MSK IV Hip: Red Flags and Referred Pain

Red Flags and Referred Pain

• Hip capsular pattern = flex > abd > ir > ext

Tissue Type

• Weak MMT, limited AROM, normal PROM, limited PROM of opposing muscle/MLT, and pain with activity → PRICE, ROM, stretch, isometric, and isotonic exercises
• Normal MMT, limited AROM, limited PROM, and (+) special test → PRICE, ROM, mobilizations, stretch, isometrics, and resisted exercises
• Dermatome/myotome pattern → PRICE, ROM, splinting, education, body mechanics/ergonomics, sensory re-ed, and nerve glides

Lateral Femoral Cutaneous Nerve (Meralgia Paresthetica)

• Burn/cold/ache/tingling in ant lat thigh
• Worse with hip ext (prone lying)
• (+) special test → manual therapy and functional exercises

Osteochondrosis

• Abnormal bone growth seen in children

Legg-Calve-Perthe Disease

• Avascular necrosis of head of femur
• Insidious onset (1-3 months) of limp with hip or knee pain
• Limited hip ABD, flex, and IR
• Peak incidence: 5-7 months, more common in males than females

Slipped Capital Femoral Epiphysis (SCFE)

• Growth plate damaged, causing head of femur to slip from femoral neck
• Acute or chronic presentation; pain may be referred to knee or ant thigh
• P!and limited IR
• Pre-adolescent/recent growth spurt

Hip Pointer

• Iliac crest contusion from direct blow, usually at or near ASIS
• Tenderness over ASIS
• P!with passive hip ext
• P!with resisted flex, ER, ABD, active trunk motions
• P!with laughing, coughing, sneezing
• Intervention: PRICE → stretching → trunk strengthening

Athletic Pubalgia (Sports Hernia)

• Chronic inflammatory, overuse
• Weakening of mm or tendons of lower abdominal wall
• Secondary to repetitive shear stress
• Associated with rot and pivoting movements
• SL mvmts: kicking, springing
• Most common in men
• Inc pain with activities and no pain at rest
• P!Usually radiates to adductor mm region
• P!Difficult to pinpoint
• Any increase in intra-abdominal pressure
• Abnormalities in jt and mm that inc stress placed on pubic region
• Limited hip ROM, inc ADD mm tone, inc rec abd tone, tight iliopsoas, hypomobility of Upper lumbar spine, and dec lumbopelvic stability
• DDx: SIJ

Anteromedial Groin Pain

• Pt ℅:
• Structural impairment:
• Functional impairment:

Femoroacetabular Impingement (FAI)

• CAM, Pincer, or combination
• ICF: Mobility Deficits
• (+) scour
• Restricted mobility w/ FABER
• Hip flexor tightness
• Lumbar extensors = weak
• Inhibited glutes and abdominals
• Strengthen hip ABD, glutes, iliopsoas, and ER

This quiz covers the red flags and referred pain of the hip, including the hip capsular pattern and its associated tissue types, objective findings, and interventions.