HIP STI 2

Question 1

Symptoms of deep gluteal syndrome

Answer 1

Buttock pain +/- posterior thigh pain
+/- P+N’s or Numbness
Symptoms aggravated by prolonged sitting (worse on hard surface), sit to stand, lifting, flexing forward or walking, side-lying at night ( if in FAIR position
Pain w/ bowel movements

Question 2

when patient suffer from deep gluteal syndrome how is pain eased

Answer 2

with pillow between knees in SL

Question 3

Special tests for deep gluteal syndrome

Answer 3

FAIR (Flex/Add/IR) – practical class
Active Piriformis Stretch test -practical class
Seated Piriformis Stretch test-practical class
Beatty test
Freiberg sign

Question 4

how is seated piriformis stretch test conducted

Answer 4

patient seated in 90 degree hip flexion
examiner extends knee, move hip in adduction w/ IR
Palpate 1cm lateral to ischium and proximally at sciatic notch

Question 5

How is active piriformis test conducted

Answer 5

patient in supine , on side
patient pushes heel down, abducts w/ER against resistance
palpate at level of piriformis

Question 6

FAIR

Answer 6

Hip flexion/add/IR

compression of sciatic nerve

Question 7

FAIR test causes compression of what nerve

Answer 7

sciatic nerve

Question 8

Beatty test

Answer 8

lie on unaffected side, knee and hip flexed

Abduct thigh and examiner applies resistance

Question 9

2 types of cause of deep gluteal syndrome

Answer 9

non-discogenic

extrapelvic entrapment of sciatic nerve

Question 10

deep gluteal syndrome is also known as

Answer 10

piriformis syndrome

Question 11

aetiology of deep gluteal syndrome

Answer 11

Piriformis Syndrome-hypertrophy/ increased tone/protective spasm. Trauma e.g. fall onto buttock
Quadratus Femoris and Ischiofemoral impingement (IFI)– narrowing of ischiofemoral space
Hamstring problems: avulsion fracture, muscle strain, contusions over origin

Question 12

differential diagnosis of deep gluteal syndrome

Answer 12

Lumbar spine nerve root compression (radiculopathy)
Spinal stenosis 
Facet joint
Pelvic tumours
SIJ dysfunction

Question 13

how is deep gluteal syndrome differential diagnosis outruled

Answer 13

CT, MRI, EMG, Ultrasound

Question 14

management of deep gluteal syndrome depends on what

Answer 14

cause;
articular
myofascial

Question 15

management of deep gluteal syndrome

Answer 15

Soft tissue mobilisation
Trigger point release
Gentle sciatic nerve mobilisation ( to be covered in 2nd year)
Strengthen weakened muscles e.g. gluteals
Correct faulty movement patterns

Question 16

procedures may take place to treat deep gluteal syndrome

Answer 16

Injection of local anaesthetic or botulinum neurotoxin (Waseem et al, 2011)
Surgical Release /Decompression

Question 17

why should you be cautious when muscle stretchinig for deep gluteal syndrome

Answer 17

nerve sensitivity

Question 18

ischiofemoral impingement

Answer 18

Impingement of Quadratus Femoris muscle between lesser trochanter and ischium.

Question 19

aetiology of ischiofemoral impingement

Answer 19

Coxa Valgus
Prominent lesser tuberosity
Inter-trochanteric fracture
Post THR
Hip OA

Question 20

ischiofemoral impingement is the narrowing space of

Answer 20

femur and ischium

Question 21

ischiofemoral impingement means reduction in what movement

Answer 21

Hip;

Ext, Add, ER

Question 22

contributing factors of ischiofemoral impingement

Answer 22

leg Length discrepancy, Weak hip Abductors

Question 23

ischiofemoral impingement symptoms

Answer 23

Buttock pain lateral to ischium 
\+/- post thigh pain 
\+/- saddle pain
Can mimic Sciatic Nerve pain
Pain aggravated by single leg loading activities

Question 24

what to conduct for ischiofemoral impingement physical examination

Answer 24

long stride walking - +ive posterior pain made during extension, relieved w/ short strides
patient in SL - passive put patient in hip ext and add,

Question 25

management of ischiofemoral impingement

Answer 25

Address any leg length dysfunction Address any gluteal muscle weakness Correct faulty habitual posture: hip ext/Add/ER

Question 26

proximal hamstrings tendinopathy

Answer 26

Insertional tendinopathy at the ischial tuberosity

Question 27

typical patients who have proximal hamstrings tendinopathy

Answer 27

Common in distance runners, athletes involved in sagittal plane activities ( sprinting/hurdling) or change of direction activities ( football, hockey

