- Deep buttock and lateral thigh pain
- MOI: overuse
- (-) sitting, walking up stairs
- ROM (-) AROM - hip flexion & RROM - Knee flexion
- +/- radicular symptoms into LE
- Management
Hamstring strain
Test: SLR, Bent knee stretch test
Education (grade, avoidance, proper warm-up) >
- 30’s peak age, F, athletes
- MOI: hip flexion (eps in External rotation)
- Intermittent groin pain (-) with activity, (+) rest
- Audible “clicking” or “catching”
- Radiating pain ant thigh to above the knee
- Prom - pain with hip ext, Arom pain with hip flex/LR
Iliopsoas strain
AKA: “Dancers Hip” or “Jumpers Hip”
Test:
Thomas test
Management:
Activity modification > rest > myofascial > stretch (antagonists) > strengthen (flexors)
- MOI: kicking, sprinting, change of direction
- Anterior hip pain
- A/Rrom - pain with hip flex + knee ext, Prom - hip ext
- Management?
Quadriceps strain
Test:
- Muscle testing
* hip flex = quads * hip flex + ER = iliopsoas
- PRICE > positioning (knee flex) > stretch > isometric > isotonic
- MOI: sudden change in direction (soccer)
- Groin pain
- pain with A/Rrom adduction + flexion
- ## pain with direct palpation of groin muscle
Adductor Strain
- Adductor Squeeze Test
- Passive Abduction
PRICE > PRROM > Isometric > isotonic
- Weak hip abductors
- Lateral knee pain
- LONG DISTANCE + DOWNHILL running aggravates
- Management?
ITB syndrome
Test: Nobel’s + Ober
- Rest > Modalities > glut med/min strengthening
- 15-40, F
- Extension -> flexion (Iliopsoas)
- IR -> ER (TFL, Glut max)
- +/- pain
- Weak abs and hamstrings
- Imaging?
- Management?
Snapping hip Syndrome
Dx Ultrasound
- Stretching + strengthening
- if painful, rule out labral tear
- F, unilateral hip pain
- Post/lateral thigh pain can radiate above the knee
- POINT TENDERNESS
- Pain sleeping on side
- RROM pain - abduction
Trochanteric bursitis
“GTPS”
Gluteal - Rrom Ext
Iliopsoas - Rrom Flex
- Sharp, localized groin pain
- Worse after a heavy meal or extended standing
- Lifting, coughing, bending aggravate
- Management?
Inguinal hernia
GP > surgery > post op core strengthening
- 30-40, M
- Pain lateral hip and radiates down to knee
- Overweight, Diabetic
- (-) walking, standing
- Management?
Meralgia Parasthetica
- Education (weight loss > loose clothing)
- Groin pain made worse with activity
- (-) hip adduction
- Childbirth, rugby/soccer, urological surgery
Osteitis Pubis
- F, < 1
- Asymmetric skin folds (uni flat buttock)
- Tight hip adductors
- Decreased AROM - Abduction
- Sleepless nights, avoiding walking/crawling
- Imaging?
Hip Dysplasia
Tets:
Ortalani - “in”, Abd + distraction
Barlow - “out”, Add + compression
Xray - putts triad
(shallow acetabulum, small femoral head, dislocation sup/lat)
- 20-30, F
- Pain, stiffness in the groin
- Swollen, red
- +/- pain with thigh extension
- Hint?
- Management?
Myositis Ossificans
Hint - post traumatic
- Imaging - xray (post 3 weeks)
- Management - rest > US, PFROM
- 40-50, M (6:1)
- Obese
- BILATERAL gradual onset of dull, achy groin pain
- May refer down into the knees
- +/- A & Prom restricted and painful. RROM wnl
- Imaging?
- Management?
Avascular Necrosis (AN)
Imaging
- MRI (GS)
- Xray (WNL early stages)
Ortho, manual = contraindicated until complete recovery and pain free
- LCP in children 3-12 (hip and knee pain)
- 3-12, M (4:1)
- Insidious onset hip, knee, or groin pain
- (-) leg movement
- Antalgic gate
- +/- pain felt in KNEES or UNAFFECTED HIP
- Flexion and adduction contractures
- Limited ABD + IR
Legg-Calve-Perthes
