Hip Pathology

Question 1

Piriformis Syndrome: population & risk factors

Answer 1

F > M
Prolonged sitting.
Sciatic N variant.
Lumbar/SIJ patho.

Question 2

Piriformis Syndrome: MOI

Answer 2

Trauma to gluteal region.
Post-surgical injury.
Overuse.

Question 3

Piriformis Syndrome: objective exam

Answer 3

Normal DTRs.
(+) FAIR
Piriformis TTP
Weak hip ABD & ext

Question 4

Piriformis Syndrome: subjective exam

Answer 4

Gluteal pain (can refer to hip, thigh, lower leg).
Paresthesia along sciatic N.
Difficulty walking.
Aggs = prolonged sitting, squatting, stairs.

Question 5

Piriformis Syndrome: old theory

Answer 5

Caused by shortened/tight piriformis

Question 6

Piriformis Syndrome: new theory

Answer 6

Caused by lengthened piriformis; due to compensation for weak glutes. But piriformis much smaller than glutes, so it gets STRESSED

Question 7

Piriformis Syndrome: how can we test for weak glutes/ piriformis compensation?

Answer 7

Squat or stairs. If knee goes into valgus, piriformis prob trying too hard

Question 8

GTPS is a broad pathology, describing…

Answer 8

Lateral hip pain & tenderness near the greater trochanter

Question 9

GTPS: MOI

Answer 9

Repeated microtrauma to glut tdn insertion on GT.
Repeated hip flex/ext = friction of ITB over GT.

Question 10

GTPS: population/risk factors

Answer 10

Ipsi ITB pain
Knee OA
Obesity
40-60yo
F > M

Question 11

GTPS: subjective

Answer 11

Pain in lateral hip/buttock with lying on painful side, prolonged standing/sitting, STS, cross leg sitting, stairs, running & high impact activity.
Flexion causes tension on ITB.

Question 12

GTPS: objective

Answer 12

TTP near greater trochanter
Pain with: passive hip adduction, resisted ABD, resisted IR.
SL stance: cannot hold for 30s without ↑ pain and/or Trend.
(+) FABER - stretches glut med/min tdns
(+) External Derotation

Question 13

GTPS: non-PT treatment

Answer 13

NSAID, rest, ice, weight loss, cortico inject, platelet rich plasma, shock wave therapy.
Surgery: glut tdn repair, ITB release, bursectomy

Question 14

GTPS: pt education

Answer 14

Avoid running on cambered surfaces (beaches).
Avoid extreme hip adduction positions (cross-leg sitting).
Sleep on non-painful side.
Avoid stretching piriformis, ITB, adductors.
Avoid hanging on 1 hip in standing.

Question 15

GTPS: PT treatment Phase 1

Answer 15

Activity modification, pain management.
Prolonged isometrics (helps pain).

Question 16

GTPS: PT treatment Phase 2

Answer 16

Heavy, slow resistance exercise.
Prolonged isometrics.

Question 17

GTPS: PT treatment Phase 3

Answer 17

Sports-specific movements

Question 18

GTPS: PT treatment Phase 4

Answer 18

Return to sport

Question 19

Athletic Pubalgia: population/risks

Answer 19

Young athletes
M > F
70% soccer
Muscle imbalance

Question 20

Athletic Pubalgia: often affects what muscles?

Answer 20

Rectus abdominis
Adductor longus
Psoas

Question 21

Athletic Pubalgia: pathophysiology

Answer 21

Powerful muscles pull & stress bone.
Muscle imbalance alters ability to transmit load, leading to pelvic instability & damage to tdn/musc/bone.

Question 22

Athletic Pubalgia: subjective

Answer 22

Pain in lower abdominal, groin, inguinal region
Aggs = Valsalva, kicking, cutting, sprinting, resisted situps

Question 23

Athletic Pubalgia: MOI

Answer 23

Insidious onset. Twist, kick, turn, direction change

Question 24

Athletic Pubalgia: objective

Answer 24

ROM: decreased hip ABD, IR, ER.
Weak/painful hip adduction.
TTP: pubic tubercle, superior pubic ramus, pubic symph, lower abs, hip adductors.

Question 25

Athletic Pubalgia: interventions

Answer 25

Pain control ROM, strength (goal is adductor:ABDuctor ratio >80%) Lumbopelvic stability Return to sport

Question 26

OA: 3 components

Answer 26

cartilage damage + narrow joint space + osteophytes.

Question 27

OA: gold standard for dx

Answer 27

xray

Question 28

OA: pt population/risks

Answer 28

>50-55yo Pediatric hip pathologies Limb length discrepancy

Question 29

OA: with limb length discrepancy, which side is usually more susceptible to OA?

Answer 29

longer, bc swinging gait = increased pressure on lateral rim of hip

Question 30

OA: subjective

Answer 30

Unilateral hip pain, deep/ache, stiffness, crepitus. Aggs = anything that shoves femoral head into acetabulum (squat, ascend stairs, active hip ext). Pain with disuse, vigorous use, or after period of rest.

Question 31

OA: objective

Answer 31

Decreased P/AROM: d/t local inflammation. Capsular patten: IR > flex > ABD > maybe ext (+) FABER, FADIR, Scour

Question 32

OA: CPR 1 (at least 4/5)

Answer 32

1. Agg = squat 2. Lateral hip pain w/ flexion 3. Lateral hip pain (or groin) with Scour Test adduction 4. Pain w/ extension 5. IR PROM < 25°

Question 33

OA: CPR 2a & 2b (must meet all 3 of either)

Answer 33

Option a: 1. Hip pain 2. IR AROM < 15° 3. Flexion AROM < 115° Option b: 1. Morning stiffness <60min 2. IR < 25° with pain 3. Age >50yr

Question 34

OA: interventions

Answer 34

Educate on pain management. Strengthen around the joint. Flexibility of antagonist.