What is the CPG for DX of Hip OA?
- Adults >50
- Reports moderate pain in lateral or anterior hip with WB
- Morning stiffness < or = to 60 min.
- Pain with hip IR and hip IR less than 15 degrees
- Hip flexion less than 115 degrees
What are the CPR for Hip OA?
- squat is an aggravating factor
- AROM hip extension causes pain
- AROM Hip flexion causes lateral pain
- Scour test with addiction causes lateral hip/ groin pain
- PROM hip IR < 25 degrees
Name three self reported outcome measures that are considered to have strong evidence for activity limitations in patients with Hip OA.
- WOMAC
- LEFS
- Harris Hip Score
List four functional measures that are considered strong evidence for measuring functional deficits in Hip OA.
- 6 minute walk
- 30 second chair stand test
- timed up and go test
- stair measure
What are two types of FAI?
- CAM impingement
- increased femoral neck diameter
- Pincer impingement
- increased acetabular depth
What are characteristics of CAM impingement.
- Typical in men 20-30 years of age
- Shears at chondrolabral junction as it enters the acetabulum during hip flexion
- results in chondolabral seperation
What are characteristics of pincer impingement?
- Typical in women 30-40 years old
- overcoverage crushes the labrum against the normal femoral neck in flexion and IR.
- results in labral degeneration without chondral injury
- possible ossification of rim
What are the signs of FAI?
- C/O
- c sign
- anterior groin pain
- pain with sitting, standing, walking, and sports activities
- sharp pain with clicking
What are the symptoms of FAI?
- Muscle weakness(abd, flex and add)
- gait limitations
- joint mobility deficits
What special tests can you use to diagnose FAI?
- FABER
- FADIR
- resisted SLR
What is a sports hernia?
- Weakness of the posterior inguinal wall without a clinically palpable hernia.
What is the consensus meeting cluster to diagnose a sports hernia?
- Pinpoint tenderness over the pubic tubercle at conjoined tendon
- Palpable tenderness over the deep inguinal ring.
- Pain with no obvious hernia.
- Pain at the origin of the adductor log us tendon.
- Dull, diffuse pain in the groin.
Need 3/5
Manual therapy is considered to have ___________ evidence for treatment in hip OA
Strong
Patient education - teaching activity modification, supporting weight reduction and methods of off loading are considered to have ________ evidence according to CPG.
Moderate
According to CPG, functional gait and balance training, weight loss and an individual prescription for therex are considered to have _______ evidence
Weak
According to CPG, flexibility, strengthening and endurance exercises are considered to have ___________ evidence to support the use as an intervention in treating hip OA.
Strong
What treatments can you use to treat patients with FAI.
- Trigger point massage of RF, TFL, glute med
- Lumbar spine mobilizations - grade 3-4
- Hip capsule distraction( mulligan w/ movement)
- electroacupuncture at L2-5
- rehab exercises for strength,endurance and lumbopelvic stability
Is an MRI effective in diagnosing Hip OA?
- No
- SR for MRI- Sn 61%, Sp 82%; -LR .47, +LR 3.4
What is the CPG for diagnosing FAI?
- Sharp or aching pain in the anterior hip/groin and or lateral hip.
- Pain is aggravated by sitting.
- FABER +
- Hip IR<20 degrees with hip at 90
- Limitations with hip abd and flexion
- treatment with HVLA, low amp traction and rotational manip/mobs
What outcome measures show level 1 evidence for the hip?
- Hip outcome score
- HAGOS - young population
- International Hip outcome Tool(iHOT 33) MCID s/p arthroscopy 6 points
Characteristics of Hamstring syndrome- sciatic nerve entrapment
- Associated with active individuals; distance runners, sprinters, jumpers
- Pain with sitting, resisted knee flexion with hip flexed to 90
- pain free resisted knee knee flexion with hip extended
- do not perform HS stretching
- have them sit on dorsal wedge pillow
- gentle neural mobilizations
Hamstring tendinopathy
Microtraumatic loading of the tendinous junction
- (+) Pain with resisted knee flexion, hip flexed to 90
- (-) slump, SLR
- transverse friction massage, gentle hs stretching, gradual eccentric activation
Illiopsoas bursitis
- TTP along bursa
- anterior hip pain, worse with passive hip extension and resisted hip flexion
- May complain of snapping
Trochanteric bursistis
- treat with rest, NSAIDs, ice
- posterior taping to glut med
