Hip

Question 1

Validated Hip outcome measures (non OA)

Answer 1

HOS- hip outcome score
Ihot- international hip outcome tool (ihot33)
Copenhagen ( HAGOS)- hip and groin outcome score

Question 2

Hip outcome measure OA

Answer 2

WOMAC- Western Ontario and McMaster OA index
LEFS
Harris Hip Score

Question 3

Hip OA interventions

Answer 3

Anti inflammatories, corticosteroid injections, manual therapy (B), Therex ( stretching, PRE, endurance) (B)

Question 4

Hip OA CPR

Answer 4

1. Stiffness < 60 min
2. Age > 50
3. Hip IR < 15 degrees
   - limited hip IR and flex < 15 degrees vs contra
4. Pain with hip IR
5. ESR < 45

Question 5

Hip OA prognostic CPR

Answer 5

1. age < 58
2. 35.9 s or less on 40 m walk
3. pain > 6/10
4. Pain < 1 year
5. unilateral hip pain

Question 6

Inidications for hip scope

Answer 6

1. failed conservative tx > 4 weeks

2. show signs of intra-articular hip pathology

Question 7

Indications for labral repair

Answer 7

1. labrum partially detached from acetabulum
2. have intrasubstance tears
   - repair over resection performed to avoid significant disruption of joint mechanics
   - better outcomes with repair over resection

Question 8

Hip Scope ROM and WB

Answer 8

1. CPM 2-4 weeks postop 30-70 initially
2. full PROM by 2 weeks- AROM starts 2 at weeks
   - isometrics starting day 2
3. Usually FFWB with AC
4. Avoid excessive ER for 4 weeks due to stretching of anterior capsuloligamentous structures
   - avoid flexion/ABD to prevent inflammation
5. microfracture or osteoplasty PWB- Wolfs law

Question 9

Peds hip pain 5-8 year olds

Answer 9

transient synovitis

Question 10

Hip pain in adolescents (pre teens)

Answer 10

SCFE

• groin, ant thigh, ant knee pain
• limping
• (+) drehman sign (ER and Abd with hip flex)
• pain/ liminted ROM with hip IR

Question 11

Developmental hip dyspagia

Answer 11

infants

Question 12

Coxa Saltans (snapping hip) causes

Answer 12

Can be intra or extraarticular

Intraarticular
1. ilipsoas- over iliopectineal eminence

Extraarticular

1. ilipsoas
   - over femoral head
   - (pectin pubis)
2. ITB
   - over greater troch
3. Glute max
   - over greater troch (posterior hip)
4. Iliofemoral lig- over anterior femoral head
5. Hamstring- over ischial tub

Question 13

Femoral Triangle

Answer 13

Superior: inguinal ligament
Medially: adductor longus
Lateral: lat border of sartorius
Floor: Add longus, pectineus and iliopsoas

Question 14

orientation of acetabulum

Answer 14

ventrally, laterally, caually

Question 15

pubofemoral ligament

Answer 15

restrains ext, ER, ABD

Question 16

ischiofemoral ligament

Answer 16

2 bands

1. Pars superioris: restrics ext, ER, add
2. pars inferioris: restrics ext

Question 17

Flexion component movements

Answer 17

flex/abd/ir

Question 18

Ext component movement

Answer 18

ext/add/er

Question 19

Abd component movemnt

Answer 19

abd/ext/ER

Question 20

ADD component movement

Answer 20

ADD/flex/ER

Question 21

Peds hip pain 4-10 yo

Answer 21

transient synovitis, JRA, LCP

Question 22

Hip pain 15-25

Answer 22

Articular Osteochondritis dissecas

Question 23

Aching hip pain

Answer 23

bursitis, tendinopathy, arthritis or arthrosis

Question 24

Sharp pain

Answer 24

esp when combined with clicking/locking/instability= labrum; can also be loose bodies

Question 25

Groin pain with coughing sneezing or straining

Answer 25

Think hernia, sports hernia( tendinopathy of add longus or rectus abd), pubic symphyseal affliction, lumbar spine

Question 26

Posterolateral hip pain ddx

Answer 26

Trochanteric bursitis, piriformis syndrom, gluteal tendonitis, loosening from THR, referred pain from lumbar/SIJ

Question 27

Signs of a loose body (clinical triad)

Answer 27

1. sharp radiating pain 2. Non capsular loss of ROM with empty end feel 3. instability, feeling like LE will give out

Question 28

Hamstring syndrome triad sx (sciatic nerve entrapment)

Answer 28

1. pain with palpation to lateral ischial tub 2. pain with resisted knee flexion with hip at 90 and knee extended to the limit - no pain with resisted knee flexion in prone 3. pain with sitting

Question 29

hamstring tendonopathy

Answer 29

pain with resisted knee flexion in hip 90 or 0 flexion | no pain with sitting

Question 30

Trochanteric bursitis differential

Answer 30

1. pain with palpation 2. pain with FADER*, FADIR (less painful than tendonopathy) 3. no pain with SLR 4. pain with sitting

Question 31

Sports related groin pain

Answer 31

bilateral resisted hip ADD; accompanied by bone marrow edema

Question 32

Pelvic ring instability tx

Answer 32

1. strengthen transversus abd 2. strengthen pelvic floor muscles 3. wear SI belt (23 hrs/day --> less) Symptomatic with active SLR test - alleviated with compression to pelvis (SI compression)

Question 33

Sportsmans hernia, "hockey hernia", athletic pubalgia

Answer 33

- weaknening /stressing on the transversalis fascia, conjoined tendon and interal oblique fibers, creating an inside out hernia within the dorsal wall of the inguinal canal - pain at lower ab, inguinal or groin regions exacerbated with valsalva or exertion

Question 34

Tests for hip stress fx

Answer 34

- single leg hop - fulcrum test ( seated, hand weaved under involved side, over contra, and push down on involved side) - bone scan/MRI

Question 35

Neuralgia Parasthetica

Answer 35

- lateral femoral cutaenous nerve entrapment | - best with injection or surgical management

Question 36

Calcific tendonitis

Answer 36

occurs with persistent bursitis.

Question 37

Iliopsoas bursitis

Answer 37

- pain to anterior hip - pain with resisted hip flexion and passive hip ext Special tests 1. snapping hip- supine- hip flex/add/ER then return to neutral- assess for hip click 2. supine heel raise- resisted hip flex at 15 degrees

Question 38

Adductor strain imaging

Answer 38

ultrasound 84% sensitivity Gadolinium enhances MRI- not great

Question 39

Tx for sports hernia

Answer 39

aka gilmore groin - Rest 6-8 weeks - ADD stretching/strengthening can return to sports 10-12 weeks if painfree

Question 40

hamstring injury special tests

Answer 40

puranen orova- standing hamstring stretch bent knee test- slow extension of knee with hips and knees maximally flexed mod bent knee test- rapid ext of knee with hips and knees flexed taling off shoes sign- biceps femoris- flexed knee that goes to take off shoes being tested