Musculoskeletal LQ Week 5 - Hip Pathologies

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Questions and Answers

In which sports is the incidence of hamstring strain per 1000 hours of exposure highest?

  • Non-contact sports
  • Track and field
  • Contact sports (correct)
  • Australian rules football

Which of the following is a modifiable risk factor for hamstring injuries?

  • Hamstring fascicle length (correct)
  • Anterior cruciate ligament injuries
  • Age
  • Calf strains

What is the common mechanism of injury for a hamstring strain?

  • Repetitive strain on the hamstring muscles.
  • A slow, gradual stretching of the hamstring muscles.
  • A sudden, forceful contraction of the hamstring muscles. (correct)
  • A direct blow to the posterior thigh.

What is a clinical finding associated with a hamstring strain?

<p>Pain with palpation to the posterior thigh or ischial region. (D)</p> Signup and view all the answers

Which of the following is a non-modifiable risk factor for hamstring injuries?

<p>Age (C)</p> Signup and view all the answers

What does the "Functional Assessment Scale for Acute Hamstring Injuries" measure?

<p>Functional ability and return to sport readiness. (D)</p> Signup and view all the answers

What is the typical treatment approach for a hamstring strain?

<p>Rest, ice, compression, and elevation (RICE) followed by rehabilitation. (C)</p> Signup and view all the answers

Which of the following is NOT a key clinical finding associated with iliopsoas strain?

<p>Pain with palpation to the posterior thigh or ischial region. (B)</p> Signup and view all the answers

Which of the following activities is likely to be painful for someone with an iliopsoas strain?

<p>Getting out of a car. (D)</p> Signup and view all the answers

What does the Minimal Detectable Change (MDC) represent in outcome measures?

<p>The minimum amount of change required to exceed measurement error (D)</p> Signup and view all the answers

Which self-report measure specifically targets functionalities related to everyday tasks?

<p>Lower Extremity Functional Scale (LEFS) (C)</p> Signup and view all the answers

What is the purpose of Minimal Clinically Important Difference (MCID)?

<p>To determine how much change patients find beneficial (D)</p> Signup and view all the answers

Which of the following is NOT a self-report measure specifically used for hip pathologies?

<p>Functional Independence Measure (FIM) (A)</p> Signup and view all the answers

Which statistical measure is primarily concerned with patient perceptions of improvement?

<p>Minimal Clinically Important Difference (MCID) (B)</p> Signup and view all the answers

What is one of the potential outcomes linked to increased Body Mass Index (BMI)?

<p>Higher likelihood of joint pain (D)</p> Signup and view all the answers

Which assessment tool is specifically used for measuring hip pain?

<p>WOMAC (B)</p> Signup and view all the answers

Which combination of assessment measures is recommended for evaluating a patient's condition?

<p>One pain measure and one body function scale (D)</p> Signup and view all the answers

What does a 'C-sign' indicate in clinical findings?

<p>Moderate anterior or lateral hip pain during weight-bearing activities (D)</p> Signup and view all the answers

What is a potential consequence of unhealthy eating habits in relation to BMI?

<p>Higher risk of osteoarthritis (D)</p> Signup and view all the answers

What is the primary mechanism behind an adductor strain?

<p>Overuse of one or more of the adductor muscles (D)</p> Signup and view all the answers

Which clinical finding is NOT associated with an adductor strain?

<p>Increased hip internal rotation (C)</p> Signup and view all the answers

What is a common treatment consideration for athletes with an adductor strain?

<p>Manual therapy as needed (C)</p> Signup and view all the answers

What is the primary cause of lateral hip pain in gluteal tendinopathy?

<p>Thickening and thinning of gluteus medius tendon (B)</p> Signup and view all the answers

Which population is most commonly affected by gluteal tendinopathy?

<p>Individuals over 40 years of age (B)</p> Signup and view all the answers

Which symptom is characteristic of metastatic bone pain?

<p>A deep unrelenting pain (D)</p> Signup and view all the answers

What is a characteristic symptom of a neck of femur fracture?

<p>Aggravated pain during weight bearing (D)</p> Signup and view all the answers

Which symptom might suggest hip joint pathology?

<p>Hip locking and clicking (B)</p> Signup and view all the answers

Which condition can present with pain in the groin, buttocks, anterior thigh, and/or lateral hip?

