Module 7-8

Question 1

Dx and Age

Congenital/developmental
Growth plate/vascular
Trauma/overuse/functional
Arthritis/fracture

Answer 1

Congenital/developmental → infants = DHD or dislocation – 0-4 y/o

Growth plate/vascular → children/adolescents = LCPD – 2-10 y/o, SCFE – 10-14 y/o

Trauma/overuse/functional → young adults & adults = Femoral neck stress fracture – 14-30s (and >65 y/o), “Snapping” hip – 20-30 y/o

Adult idiopathic AVN – 20-40 y/o = Arthritis/fracture → elderly OA – 30s – 60+ y/o

Question 2

Muscles of the hip

EX = (1)
FL = (1)
ABD = (3)
ADD = (3)

Answer 2

EX = GMax + hammies, gemelli, OI, ADDMag

FL = Iliopsoas + TFL, RecFem, Sartorius, ADD (but minimal)

ABD = GMed, GMin, TFL, piriformis - Dynamic pelvic stability, sports injuries like PFPS, ITBS

ADD = ADDMag, ADDLong, ADDBrev, pectineus
 Accessory role in stability

Question 3

Iliofemoral ligament

Pubofemoral ligament

Ischiofemoral ligament

Each resist what movement?

Answer 3

IFL = hyper EX (y-shape)

PFL = hyperABD

IschioFL = hyper EX and medial compressive forces

Question 4

Biomech of the hip - BW + active muscle contraction at the hip…

Stance phase of gait = __-__x BW

Running = __-__x BW

Stairs = __x BW

Answer 4

Stance phase of gait = 2.5-4x BW

Running = 4.5-5x BW (some sources say 8x)

Stairs = 6x BW

Question 5

Red flags for hip pain

Answer 5

 Rheumatologic conditions (AS, Reiter’s, RA, PA), infections, tumours, stress fractures, epiphyseal joint fractures. ioint pathology: AVN, LCP, SCFE, congenital DDH, AAA

Question 6

Based on MRI studies, >__% of hips display abnormalities; how many % have labral lesions?

Answer 6

70% and 70%

Question 7

What is hip-spine syndrome in older patients?

Answer 7

 In elderly patients, ‘hip-spine syndrome’ refers to coexisting degenerative changes in the hip and spine – DDx is often difficult

 Elderly (and other) patients with LBP often have limited hip mobility and ROM  surgical hip correction can positively influence the LBP

Question 8

T or F: LBP is a poor prognostic factor for patients with hip OA (but not knee OA)

Answer 8

T

Question 9

T or F: hip OA is over-diagnosed

Answer 9

F - it’s under Dx

Question 10

What is a hip “pointer”?

Answer 10

o Disabling contusion of the iliac crest
 Multiple muscles attach – Sart/IO/EO/LD/ES
o Onset: direct trauma / fall on hard surface
o Pain, bruising, muscle spasm
o DDx: avulsion (use MMT/palpation)
o Treatment: modalities, rest, ice, ROM, strengthening
o Prognosis: normally ~ 3 weeks

Question 11

Avulsion/apophyseal injuries?

MC in population/MOI

Answer 11

skeletally immature pt, ECC loading of muscle attachment

Question 12

Dislocation/subluxation (traumatic and atraumatic)

Which hip dislocation is MC in MVAs?

Answer 12

posterior Dx

this is considered a medical emergency

Question 13

Hip instability may present with what? What is it caused by?

Answer 13

 May present with: pain, psoas or ITB snapping, apprehension, or recurrent instability episodes without a defined (initial) injury

 Causes: repetitive microtrauma from axial loading and external rotation, generalized ligamentous laxity, or collagen disorders like Ehlers-Danlos

Question 14

Trochanteric bursitis/ GTPS

Clinical correlations with what? (4)

Answer 14

female, ITB tenderness, LBP, knee OA

 Chronic continuous or intermittent pain
 May radiate to the lateral hip or thigh
 Pain ↑ with activity, lying on the affected side
 Local palpation of GT area recreates pain
 Supine resisted hip ext rot & single-leg stance may be positive for tendinous or bursal involvement