Neuromuscular disorders of the hip joint and pelvis Flashcards Preview

Peripheral Musculoskeletal Science > Neuromuscular disorders of the hip joint and pelvis > Flashcards

Flashcards in Neuromuscular disorders of the hip joint and pelvis Deck (23):
1

Why is activity-related groin pain so common in some sports?

-complex anatomy
-high load
high velocity
-poor rehab of past injuries

2

What is so special about the adductor region?

the blending of muscle fibres - no single attachment point for each muscle

3

Why is the femur curved in the saggital plane?

it means that the adductors can function as extensors or flexors

4

Where is adductor longus at the highest risk of strain injury?

during transition from hip extension to hip flexion

5

What is the definition of a diagnosis?

pathoanatomical source of symtoms
-type of pathology
-where, what, when

6

What is the classification?

the 'why' of the disorder, and why it developed

7

According to the Doha agreement, what are the terminologies for groin pain?

-adductor-related
-iliopsoas-related
-pubic-related
-inguinal-related
They are all interconnected

8

Adductor-related groin pain

-adductor tendonopathy/enthesopathy
-adductor tenderness and pain on resisted adduction testing

9

Ilio-psoas related groin pain

-iliopsoas tendinopathy or bursitis
-pain on resisted hip flexion and/or pain on stretching hip flexors

10

Inguinal-related groin pain

-abdominal conjoined tendinopathy
-enthesis on inguinal ligament
-pain at inguinal canal region and tenderness of inguinal canal (but no palpable hernia)
-pain on cough, sneeze, valsalva

11

Pubic-related groin pain

-BSI (osteitis pubis), stress # pubic rami/body of pubis
-tenderness of pubic synthesis and immediately adjacent bone

12

Subjective examination features of inguinal-related groin pain

Symptom behaviour:
-uni/bi-lateral prox groin pain with running, kicking, change of direction
-cough/sneeze provocative
Activity
-loss of acceleration/speed
-loss of kick distance
PRO
-HAGOS
HPC
-insidious onset or acute event preceding persisting symptoms
-chronic + episodic
Loading history
-change of position
change/fluctuation in training/loading

13

Physical examination features of inguinal-related groin pain

Diagnostic tests
-pain on resisted trunk flexion/adductor resistance
-lower abdominal wall TOP
-Copenhagen 5 sec squeeze test
-rule out other MSK conditions FABER, FADIR, obturator nerve examination

14

Subjective examination features of pubic-related groin pain

Symptom behaviour
-uni/bi-lateral proximal groin pain with running, kicking, changing direction
-post activity/morning stiffness
Activity
-loss of acceleration/speed
-loss of kick distance
PRO
-HAGOS
HPC
-insidious onset or acute event preceding persisting symptoms
-chronic + episodic
-limited/no improvement with rest in ST
Loading history
-change of position
change/fluctuation in training/loading

15

Physical examination features of pubic-related groin pain

Diagnostic tests
-pain on resisted adductor resistance
-pubic bone TOP
-Copenhagen 5 sec squeeze test
-rule out other MSK conditions FABER, FADIR, obturator nerve examinatio

16

Subjective examination features of adductor-related groin pain

Symptom behaviour
-uni/bi-lateral prox groin pain with running, kicking, change of direction
-post activity/morning stiffness
Activity
-loss of acceleration/speed
-loss of distance with long kicks
-stiffness/tighness during/after activity
PRO
-HAGOS
HPC
- insidious onnset or may have acute event preceding persisting symptoms
Loading history
-change of position
-change in training

17

Physical examination features of adductor-related groin pain

Diagnostic
-pain on resisted adductor resistance
-adductor TOP
-Copenhagen 5 sec squeeze

18

Clinical features of hip joint arthropathy

Symptom behaviour
-pain with loading/WB
-stiffness/pain after rest
-hip joint stiffness.loss of mobility/mechanical symptoms
PROs
-HOS
-oxford hip score
-Harris hip score
-WOMAC
HPC
-insidious onsent
history of past hip trauma

19

Hip OA objective clinical features

Tests
-FADIR
-quadrant
-FABER
Observation
-hip in open-pack position
Hip ROM
-impingement signs at EROM
-equal loss of AROM and PROM
-ROM loss in capsular pattern

20

What are dynamic factors affecting the hip joint?

-abnormal stress and contact between femoral head and acetabular rim
-but motion stresses are normal
-mechanical stresses can result in reactive hip pain

21

What is FAI?

-abnormal contact between femoral head and acetabular leading to compression/impingement +/- tearing of acetabular labrum
-likely to occur during twisting or pivoting that require a relatively large hip ROM
-variation of bony morphology

22

What are the two principal forms of FAI?

-pincer: caused by excessive acetabular cover
-cam: caused by non-spherical head and resultant loss of femoral head-neck offset

23

What is the mechanism of a cam deformity development?

-reactive bone apposition at antero-superior aspect of head neck junction
-sports activity that alter shape of growth plate