<p>Osteoarthritis (D)</p> Signup and view all the answers

What might unexplained weight loss indicate in the context of lateral hip pain?

<p>Possible metastatic bone disease (C)</p> Signup and view all the answers

What characterizes lumbar spine referral pain?

<p>Pain with a specific dermatomal distribution (A)</p> Signup and view all the answers

Which clinical finding is associated with hip osteoarthritis?

<p>Hip internal rotation range of motion less than 24 degrees (B)</p> Signup and view all the answers

What is the average timing for completing the 30-Second Sit to Stand Test in patients with hip osteoarthritis?

<p>12.6 repetitions (B)</p> Signup and view all the answers

What imaging technique is primarily utilized for diagnosing hip osteoarthritis?

<p>Plain-film radiography (B)</p> Signup and view all the answers

In the context of hip osteoarthritis, what is the significance of the FABER test?

<p>Identifies potential hip pathologies (B)</p> Signup and view all the answers

Which intervention is most appropriate for patients with mild to moderate hip osteoarthritis?

<p>Tailored exercise prescription (A)</p> Signup and view all the answers

What is one of the clinical findings indicating femoroacetabular impingement syndrome?

<p>Hip pain secondary to mechanical impingement (D)</p> Signup and view all the answers

Which symptom typically accompanies greater trochanteric pain syndrome?

<p>Decreased hip abductor strength (C)</p> Signup and view all the answers

Which test measures how long a patient can maintain a single-limb stance for diagnosing hip osteoarthritis?

<p>Single Limb Stance Timed Test (D)</p> Signup and view all the answers

What is the average time a patient should take to complete the 4 Square Test?

<p>8 to 9 seconds (B)</p> Signup and view all the answers

What is one of the limitations of passive hip internal rotation in patients with hip osteoarthritis?

<p>Restriction leading to significant discomfort (C)</p> Signup and view all the answers

Which component of patient education is crucial for managing hip osteoarthritis?

<p>Weight reduction and unloading of arthritic joints (B)</p> Signup and view all the answers

What does a 'C-Sign' indicate in a patient assessment?

<p>Potential hip pathology (B)</p> Signup and view all the answers

Which of the following factors is least likely to be a contributor to labral tears in hip osteoarthritis?

<p>Known traumatic events (C)</p> Signup and view all the answers

What is the maximum score for the Copenhagen Hip and Groin Outcome Score (HAGOS)?

<p>100 (C)</p> Signup and view all the answers

What does the MCID for the International Hip Outcome Tool (I-HOT12) measure?

<p>13 points (D)</p> Signup and view all the answers

Which of the following is not a subscale of the International Hip Outcome Tool?

<p>Physical function in sport (C)</p> Signup and view all the answers

What indicates worse pain and functional limitation in the Western Ontario and McMaster Universities Arthritis Index (WOMAC)?

<p>Higher scores (D)</p> Signup and view all the answers

What is the MDC for the Lower Extremity Functional Scale (LEFS)?

<p>9 points (A)</p> Signup and view all the answers

Which age group is most commonly associated with Leg-Calve-Perthes Disease?

<p>4-8 years (C)</p> Signup and view all the answers

What aspect does the Hip Disability and Osteoarthritis Outcome Score (Hip-DOS) primarily evaluate?

<p>Quality of life related to hip health (D)</p> Signup and view all the answers

What symptom is associated with snapping hip syndrome?

<p>A snapping sound with motion (D)</p> Signup and view all the answers

How many items are in the Hip Disability and Osteoarthritis Outcome Score (Hip-DOS) questionnaire?

<p>40 (C)</p> Signup and view all the answers

Which of the following is included in both the Copenhagen Hip and Groin Outcome Score and the Hip Disability and Osteoarthritis Outcome Score?

<p>Symptoms (A)</p> Signup and view all the answers

What is the maximum score for the Western Ontario and McMaster Universities Arthritis Index (WOMAC)?

<p>100 (D)</p> Signup and view all the answers

Which measure is best suited for determining prognosis in patients with hip conditions?

<p>All the above (A)</p> Signup and view all the answers

How many questions are in the International Hip Outcome Tool (I-HOT12)?

