The Hip Region

Question 1

In what sports is adductor tendinopathy common?

Answer 1

Sports with kicking & rapid direction changes e.g. soccer, AFL, hockey

Question 2

What is the acute mechanism of injury for labral tears?

Answer 2

• Twisting injury, fall or pedestrian accident

- Acute onset groin pain, through to LS pain

Question 3

What is the chronic degenerative mechanism of injury for labral tears?

Answer 3

Traction pulls the labrum off the acetabulum over a long period

Question 4

What is the treatment for labral tears?

Answer 4

• Arthroscopic debridement

- Repair of bone fragments

Question 5

What are labral tears a precursor to?

Answer 5

OA

Question 6

What are the two types of femoroacetabular impingement (FAI)?

Answer 6

• Cam impingement

- Pincer impingement

Question 7

What are the characteristics of cam impingement?

Answer 7

• Malshaped femoral head
• Abnormal motion
• Labral tears & articular degeneration

Question 8

What are the characteristics of pincer impingement?

Answer 8

• Acetabulum malshaped or femoral head laxity

- Capsulolabral pinching = inflammation = degeneration

Question 9

What are some of the less common medical causes of hip/groin pain?

Answer 9

• Appendicitis
• Urinary tract abnormality
• Prostatitis
• Gynaecological abnormality
• Rheumatological disorders e.g. ankylosing spondylitis
• Tumours e.g. testicular

Question 10

What area of pain indicates either glut med tendinopathy of greater trochanteric pain syndrome (GTPS)?

Answer 10

Over greater trochanter, sacrum, posterior & lateral thigh

Question 11

What may glut med tendinopathy or GTPS be confused with?

Answer 11

Trochanteric bursitis

Question 12

What are aggravating factors of glut med tendinopathy?

Answer 12

• Sleeping on affected side
• Descending stairs
• Sitting for long periods esp with crossed legs

Question 13

What objective sign is associated with glut med tendinopathy?

Answer 13

Positive Trendelenburg sign/gait

Question 14

What is the treatment for glut med tendinopathy?

Answer 14

Strengthening

• Abduction supine & standing
• Bridging exercises
• TA exercises
• Static quads

Stretching
- Iliopsoas to improve hip extension

Gait retraining

Question 15

What is osteitis pubis?

Answer 15

Inflammation of the pubic bones

Question 16

What are the XR features of osteitis pubis?

Answer 16

• Subchondral erosion (bone thinning out)

- Pub symphysis joint sclerosis

Question 17

What type of XR view should be used for osteitis pubis?

Answer 17

Flamingo (standing on one leg)

Question 18

What people commonly get osteitis pubis?

Answer 18

• Soccer players
• Runners
• Post-pregnancy
• Post pelvic operations

Question 19

What are the signs and symptoms of osteitis pubis?

Answer 19

• Localised pubic pain
• Tenderness
• Muscle spasm
• Limp
• Muscle stretching increases pain

Question 20

What is the hypothesised relationship between TA & groin pain?

Answer 20

• TA contracts in a feed-forward manner to prevent movement of the pelvic ring
• Slow contraction in the presence of groin pain can result in movement of the pelvis

Question 21

What are the implications of the relationship between TA & groin pain?

Answer 21

Part of treatment needs to include retraining/restoring neuromotor control to TA to improve stabilisation of the pelvic ring

Question 22

What are the NTBM conditions of the hip/groin area?

Answer 22

• Slipped capital femoral epiphysis (SCFE)
• Legg-calve-perthes disease
• AVN
• Stress fracture (NOF, inferior pubic ramus)

Question 23

What is SCFE?

Answer 23

• Posteromedial & inferior slipping of the proximal femoral epiphysis
• Secondary loss of HF, ER, Abduction

Question 24

What population is affected by SCFE?

Answer 24

• Males > females (2:1)
• 10-17 years
• 75% are obese
• 25% are bilateral

Question 25

What are the clinical features of SCFE?

Answer 25

- Pain (hip, thigh, knee) - Muscle spasm - Limp - Decrease in HF, abd, IR/ER

Question 26

What should you always check when a child presents with knee pain?

Answer 26

Always check the hip

Question 27

What is Legg-Calve-Perthes disease?

Answer 27

- Temporary avascular necrosis of femoral head occurring spontaneously in childhood - Results in collapsing of femoral head if not treated/unloaded

Question 28

What population is affected by Perthes?

Answer 28

- Males > females (4:1) | - 2-13 years

Question 29

What is the likely aetiology of Perthes?

Answer 29

- Artery of ligamentum trees closes in childhood - Femoral neck artery takes over blood supply - May happen if femoral neck artery is delayed

Question 30

What are the clinical features of Perthes?

Answer 30

- Groin pain, radiating to knee - Painful limp - Pain limiting hip ROM - Muscle spasm - Later, hip stiffness - Depends on severity

Question 31

What is the treatment for Perthes?

Answer 31

- Stabilisation of joint for healing (crutches, traction in bed, cast, abduction brace) - Surgery - Manage pain, inflammation - ROM: Gait retraining, physio, aquatics, exercises (abduction, rotation)

Question 32

What stress fractures are associated with hip/groin pain?

Answer 32

- Ischial tuberosity - Pubic rami - Neck of femur - Shaft of femur - Sacral body

Question 33

What are the two mechanisms of NOF stress fractures?

Answer 33

- Tension: Superior surface, emergency due to full fracture risk - Compression: Inferior surface

Question 34

What are the treatments for NOF stress fractures?

Answer 34

- Tension: Surgery or strict bed rest | Compression: NWB, then increase