Readings - Hip

Question 1

If a pt does not have painful clicking, what can we mostly rule out ?

Answer 1

Labral tear

Question 2

List 6 common causes of anterior hip pain

Answer 2

1. Labral tear
2. Chondropathy
3. OA
4. Synovitis
5. Groin related pain
6. Ligamentum Teres tear

Question 3

List 4 not to be missed causes of anterior hip pain

Answer 3

1. Avascular necrosis of femoral head
2. Synovial chondromatosis
3. Slipped capital femoral epiphysis
4. Perthes disease

Question 4

Most common cause of lateral hip pain

Answer 4

1. Glute med. tear or tendinopathy

Question 5

List 3 not to be missed causes of lateral hip pain

Answer 5

1. Tumour
2. Nerve root compression
3. NOF #

Question 6

What is a highly sensitive test for a labral tear ?

Answer 6

FADIR

Question 7

List two PROMs for hip pathology

Answer 7

1. Copenhagen hip and groin outcome score

2. Hip dysfunction and OA outcome score

Question 8

List two highly sensitive tests when testing OA

Answer 8

1. Passive internal rotation less than 25 degrees

2. Pain with active hip extension

Question 9

Pain and reduced range on a Thomas test can confidently indicate what?

Answer 9

Non-specific Intrarticular pathology and length of hip flexors

Question 10

What is the close-packed position of the hip joint ?

Answer 10

Extension, adduction and IR

Question 11

Femoral retro version might limit what movement ?

Answer 11

Internal rotation

Question 12

Acetabular retroversion may limit what movement

Answer 12

Internal rotation

Question 13

How might foot probation impact the hip?

Answer 13

Lead to internal tibial rotation, in turn leading to overload on the ITB. Increased ITB tension adds further compressive force on the greater trochanter, potentially cause tendinopathy or bursitis.
Internal tibial rotation may also lead to femoral internal rotation, adding further joint reaction force to the acetabular

Question 14

Define a CAM Femoral-acetabular impingement

Answer 14

• morphological abnormality on the head-neck junction of femur

Question 15

Define a Pincer Femoral-acetabular impingement

Answer 15

Morphological abnormality on the acetabulum

Question 16

What movements are problematic in Pincer FAI

Answer 16

Hip flexion

Question 17

What movements are problematic in CAM FAI

Answer 17

Hip flexion and internal rotation

Question 18

What should those with FAI be instructed to avoid ?

Answer 18

The position of impingement

Question 19

What is the position of impingement in FAI

Answer 19

Flexion, IR and adduction

Question 20

For sports, what activity modifications should be made for a pt with FAI

Answer 20

• reduce COD and getting low (extreme flexion) where possible
• positional change ?

Question 21

What two disorders of the hip can increase risk of Labral tear

Answer 21

1. Cam-type FAI

2. Developmental dysplasia of the hip

Question 22

Patients with labral tears are 40% more likely to have coexisting what?

Answer 22

Chondropathy

Question 23

How might a damaged labrum lead to hip chondropathy

Answer 23

1. Reduced chondral nutrition via synovial fluid

2. Reduced load bearing capacity in damaged labrum - force therefore transmitted to the bony surfaces

Question 24

What position and degree of movement in gait puts greater stress on the anterior soft tissue in the hip

Answer 24

Last 20-30% of stance phase, which consists of 5 degrees hip extension

Question 25

What gait retraining can be done for a labral pathology

Answer 25

- minimising hip extension at the end of stance phase

Question 26

Ligamentum Teres tears commonly occur with what injuries

Answer 26

1. FAI 2. Dysplasia 3. Synovitis

Question 27

Ligamentum Teres tear management is mostly managed similarly to labral pathology, with a particular emphasis on what two exercise principles ?

Answer 27

1. Regaining neuromotor control | 2. Proprioception at the hip

Question 28

What other pathologies increase chondropathy and ultimately OA of the hip ?

Answer 28

1. FAI 2. Decreased acetabular anteversion 3. Labral pathology 4. DDH

Question 29

What 3 pathologies are associated with hip instability ?

Answer 29

1. Cam-type FAI 2. Ligamentum Teres tears 3. Excessive anteversion

Question 30

What are the most provocative loading positions for someone with hip pathologies to be avoided ?

Answer 30

1. Rotational loads 2. Loading at EOR 3. Overload in the impingement position

Question 31

Should the glute max be retrained in intra-articular hip pathology and if so why? What position is best to begin retraining ?

Answer 31

- Yes - it provides hip stabilisation by resisting anterior hip forces - prone isometric external rotation against minimal resistance

Question 32

Thickening of the ITB and bursae is an adaptive response to what? And how does this affect

Answer 32

- repetitive compressive forces | - thickening leads to reduced tensile loading capacity

Question 33

What joint positions strongly influences lateral soft tissue compressive loading of the hip joint ?

Answer 33

Adduction

Question 34

Lateral hip pain with lack of tenderness palpated over the lateral hip would indicate what?

Answer 34

- other more remote conditions should be considered rather than lateral hip pain causing pathology

Question 35

In lateral hip pathology, what FABER result would you expect ?

Answer 35

- normal or minimally limited range but reproduction of lateral hip pain

Question 36

List 1 test with good sensitivity and specificity for detecting a gluteal tendinopathy in lateral hip pain

Answer 36

1. SLS and reproduction of pain over the GT within 30 seconds of standing

Question 37

What positional habits should be avoided in lateral hip pain

Answer 37

1. Sitting with knees crossed or together 2. Hip hanging whilst standing 3. Side lying

Question 38

In runners with lateral hip pain, what education should be given

Answer 38

- run on flat surface, mostly straight line running | - hill running avoided

Question 39

List one early hip exercise for lateral hip pain

Answer 39

1. Isometric hip abduction to minimise compression

Question 40

Use of Clams in lateral hip pain?

Answer 40

May be provocative and should be avoided

Question 41

What does the Ober’s test tell us ?

Answer 41

Assess tightness in the TFL and therefore tightness of the ITB

Question 42

Reducing step length should be considered for what to injuries ?

Answer 42

- tib ant tendinopathy | - GTPS