<p>12 (A)</p> Signup and view all the answers

What demographic is most likely to have degenerative joint disease as part of their patient history?

<p>Individuals over 50 (A)</p> Signup and view all the answers

What type of pain is characterized by being dull and deep, potentially indicating arthritis or Paget disease?

<p>Dull, deep, aching pain (B)</p> Signup and view all the answers

Which condition is most likely indicated by sharp, intense pain that occurs suddenly during weight bearing?

<p>Fracture (D)</p> Signup and view all the answers

What condition is indicated by tingling pain that radiates?

<p>Radiculopathy (D)</p> Signup and view all the answers

What is a likely cause when there is increased pain while sitting with the affected leg crossed?

<p>Trochanteric bursitis (B)</p> Signup and view all the answers

What condition is most commonly associated with unremitting, long duration pain?

<p>Paget disease (A)</p> Signup and view all the answers

In what situation should a health professional proceed with urgent referral?

<p>Moderate-high concern features (D)</p> Signup and view all the answers

What is a primary risk factor for septic hip arthritis?

<p>Immunosuppression (A)</p> Signup and view all the answers

Which symptom is most commonly associated with inguinal hernias?

<p>Bulging in the abdomen (B)</p> Signup and view all the answers

Which of the following patients is at higher risk for a femoral neck fracture?

<p>Females older than 70 (A)</p> Signup and view all the answers

What symptom is commonly associated with avascular necrosis?

<p>Mild and intermittent pain (D)</p> Signup and view all the answers

What is a key characteristic of appendicitis?

<p>Pain in the right lower quadrant (C)</p> Signup and view all the answers

Which factor is a primary risk for developmental dysplasia of the hip?

<p>Breech delivery (B)</p> Signup and view all the answers

What should be prioritized during the physical examination of a hip pain patient?

<p>Identifying the most likely hypotheses (C)</p> Signup and view all the answers

What is a common sign of septic hip arthritis during a physical examination?

<p>Warmth and swelling of the joint (A)</p> Signup and view all the answers

At what age is Legg-Calve Perthes disease most commonly diagnosed?

<p>5-8 years (D)</p> Signup and view all the answers

Which of the following is NOT a symptom of ovarian cysts?

<p>Severe abdominal pain (A)</p> Signup and view all the answers

Which imaging measurement is crucial for assessing hip conditions?

<p>Neck-shaft angle (A)</p> Signup and view all the answers

What is a hallmark feature of Slipped Capital Femoral Epiphysis (SCFE)?

<p>Pain worsens with weightbearing (A)</p> Signup and view all the answers

In which context should watchful waiting be applied in a patient's management plan?

<p>Moderate concern features present (D)</p> Signup and view all the answers

What finding would be indicative of acute transient synovitis?

<p>Refusal to bear weight (B)</p> Signup and view all the answers

What type of bursitis is indicated by pain at sitting with the legs not crossed?

<p>Ischiogluteal bursitis (C)</p> Signup and view all the answers

Which of the following conditions presents with a crescent sign?

<p>Legg-Calve Perthes disease (A)</p> Signup and view all the answers

Which statement is true regarding colon cancer risk factors?

<p>Family history is a significant risk factor (A)</p> Signup and view all the answers

What is the most important first step when faced with someone exhibiting red flag symptoms?

<p>Perform a thorough physical examination (C)</p> Signup and view all the answers

What is NOT a common symptom of appendicitis?

<p>Lower back pain (C)</p> Signup and view all the answers

What maneuver is used to test for developmental dysplasia of the hip?

<p>Barlow's test (A)</p> Signup and view all the answers

Which of the following conditions is characterized by avascular necrosis?

<p>Legg-Calve Perthes disease (D)</p> Signup and view all the answers

What symptoms are more indicative of inflammatory disease in the context of hip pain?

<p>Frank clinical inflammation and symmetrical signs (D)</p> Signup and view all the answers

Which symptom is a common indicator of ischiofemoral impingement?

<p>Snapping sensation in ischiofemoral interval (A)</p> Signup and view all the answers

Which examination finding is indicative of piriformis syndrome?

<p>Tenderness over the greater sciatic notch (C)</p> Signup and view all the answers

What is a management strategy for gluteal tendinopathy?

<p>Exercise therapy focusing on isometric exercises (D)</p> Signup and view all the answers

What demographic is more likely to experience piriformis syndrome?

