Podcast
Questions and Answers
In which sports is the incidence of hamstring strain per 1000 hours of exposure highest?
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?
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?
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?
What is a clinical finding associated with a hamstring strain?
Which of the following is a non-modifiable risk factor for hamstring injuries?
Which of the following is a non-modifiable risk factor for hamstring injuries?
What does the "Functional Assessment Scale for Acute Hamstring Injuries" measure?
What does the "Functional Assessment Scale for Acute Hamstring Injuries" measure?
What is the typical treatment approach for a hamstring strain?
What is the typical treatment approach for a hamstring strain?
Which of the following is NOT a key clinical finding associated with iliopsoas strain?
Which of the following is NOT a key clinical finding associated with iliopsoas strain?
Which of the following activities is likely to be painful for someone with an iliopsoas strain?
Which of the following activities is likely to be painful for someone with an iliopsoas strain?
What does the Minimal Detectable Change (MDC) represent in outcome measures?
What does the Minimal Detectable Change (MDC) represent in outcome measures?
Which self-report measure specifically targets functionalities related to everyday tasks?
Which self-report measure specifically targets functionalities related to everyday tasks?
What is the purpose of Minimal Clinically Important Difference (MCID)?
What is the purpose of Minimal Clinically Important Difference (MCID)?
Which of the following is NOT a self-report measure specifically used for hip pathologies?
Which of the following is NOT a self-report measure specifically used for hip pathologies?
Which statistical measure is primarily concerned with patient perceptions of improvement?
Which statistical measure is primarily concerned with patient perceptions of improvement?
What is one of the potential outcomes linked to increased Body Mass Index (BMI)?
What is one of the potential outcomes linked to increased Body Mass Index (BMI)?
Which assessment tool is specifically used for measuring hip pain?
Which assessment tool is specifically used for measuring hip pain?
Which combination of assessment measures is recommended for evaluating a patient's condition?
Which combination of assessment measures is recommended for evaluating a patient's condition?
What does a 'C-sign' indicate in clinical findings?
What does a 'C-sign' indicate in clinical findings?
What is a potential consequence of unhealthy eating habits in relation to BMI?
What is a potential consequence of unhealthy eating habits in relation to BMI?
What is the primary mechanism behind an adductor strain?
What is the primary mechanism behind an adductor strain?
Which clinical finding is NOT associated with an adductor strain?
Which clinical finding is NOT associated with an adductor strain?
What is a common treatment consideration for athletes with an adductor strain?
What is a common treatment consideration for athletes with an adductor strain?
What is the primary cause of lateral hip pain in gluteal tendinopathy?
What is the primary cause of lateral hip pain in gluteal tendinopathy?
Which population is most commonly affected by gluteal tendinopathy?
Which population is most commonly affected by gluteal tendinopathy?
Which symptom is characteristic of metastatic bone pain?
Which symptom is characteristic of metastatic bone pain?
What is a characteristic symptom of a neck of femur fracture?
What is a characteristic symptom of a neck of femur fracture?
Which symptom might suggest hip joint pathology?
Which symptom might suggest hip joint pathology?
Which condition can present with pain in the groin, buttocks, anterior thigh, and/or lateral hip?
Which condition can present with pain in the groin, buttocks, anterior thigh, and/or lateral hip?
What might unexplained weight loss indicate in the context of lateral hip pain?
What might unexplained weight loss indicate in the context of lateral hip pain?
What characterizes lumbar spine referral pain?
What characterizes lumbar spine referral pain?
Which clinical finding is associated with hip osteoarthritis?
Which clinical finding is associated with hip osteoarthritis?
What is the average timing for completing the 30-Second Sit to Stand Test in patients with hip osteoarthritis?
What is the average timing for completing the 30-Second Sit to Stand Test in patients with hip osteoarthritis?
What imaging technique is primarily utilized for diagnosing hip osteoarthritis?
What imaging technique is primarily utilized for diagnosing hip osteoarthritis?
In the context of hip osteoarthritis, what is the significance of the FABER test?
In the context of hip osteoarthritis, what is the significance of the FABER test?
Which intervention is most appropriate for patients with mild to moderate hip osteoarthritis?
Which intervention is most appropriate for patients with mild to moderate hip osteoarthritis?
What is one of the clinical findings indicating femoroacetabular impingement syndrome?
What is one of the clinical findings indicating femoroacetabular impingement syndrome?
Which symptom typically accompanies greater trochanteric pain syndrome?
Which symptom typically accompanies greater trochanteric pain syndrome?
Which test measures how long a patient can maintain a single-limb stance for diagnosing hip osteoarthritis?
Which test measures how long a patient can maintain a single-limb stance for diagnosing hip osteoarthritis?
