain exacerbated by activities such as running, pivoting on 1 leg, kicking, or pushing off to change direction, as well as by lying on the side

Pain occurring with walking, climbing stairs, coughing, or sneezing

A sensation of clicking or popping upon rising from a seated position, turning over in bed, or walking on uneven ground

Weakness and difficulty ambulating

Fever, chills, or rigors along with pubic pain (osteomyelitis must be ruled out)

28

Hip Dislocation

Typical MOI involves a violent traumatic force such as a motor vehicle accident or a fall from a height.

In nine out of ten hip dislocations, the head of the femur is pushed out and back.

29

Hip Dislocation Presentation and Treament

A hip dislocation is very painful; the patient is unable to move the leg and if there is nerve damage may not have any feeling in the foot or ankle area.

Hip is characteristically flexed and internally rotated

A hip dislocation is an orthopedic emergency. Call for help immediately and do not try to move the injured person.

30

Ligamentus Teres Femoris

Also called "ligament of the head of the femur".

Its wide end is attached to he margins of the acetabular notch and to the transerve acetabular ligament, and its narrow end is attached to the fovea or pit in the femur.

Usually it contains a small artery to the head of the femur, which is a branch of the obturator artery.