<p>Women, with a 6:1 incidence ratio to men (A)</p> Signup and view all the answers

Which activity is most likely to aggravate pain from a hamstring strain?

<p>Running at high speeds with rapid direction changes (B)</p> Signup and view all the answers

What pattern of pain is typically associated with quadratus femoris tear?

<p>Pain over the ischiofemoral region (D)</p> Signup and view all the answers

Which of the following is a symptom of piriformis syndrome?

<p>Chronic deep gluteal pain (C)</p> Signup and view all the answers

Which of the following tests is used to evaluate the presence of hip pathology?

<p>FABER test (B)</p> Signup and view all the answers

What is the recommended initial approach to managing piriformis syndrome?

<p>Isolated muscle recruitment exercises (A)</p> Signup and view all the answers

Which of the following is NOT characteristic of a hamstring strain?

<p>Experiencing pain primarily in the shoulder region (D)</p> Signup and view all the answers

Which anatomical feature's interaction is integral to the development of piriformis syndrome?

<p>Compression of the sciatic nerve by the piriformis muscle (A)</p> Signup and view all the answers

Flashcards

Self-Report Measures

Tools for patients to communicate the impact of hip conditions on their function.

Minimal Detectable Change (MDC)

The smallest change in a measure that indicates true improvement beyond error.

Minimal Clinically Important Difference (MCID)

The least change on an outcome measure that patients find beneficial.

Lower Extremity Functional Scale (LEFS)

A self-report measure assessing a person's ability to perform daily tasks via 20 questions.

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International Hip Outcome Tool (I-HOT12)

A tool assessing specific hip-related quality of life measures for patients.

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Increased BMI

Higher body mass index linked to greater risk of hip osteoarthritis (OA).

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WOMAC

A validated questionnaire for assessing hip pain and function in osteoarthritis patients.

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Hip Disability and Osteoarthritis Outcome Score (HOOS)

A measure evaluating the status of patients with hip disorders, focusing on function and symptoms.

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Pressure Pain Threshold

The minimum pressure that causes pain, used to assess sensitivity in the hip area.

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Functional Scale Selection

Choosing one hip pain scale and one body function scale for evaluation in clinics.

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Dull, deep, aching pain

Pain commonly associated with arthritis or Paget disease.

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Sharp, sudden pain on weight bearing

Intense pain often linked to fractures.

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Tingling pain that radiates

Pain spreading outwards, indicating radiculopathy or spinal issues.

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Increased pain while sitting crosslegged

Pain exacerbated by crossing legs, may indicate trochanteric bursitis.

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Pain while sitting, legs not crossed

Indicates ischiogluteal bursitis, characterized by buttock pain.

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Pain after standing or walking

Commonly linked to hip arthrosis.

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Pain on attempted weight bearing

May suggest occult fractures or severe arthrosis.

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Long duration of unremitting pain

Chronic pain possibly due to Paget disease or metastatic cancer.

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Low level of concern

No concerning features; can begin therapy trial.

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Moderate-high level of concern

Some concerning features; may require urgent referral.

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High level of concern

Emergency situation requiring immediate referral.

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Septic hip arthritis

Infection causing joint inflammation, acute pain, and swelling.

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Femoral neck fracture

Common among older adults post-fall; characterized by severe groin pain.

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Avascular necrosis

Bone death due to blood supply loss, typically in femoral head.

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Radiculopathy

Nerve pain that radiates due to nerve root compression.

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Adductor Strain

An injury due to sudden stretch, weakness, or overuse of adductor muscles.

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Gait Training

A rehabilitation method to improve walking patterns after injury.

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Energy Storage Loading

A method to load tissues to prepare for dynamic movements.

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Clinical Findings of Adductor Strain

Symptoms include groin pain, weakness, and pain during hip abduction.

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Return to Sport Objectives

Goals include restoring strength, flexibility, and functional movement patterns.

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Gluteal tendinopathy

Condition involving pain due to injuries in gluteus medius and minimus tendons.

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Greater trochanter pain

Pain located over the greater trochanter, extending down the lateral thigh.

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Bursal changes

Alterations in bursal structure observed on ultrasound and MRI.

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Bone metastasis

Spread of cancer to bones, commonly affecting the hip region.