What is the average time a patient should take to complete the 4 Square Test?
What is the average time a patient should take to complete the 4 Square Test?
What is one of the limitations of passive hip internal rotation in patients with hip osteoarthritis?
What is one of the limitations of passive hip internal rotation in patients with hip osteoarthritis?
Which component of patient education is crucial for managing hip osteoarthritis?
Which component of patient education is crucial for managing hip osteoarthritis?
What does a 'C-Sign' indicate in a patient assessment?
What does a 'C-Sign' indicate in a patient assessment?
Which of the following factors is least likely to be a contributor to labral tears in hip osteoarthritis?
Which of the following factors is least likely to be a contributor to labral tears in hip osteoarthritis?
What is the maximum score for the Copenhagen Hip and Groin Outcome Score (HAGOS)?
What is the maximum score for the Copenhagen Hip and Groin Outcome Score (HAGOS)?
What does the MCID for the International Hip Outcome Tool (I-HOT12) measure?
What does the MCID for the International Hip Outcome Tool (I-HOT12) measure?
Which of the following is not a subscale of the International Hip Outcome Tool?
Which of the following is not a subscale of the International Hip Outcome Tool?
What indicates worse pain and functional limitation in the Western Ontario and McMaster Universities Arthritis Index (WOMAC)?
What indicates worse pain and functional limitation in the Western Ontario and McMaster Universities Arthritis Index (WOMAC)?
What is the MDC for the Lower Extremity Functional Scale (LEFS)?
What is the MDC for the Lower Extremity Functional Scale (LEFS)?
Which age group is most commonly associated with Leg-Calve-Perthes Disease?
Which age group is most commonly associated with Leg-Calve-Perthes Disease?
What aspect does the Hip Disability and Osteoarthritis Outcome Score (Hip-DOS) primarily evaluate?
What aspect does the Hip Disability and Osteoarthritis Outcome Score (Hip-DOS) primarily evaluate?
What symptom is associated with snapping hip syndrome?
What symptom is associated with snapping hip syndrome?
How many items are in the Hip Disability and Osteoarthritis Outcome Score (Hip-DOS) questionnaire?
How many items are in the Hip Disability and Osteoarthritis Outcome Score (Hip-DOS) questionnaire?
Which of the following is included in both the Copenhagen Hip and Groin Outcome Score and the Hip Disability and Osteoarthritis Outcome Score?
Which of the following is included in both the Copenhagen Hip and Groin Outcome Score and the Hip Disability and Osteoarthritis Outcome Score?
What is the maximum score for the Western Ontario and McMaster Universities Arthritis Index (WOMAC)?
What is the maximum score for the Western Ontario and McMaster Universities Arthritis Index (WOMAC)?
Which measure is best suited for determining prognosis in patients with hip conditions?
Which measure is best suited for determining prognosis in patients with hip conditions?
How many questions are in the International Hip Outcome Tool (I-HOT12)?
How many questions are in the International Hip Outcome Tool (I-HOT12)?
What demographic is most likely to have degenerative joint disease as part of their patient history?
What demographic is most likely to have degenerative joint disease as part of their patient history?
What type of pain is characterized by being dull and deep, potentially indicating arthritis or Paget disease?
What type of pain is characterized by being dull and deep, potentially indicating arthritis or Paget disease?
Which condition is most likely indicated by sharp, intense pain that occurs suddenly during weight bearing?
Which condition is most likely indicated by sharp, intense pain that occurs suddenly during weight bearing?
What condition is indicated by tingling pain that radiates?
What condition is indicated by tingling pain that radiates?
What is a likely cause when there is increased pain while sitting with the affected leg crossed?
What is a likely cause when there is increased pain while sitting with the affected leg crossed?
What condition is most commonly associated with unremitting, long duration pain?
What condition is most commonly associated with unremitting, long duration pain?
In what situation should a health professional proceed with urgent referral?
In what situation should a health professional proceed with urgent referral?
What is a primary risk factor for septic hip arthritis?
What is a primary risk factor for septic hip arthritis?
Which symptom is most commonly associated with inguinal hernias?
Which symptom is most commonly associated with inguinal hernias?
Which of the following patients is at higher risk for a femoral neck fracture?
Which of the following patients is at higher risk for a femoral neck fracture?
What symptom is commonly associated with avascular necrosis?
What symptom is commonly associated with avascular necrosis?
What is a key characteristic of appendicitis?
What is a key characteristic of appendicitis?
Which factor is a primary risk for developmental dysplasia of the hip?
Which factor is a primary risk for developmental dysplasia of the hip?
What should be prioritized during the physical examination of a hip pain patient?
What should be prioritized during the physical examination of a hip pain patient?