Question 28

aetiology of proximal hamstrings tendinopathy

Answer 28

compression of the tendon during hip flexion/adduction

Question 29

intrinsic factors related to proximal hamstrings tendinopathy

Answer 29

age increased BMI Metabolic issues

Question 30

extrinsic factors related to proximal hamstrings tendinopathy

Answer 30

Training errors- increasing training load too quickly

Question 31

symptoms of proximal hamstrings tendinopathy

Answer 31

Deep localised pain in the region of the ischial tuberosity | worse in am, eases w/ activity worse afterwards

Question 32

proximal hamstrings tendinopathy aggravated by

Answer 32

running ( high speed or uphill), Deep hip flexion (lunging, deep squat), sitting on hard surface, Hams stretches ( eg Yoga down-dog)

Question 33

tests for proximal hamstrings tendinopathy

Answer 33

Pain with stretch’ (tensile load) tests Puranen-Ovrava test Bent- Knee Stretch test Modified Bent Knee Stretch Test

Question 34

how is puranen ovrava test conducted for what STI

Answer 34

hip flexed 90 knee extended foot supported for proximal hamstring tendinopathy

Question 35

Explain bent knee stretch test and for what STI

Answer 35

supine affected knee and hip max. flexed passively slowly stretch knee for proximal hamstring tendinopathy

Question 36

explain modified bent knee stretch test for what STI

Answer 36

supine legs extended grasp affected leg behind heel w/ 1 hand and knee w/ other max flex hip and knee and straighten knee proximal hamstring tendinopathy

Question 37

signs of proximal hamstring tendinopathy

Answer 37

``` Pain with contraction E.g. single leg bridge (A) Long-lever bridge (B) Arabesque (C ) pain on palpation at insertion ```

Question 38

management of proximal hamstring tendinopathy

Answer 38

Reduce tensile and compressive loads so rest from aggravating activities, consider cross- training AVOID HAMSTRING STRETCHING Start introducing loading activities when pain settles ( 0-3/10 during and for short period after exercise is acceptable) Phase 1: Isometric Hams e.g. bridge, single leg bridge, long-lever bridge Phase 2: Isotonic Hamstrings with minimal hip flexion Phase 3: Isotonic Hamstrings with increased Hip Flexion (70-90)

Question 39

lateral hip pain may be indicative of

Answer 39

greater trochanter pain syndrome

Question 40

greater trochanter pain syndrome

Answer 40

Chronic lateral hip pain commonly due to pathology in the tendons Gluteus medius/ minimus Tensor fascia lata

Question 41

what type of condition is greater trochanter pain syndrome

Answer 41

Degenerative condition

Question 42

signs of greater trochanter pain syndrome

Answer 42

pain location - lateral aspect of lower hip maybe below knee aggravated - sleeping on affected side, weight bearing(walking - single leg stance), stairs pain in resisted abduction pain in palpation of greater trochanter

Question 43

management of GTPS management

Answer 43

strengthening exercises and load management Load Management Avoid Compressive positions/activities (Hip in relative ADDUCTION) Progessive Loading through ADLs and exercise Strengthening of Glut Med/Min

Question 44

LEAP protocol to treat greater trochanter pain syndrome

Answer 44

``` low load - isometric hip abduction in supine, double leg bridge or squat progress to offset bridge single leg loading standing - bilateral abduction resisted abduction in standing ```

Question 45

patient is suffering pain the in the buttock Pins and Needles / numbness Feels worse when sitting for a long time, sitting to standing. What tests do you do?

Answer 45

``` Deep gluteal syndrome FAIR - Flex/Add/IR Active pififormis stretch test Seated piriformis stretch Beatty test Freiberg sign ```

Question 46

patient is suffering from buttock pain lateral to ischium +/- post thigh pain takes shorter stride as long strides causes pain in back of thigh what tests do you perform?

Answer 46

IFI test - side lying | extension and adduction

Question 47

deep localised pain in the region of the ischial tuberosity worse in am, running ( high speed or uphill), Deep hip flexion (lunging, deep squat)

Answer 47

Pain with stretch’ (tensile load) tests Puranen-Ovrava test Bent- Knee Stretch test Modified Bent Knee Stretch Test

Question 48

lateral hip pain aggravated - sleeping on affected side, weight bearing(walking - single leg stance) pain on palpation what tests will be conducted

Answer 48

FABER/Patrick test

Question 49

Patient with anterior groin pain also describe clicking, catching, locking, stiffness, restricted range of motion or giving way Pain aggravated by prolonged sitting, driving, climbing stairs, sport activities, Reduced strength and ROM of flexion and adduction what tests do you do?

Answer 49

FADDIR Scour/Quadrant Painful flexion and IR