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Metastatic bone pain

Deep, unrelenting pain often worse at night, indicating bone metastasis.

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Neck of femur fracture

Fracture at the neck of the femur, typically seen in older adults with osteoporosis.

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Hip joint pathology

Disorders within the hip joint like osteoarthritis or avascular necrosis.

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Lumbar spine referral

Pain from low back that radiates to the lateral thigh.

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C-Sign

A cupping of the hip above the greater trochanter indicating hip pain.

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Morning Stiffness

Stiffness lasting less than 1 hour after waking up.

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Hip Internal Rotation ROM

Range of motion for hip internal rotation less than 24 degrees.

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FABER Test

Test indicating hip pain with hip flexion, abduction, and external rotation.

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Joint Effusion

Swelling in the joint due to fluid accumulation.

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4 Square Test

Test assessing agility by stepping into different squares.

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Single Limb Stance Test

Balancing on one leg, measuring how long without support.

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30-Second Sit to Stand Test

Measure how many times a patient can stand up in 30 seconds.

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Manual Therapy

Hands-on techniques to improve movement and reduce pain.

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LEFS

Lower Extremity Functional Scale for assessing patient function.

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Hip Management Interventions

Tailored exercises and treatments for hip osteoarthritis.

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MCID for LEFS

Minimal Clinically Important Difference for LEFS is 9 points.

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Weight Reduction

Loss of weight to alleviate joint stress, especially in hip OA.

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I-HOT12

International Hip Outcome Tool with 12 questions and 4 subscales.

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Imaging for Hip OA

Plain-film radiography used to assess hip osteoarthritis.

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MCID for I-HOT12

Minimal Clinically Important Difference for I-HOT12 is 13 points.

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Femoroacetabular Impingement (FAI)

Hip pain from mechanical impingement due to abnormal anatomy.

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Greater Trochanteric Pain Syndrome

Pain arising from the region near the greater trochanter of the femur.

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HAGOS

Copenhagen Hip and Groin Outcome Score assessing hip pain with 37 questions.

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Labral Tears

Tears of the cartilage rim in the hip joint, often seen in athletes.

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MCID for HAGOS

Minimum change of 5 points per subscale on HAGOS.

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HOOS

Hip Disability and Osteoarthritis Outcome Score with 40 items and 5 subscales.

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MCID for HOOS

MCID for HOOS is not specified, but it's essential for measuring change.

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MCID for WOMAC

MCID for WOMAC includes different scores: 21 for pain, 16 for function.

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Patient Evaluation

Process to determine the need for physical therapy or further evaluation.

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Clinical Hypothesis

Formulation based on patient history and examination findings.

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Age-related disorders

Specific conditions that arise based on the patient's age.

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Referred Pain

Pain originating from hip but felt in other areas like groin or knee.

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Pain Behavior

Describes how symptoms change with activity or rest.

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Common sports injuries

Track, soccer, and football show high injury rates.

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Hamstring injury risk

Previous strain increases future hamstring injury risk by 3.6 times.

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Hamstring strain incidence

0.87 per 1000 hours in non-contact sports; higher in contact sports.

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Eccentric overload

Involves hamstring stretching under load, increasing injury risk.

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Clinically assessing hamstrings

Use strength assessment and knee extension deficit measurement.

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Pulled muscle signs

Sharp pain, swelling, and possible popping sound during activity.

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Hamstring rehabilitation

Includes pain control, isometrics, and motor control exercises.

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Hip flexor strain prevalence

12%-36% of groin injuries are due to iliopsoas strain.

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Hip flexor strain symptoms

Pain when palpating or contracting iliopsoas after injury.

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Management for hip strain

Includes pain education, isometrics, and lumbopelvic activation.

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Worse with weightbearing

Pain increases when putting weight on the joint, often indicating joint issues.

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Crescent sign

A radiological sign indicating potential avascular necrosis, visible on hip X-rays.

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Inguinal Hernia

A protrusion of abdominal content through a weak area in the inguinal canal, causing groin pain.

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Appendicitis Symptoms

Right lower quadrant pain with nausea, vomiting, and rebound tenderness indicating inflammation of the appendix.

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Colon Cancer Risk Factors

Age over 50, family history, unexplained weight loss, and bowel disturbances signify risk.