What is a common sign of septic hip arthritis during a physical examination?
What is a common sign of septic hip arthritis during a physical examination?
At what age is Legg-Calve Perthes disease most commonly diagnosed?
At what age is Legg-Calve Perthes disease most commonly diagnosed?
Which of the following is NOT a symptom of ovarian cysts?
Which of the following is NOT a symptom of ovarian cysts?
Which imaging measurement is crucial for assessing hip conditions?
Which imaging measurement is crucial for assessing hip conditions?
What is a hallmark feature of Slipped Capital Femoral Epiphysis (SCFE)?
What is a hallmark feature of Slipped Capital Femoral Epiphysis (SCFE)?
In which context should watchful waiting be applied in a patient's management plan?
In which context should watchful waiting be applied in a patient's management plan?
What finding would be indicative of acute transient synovitis?
What finding would be indicative of acute transient synovitis?
What type of bursitis is indicated by pain at sitting with the legs not crossed?
What type of bursitis is indicated by pain at sitting with the legs not crossed?
Which of the following conditions presents with a crescent sign?
Which of the following conditions presents with a crescent sign?
Which statement is true regarding colon cancer risk factors?
Which statement is true regarding colon cancer risk factors?
What is the most important first step when faced with someone exhibiting red flag symptoms?
What is the most important first step when faced with someone exhibiting red flag symptoms?
What is NOT a common symptom of appendicitis?
What is NOT a common symptom of appendicitis?
What maneuver is used to test for developmental dysplasia of the hip?
What maneuver is used to test for developmental dysplasia of the hip?
Which of the following conditions is characterized by avascular necrosis?
Which of the following conditions is characterized by avascular necrosis?
What symptoms are more indicative of inflammatory disease in the context of hip pain?
What symptoms are more indicative of inflammatory disease in the context of hip pain?
Which symptom is a common indicator of ischiofemoral impingement?
Which symptom is a common indicator of ischiofemoral impingement?
Which examination finding is indicative of piriformis syndrome?
Which examination finding is indicative of piriformis syndrome?
What is a management strategy for gluteal tendinopathy?
What is a management strategy for gluteal tendinopathy?
What demographic is more likely to experience piriformis syndrome?
What demographic is more likely to experience piriformis syndrome?
Which activity is most likely to aggravate pain from a hamstring strain?
Which activity is most likely to aggravate pain from a hamstring strain?
What pattern of pain is typically associated with quadratus femoris tear?
What pattern of pain is typically associated with quadratus femoris tear?
Which of the following is a symptom of piriformis syndrome?
Which of the following is a symptom of piriformis syndrome?
Which of the following tests is used to evaluate the presence of hip pathology?
Which of the following tests is used to evaluate the presence of hip pathology?
What is the recommended initial approach to managing piriformis syndrome?
What is the recommended initial approach to managing piriformis syndrome?
Which of the following is NOT characteristic of a hamstring strain?
Which of the following is NOT characteristic of a hamstring strain?
Which anatomical feature's interaction is integral to the development of piriformis syndrome?
Which anatomical feature's interaction is integral to the development of piriformis syndrome?
Flashcards
Self-Report Measures
Self-Report Measures
Tools for patients to communicate the impact of hip conditions on their function.
Minimal Detectable Change (MDC)
Minimal Detectable Change (MDC)
The smallest change in a measure that indicates true improvement beyond error.
Minimal Clinically Important Difference (MCID)
Minimal Clinically Important Difference (MCID)
The least change on an outcome measure that patients find beneficial.
