Hip Illness Scripts

Question 1

Avulsion Fracture

Answer 1

• Adolescents
• Males more than females
• Athletes from sudden contractions of pelvic muscles
• Early: swelling, pain, limited mobility
• Later: instability, impaired mobility, nerve damage
• Pain with palpation
• Pain with passive stretch & contraction of involved muscle

Question 2

Avascular Necrosis Femoral Head

Answer 2

• Age 20-50
• Males more than females
• Risk factors: dislocation, Fx, cancer, heavy drinking, steroid abuse, obesity, smoking
• Early: usually asymptomatic
• Later: stiff, antalgic gait, pain in leg/buttock/groin/thigh
• Pain at hip joint
• Pain with motion or load bearing not palpation
• Pain with gait, WB, ROM limitations

Question 3

Myositis Ossificans (Heterotrophic Ossification)

Answer 3

• Young adult males (result from trauma)
• Often seen in paraplegics or athletes
• Early: painful, tender, enlarging mass, decreased ROM
• Later: persistent swelling, immature bone progresses into mature lamellar cortical & trabecular bone
• Pain at the pump or lump that forms
• Pain with palpation to soft tissue mass usually with no inflammation
• Pain when using affected muscle

Question 4

Femoral neck stress fracture

Answer 4

• Younger female athletes
• Often seen in female athletes or people with poor nutrition & lifestyle activities
• Early: local pain & edema, pain increases during activity, painful & limited hip/knee AROM/PROM, anterior groin pain
• Later: <50% width of femoral neck = no surgery w/WB restrictions
• Local pain/edema at femoral neck
• Point tenderness of femoral neck
• Antalgic gait, pain PROM/AROM hip/knee, worse w/activity, groin pain

Question 5

Osteoid Osteoma

Answer 5

• Children and young adults (5-25 y/o)
• Males affected more than females
• Former trauma/prostaglandins
• Early: worse over time, mild
• Later: severe dull sometimes sharp, most often at night
• Pain mostly in legs
• Pain with palpation
• Painful with activity and wakes from sleep

Question 6

Hip OA

Answer 6

• Older adults
• Females affected more than males
• Obesity, genetics, repetitive stress, mechanical overload, & high impact spots
• Early: limited ABD and rotation
• Later: flexion, extension, & ADD becomes more difficult
• Slowly progressive hip pain, or hip-related groin pain radiating into thigh, buttocks, Orr knee
• Point tenderness at the hip and pain/sensitivity over greater trochanter
• Painful activities include limited ROM in ABD and rotation early, with flexion, extension, & ADD becoming more difficult

Question 7

IT Band Syndrome

Answer 7

• 15-50 y/o
• Men and women affected equally
• Athletes performing repetitive activities, activities that require long periods of a certain position, sudden increases in activity
• Early: pain may go away after a warm up
• Later: pain may get worse as you exercise
• Pain at outer side of knee above the jiont
• Area may have warmth and redness on outside of knee, pain/tenderness on palpation to the lateral knee, superior to joint line
• Painful activities include walking, climbing/descending stairs, & cycling

Question 8

Glute Medius Tendinopathy

Answer 8

• 40-60 y/o
• Women affected more than men
• Usually gradual overtime due to increased loading & subsequent overloading of the tendon
• Early: tendon begins to change shape & become thicker to be able to handle the stresses being placed on it
• Later: eventually the tendon can begin to degenerate
• Pain at lateral hip & greater trochanter
• Localized pain that occasionally can travel down the leg into the thigh & may go as far as the knee
• Painful activities include contracting, palpating, or stretching the glute medius, stairs, standing on one leg, lying on affected side, prolonged activity such as walking or running

Question 9

Hip partial label tear

Answer 9

• Condition is not age related
• Affects men and women equally
• Direct trauma, sporting activities that require frequent ER or hyperextension, specific movements including torsional or twisting movements, hyper ABD, hyper extension, & hyper extension with lateral rotation
• Early: pain in anterior hip, groin with possible popping, clicking, catching, limitations in ROM
• Later: progression to increased ROM limitation, increased pain with less intense activity
• Groin pain or pain in the anterior side of the hip & less commonly buttock pain
• Painful activities include constant dull pain with periods of sharp pain that worsens during activity, walking, pivoting, prolonged sitting & impact activities aggravate Sx, sometimes night pain

Question 10

Iliopsoas Bursitis

Answer 10

• From young athletes to older people with arthritis
• Can be caused by arthritis, RA, psoriatic arthritis, acute trauma, post THA, overuse, often caused by multiple mini traumas caused by vigorous hip flexion & extension
• Early: pain with hip flexion & extension
• Later: weakened gluteal & hip muscles could cause hip instability in gait after time, potential worsening “snapping” feeling
• Pain at anteriomedial aspect of thigh, can radiate to knee, hip snapping, worse with activities/relieved with rest
• Pain in femoral triangle, medial or lateral femoral artery, pressurer on bursa
• Painful activities include hip flexion/extension, running up hill, pain with IR, pain with ADD & flexion

Question 11

Trochanteric Bursitis/greater trochanteric pain syndrome

Answer 11

• Middle aged women most common, young female athletes are also at increased risk
• Women affected more than men
• Overuse of surrounding muscles, repetitive ABD, younger athletic pts = repetitive motions, middle aged pts = Hx of direct compression from sustained immobilization or low energy trauma such as ground level falls
• Early: Pain is sharp & intense in the early phases
• Later: Pain becomes more of an ache & spreads across larger area of hip
• Pain at lateral aspect of hip that may radiate down thigh
• Pain at greater trochanter
• Painful activities include ascending stairs, lying down on affected side

Question 12

Femoral acetabular impingement

Answer 12

• Cam: younger teens to 20s; males > females; Pincer: middle age active females
• Young, athletic males, overactive individuals
• Early: may be no Sx associated with hip impingement or Sx may be mild or vague
• Later: Stiffness in thigh, hip or groin, inability to flex hip beyond right angle, pain in groin area particularly after hip has been flexed
• Pain with palpation in groin although sometimes may present more laterally toward outside of hip
• Painful activities include sitting