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Ovarian Cysts

Fluid-filled sacs on the ovary, often benign but can lead to pressure and pain.

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Developmental Dysplasia of the Hip

A condition of unstable hip joints due to various risk factors affecting newborns.

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Legg-Calve Perthes Disease

Avascular necrosis of the femoral head affecting primarily boys aged 5-8, leading to hip pain.

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Acute Transient Synovitis

Inflammation of the hip's synovial lining, common in children, usually resolving within days.

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Slipped Capital Femoral Epiphysis (SCFE)

Condition in adolescents where the femoral head slips, causing hip pain and limited movement.

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Red Flag Pathologies

Signs that indicate serious conditions requiring further referral, such as severe pain or sudden symptoms.

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Barlow’s and Ortolani Test

Clinical tests to assess hip stability in newborns, indicating potential dysplasia.

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McBurney's Point

A point on the abdomen indicating where appendix pain is typically felt; positive rebound tenderness suggests appendicitis.

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Weightbearing Pain

Pain in hip or leg that worsens when standing or walking, often indicative of injury.

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Hip Abduction Bracing

An intervention for treating Developmental Dysplasia by holding the hip in an abduction position.

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Iliotibial Band Pain

Pain along the iliotibial band, often linked to lateral hip pain.

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Inflammatory Disease Signs

Clinical signs include heat, edema, and morning stiffness.

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Ischiofemoral Impingement

Pain in the ischiofemoral region, often with a snapping sensation.

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Piriformis Syndrome

Compression of the sciatic nerve by the piriformis muscle, causing buttock pain.

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Symptoms of Piriformis Syndrome

Deep gluteal pain, radiating down the sciatic nerve distribution.

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Clinical Signs of Hamstring Strain

Strains involve stretching or tearing of the hamstring muscle.

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Single Leg Stance Test

Balance test assessing hip stability and pain.

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Management for Gluteal Tendinopathy

Include load management, stretching, and exercise therapy.

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Resisted Internal Rotation Test

Assessing strength or pain during hip internal rotation.

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Examination Techniques

Includes self-report pain questionnaires and special tests for diagnosis.

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Hamstring Strain Classification

Strains are classified as mild, moderate, or severe based on tissue damage.

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Gluteal Pain and Activity

Difficulty with weight-bearing activities like walking and climbing stairs.

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Isometric Exercises

Exercises that involve muscle contractions without joint movement.

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Study Notes

Hip Pathologies Study Notes

  • Self-Report Measures: Various validated questionnaires assess hip function and pain. These include the LEFS (Lower Extremity Functional Scale), I-HOT12 (International Hip Outcome Tool), HAGOS (Copenhagen Hip and Groin Outcome Score), HOOS (Hip Disability and Osteoarthritis Outcome Score), and WOMAC (Western Ontario and McMaster Universities Arthritis Index). Each measure has a specific use case and unique properties concerning minimal clinically important difference (MCID) and minimal detectable change (MDC) scores, which reflect the minimum change considered important by patients or detectable by the measure, respectively.

Minimal Clinically Important Difference (MCID) and Minimal Detectable Change (MDC)

  • MCID: Represents the smallest change in outcome that patients perceive as beneficial.
  • MDC: The smallest change in a measurable outcome that exceeds the expected measurement error and variability. Both are crucial for evaluating treatment effectiveness.

Lower Extremity Functional Scale (LEFS)

  • Structure: Comprises 20 questions about daily activities.
  • Scoring: Patients rate their difficulty from extremely difficult to no difficulty.
  • MDC and MCID: 9 points on a 24-point scale.

International Hip Outcome Tool (I-HOT12)

  • Structure: 12 questions and 4 subscales (symptoms/function, sports/recreation, job-related concerns, social/lifestyle).
  • Validity and Reliability: Well-established reliability, validity, and responsiveness.
  • MCID: 13 points change.

Copenhagen Hip and Groin Outcome Score (HAGOS)

  • Structure: 37 items assessing pain, symptoms, Activities of Daily Living (ADLs), physical function, participation, and quality of life.
  • Scoring: Ranges from 0 (extreme symptoms) to 100 (no symptoms).
  • MCID: 5 points per subscale.