Lower Extremity Functional Scale (LEFS)
Lower Extremity Functional Scale (LEFS)
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International Hip Outcome Tool (I-HOT12)
International Hip Outcome Tool (I-HOT12)
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Increased BMI
Increased BMI
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WOMAC
WOMAC
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Hip Disability and Osteoarthritis Outcome Score (HOOS)
Hip Disability and Osteoarthritis Outcome Score (HOOS)
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Pressure Pain Threshold
Pressure Pain Threshold
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Functional Scale Selection
Functional Scale Selection
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Dull, deep, aching pain
Dull, deep, aching pain
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Sharp, sudden pain on weight bearing
Sharp, sudden pain on weight bearing
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Tingling pain that radiates
Tingling pain that radiates
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Increased pain while sitting crosslegged
Increased pain while sitting crosslegged
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Pain while sitting, legs not crossed
Pain while sitting, legs not crossed
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Pain after standing or walking
Pain after standing or walking
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Pain on attempted weight bearing
Pain on attempted weight bearing
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Long duration of unremitting pain
Long duration of unremitting pain
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Low level of concern
Low level of concern
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Moderate-high level of concern
Moderate-high level of concern
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High level of concern
High level of concern
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Septic hip arthritis
Septic hip arthritis
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Femoral neck fracture
Femoral neck fracture
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Avascular necrosis
Avascular necrosis
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Radiculopathy
Radiculopathy
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Adductor Strain
Adductor Strain
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Gait Training
Gait Training
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Energy Storage Loading
Energy Storage Loading
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Clinical Findings of Adductor Strain
Clinical Findings of Adductor Strain
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Return to Sport Objectives
Return to Sport Objectives
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Gluteal tendinopathy
Gluteal tendinopathy
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Greater trochanter pain
Greater trochanter pain
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Bursal changes
Bursal changes
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Bone metastasis
Bone metastasis
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Metastatic bone pain
Metastatic bone pain
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Neck of femur fracture
Neck of femur fracture
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Hip joint pathology
Hip joint pathology
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Lumbar spine referral
Lumbar spine referral
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C-Sign
C-Sign
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Morning Stiffness
Morning Stiffness
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Hip Internal Rotation ROM
Hip Internal Rotation ROM
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FABER Test
FABER Test
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Joint Effusion
Joint Effusion
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4 Square Test
4 Square Test
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Single Limb Stance Test
Single Limb Stance Test
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30-Second Sit to Stand Test
30-Second Sit to Stand Test
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Manual Therapy
Manual Therapy
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LEFS
LEFS
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Hip Management Interventions
Hip Management Interventions
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MCID for LEFS
MCID for LEFS
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Weight Reduction
Weight Reduction
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I-HOT12
I-HOT12
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Imaging for Hip OA
Imaging for Hip OA
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MCID for I-HOT12
MCID for I-HOT12
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Femoroacetabular Impingement (FAI)
Femoroacetabular Impingement (FAI)
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Greater Trochanteric Pain Syndrome
Greater Trochanteric Pain Syndrome
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HAGOS
HAGOS
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Labral Tears
Labral Tears
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MCID for HAGOS
MCID for HAGOS
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HOOS
HOOS
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MCID for HOOS
MCID for HOOS
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MCID for WOMAC
MCID for WOMAC
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Patient Evaluation
Patient Evaluation
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Clinical Hypothesis
Clinical Hypothesis
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Age-related disorders
Age-related disorders
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Referred Pain
Referred Pain
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Pain Behavior
Pain Behavior
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Common sports injuries
Common sports injuries
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Hamstring injury risk
Hamstring injury risk
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Hamstring strain incidence
Hamstring strain incidence
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Eccentric overload
Eccentric overload
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Clinically assessing hamstrings
Clinically assessing hamstrings
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Pulled muscle signs
Pulled muscle signs
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Hamstring rehabilitation
Hamstring rehabilitation
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Hip flexor strain prevalence
Hip flexor strain prevalence
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Hip flexor strain symptoms
Hip flexor strain symptoms
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Management for hip strain
Management for hip strain
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Worse with weightbearing
Worse with weightbearing
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Crescent sign
Crescent sign
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Inguinal Hernia
Inguinal Hernia
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Appendicitis Symptoms
Appendicitis Symptoms
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Colon Cancer Risk Factors
Colon Cancer Risk Factors
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Ovarian Cysts
Ovarian Cysts
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Developmental Dysplasia of the Hip
Developmental Dysplasia of the Hip
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Legg-Calve Perthes Disease
Legg-Calve Perthes Disease
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Acute Transient Synovitis
Acute Transient Synovitis
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Slipped Capital Femoral Epiphysis (SCFE)
Slipped Capital Femoral Epiphysis (SCFE)
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Red Flag Pathologies
Red Flag Pathologies
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Barlow’s and Ortolani Test
Barlow’s and Ortolani Test
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McBurney's Point
McBurney's Point
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Weightbearing Pain
Weightbearing Pain
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Hip Abduction Bracing
Hip Abduction Bracing
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Iliotibial Band Pain
Iliotibial Band Pain
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Inflammatory Disease Signs
Inflammatory Disease Signs
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Ischiofemoral Impingement
Ischiofemoral Impingement
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Piriformis Syndrome
Piriformis Syndrome
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Symptoms of Piriformis Syndrome
Symptoms of Piriformis Syndrome
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Clinical Signs of Hamstring Strain
Clinical Signs of Hamstring Strain
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Single Leg Stance Test
Single Leg Stance Test
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Management for Gluteal Tendinopathy
Management for Gluteal Tendinopathy
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Resisted Internal Rotation Test
Resisted Internal Rotation Test
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Examination Techniques
Examination Techniques
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Hamstring Strain Classification
Hamstring Strain Classification
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Gluteal Pain and Activity
Gluteal Pain and Activity
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Isometric Exercises
Isometric Exercises
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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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