Hip Disability and Osteoarthritis Outcome Score (HOOS)

  • Use Case: Best for hip osteoarthritis.
  • Structure: 40 items across 5 subscales (symptoms, pain, ADLs, sports/recreation, hip-related quality of life).
  • Scoring: Ranges from 0 (extreme symptoms) to 100 (no symptoms).
  • MDC: 6-8 points per subscale.

Western Ontario and McMaster Universities Arthritis Index (WOMAC)

  • Use Case: Evaluates hip and knee osteoarthritis.
  • Structure: 24 questions divided into 3 subscales – pain, stiffness, and physical function.
  • Scoring Interpretation: Higher scores indicate worse pain, stiffness, and functional limitations.
  • MCID: Varies by subscale (21 for pain, 16 for function, 13 for stiffness, 17 for total WOMAC).
  • MDC: Varies by subscale (23 for pain, 11 for function, 27 for stiffness, 12 for total WOMAC).

Patient History – Specific Considerations for Hip

  • Age-related disorders: Developmental dysplasia of the hip (0-2 years), Legg-Calve-Perthes disease (2-8 years), slipped capital femoral epiphysis (9-15 years), and degenerative joint disease (50+).
  • Mechanism of injury: Trauma, insidious onset, unknown cause, overuse, and potential signs of degenerative joint disease (DJD).
  • Pain characteristics: Mechanical vs. non-mechanical; sources (hip joint, femoral head, neck, muscles); referral patterns (low back, groin, lateral/anterior thigh, knee); behavior (worse with movement/weight bearing, difficulty crossing legs, snapping sounds).
  • Activities and limitations: Climbing steps, walking, rising from chairs; usual activities, hobbies, sustained postures, and repetitive motions.

Types of Pain and Diagnostic Clues

  • Different pain characteristics (dull, deep, aching, sharp, sudden, tingling, location-specific, and behavior) signal different potential underlying issues, from arthritis and Paget disease to fractures, radiculopathy, and specific types of bursitis.

Screening for Medical Referral

  • Level of Concern: Patients can be assessed for referral based on their signs and symptoms (low, low-moderate, moderate-high, high), and these considerations inform the need for physical therapy or an outside referral to specialists (i.e for medical investigations, surgery or further imaging).

Red Flag Pathologies (Pediatric and Other)

  • Pediatric: Legg-Calve Perthes, slipped capital femoral epiphysis, septic hip arthritis.
  • Other: Femoral neck fracture, avascular necrosis, inguinal hernia, appendicitis, colon cancer and ovarian cysts. Red flag pathologies require immediate referral to other specialists.

Hip-Specific Examinations (e.g., Hip OA)

  • Self-report questionnaires, clinical findings, and activity limitations tests help in assessing functional capacity and identifying impairments.
  • Clinical observations: Pain, stiffness, limited range of motion, muscle weakness, or altered gait patterns may indicate specific diagnoses or impairments.
  • Imaging: Plain film radiography is crucial for evaluating potential hip osteoarthritis.

Hip Management for Hip OA

  • Patient education: Activity modification, exercise, and weight reduction are integral.
  • Interventions: Stretching, strengthening, endurance exercise, manual therapy, functional gait and balance training, and assistive devices, weight loss strategies, and modalities like ultrasound.

Femoroacetabular Impingement Syndrome (FAI)

  • Pathophysiology: Mechanical impingement due to abnormal hip anatomy.
  • Prevalence: Significantly higher in athletes, particularly in women (pincer) or men (cam) FAI.

Greater Trochanteric Pain Syndrome

  • Pathophysiology: Gluteal tendinopathy (predominantly gluteus medius). Pain over the greater trochanter often radiating down the lateral thigh.
  • Prevalence: Common in individuals aged 40+.

Piriformis Syndrome

  • Pathophysiology: Neuromuscular condition often related to sciatic nerve compression from the piriformis muscle.
  • Prevalence: Moderate incidence in chronic low back pain and sports. Often higher in women.

Hamstring Strain, Hip Flexor Strain, and Adductor Strain

  • Pathophysiology: Strains or tears in the respective muscles, often impacting agility or sport-specific movements.

  • Prevalence: Common injuries in certain sports like soccer, track and field, and ice hockey.

  • Examination and management: Consideration of specific characteristics, tests, and exercises designed for these injuries.

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