Hip Conditions - DDs - PDF

***[True vs. functional leg length discrepancy]*** **Finding** **True leg length discrepancy** **Functional leg length discrepancy** ------------------ --------------------------------------------------------------------- ----------------------------...

***[True vs. functional leg length discrepancy]*** **Finding** **True leg length discrepancy** **Functional leg length discrepancy** ------------------ --------------------------------------------------------------------- --------------------------------------------------------------------- **Measurements** 1-1.5 cm side-side difference between the ASIS and medial malleolus 1-1.5 cm side-side difference between the ASIS and medial malleolus **Observation** Dynamic and static are equally affected Dynamic is more affected than static **Special test** Supine-sit - a consistent discrepancy Supine-sit -- discrepancy changes between the positions of the test ***[Iliac crest contusion vs. iliac crest fracture vs. avulsion fracture vs. Apophysitis]*** +-------------+-------------+-------------+-------------+-------------+ | **Finding** | **Iliac | **Iliac | **Avulsion | **Apophysit | | | crest | crest | fracture** | is** | | | contusion** | fracture** | | | +=============+=============+=============+=============+=============+ | **Observati | Swellling | Some | Visible | Some | | on** | -- | swelling | bony | swelling | | | disproporti | | prominence | | | | onate | | within a | | | | at lateral | | few | | | | hip + thigh | | millimeters | | | | | | from the | | | | | | iliac crest | | +-------------+-------------+-------------+-------------+-------------+ | **Pain | Sharp, | | Dull and | | | quality** | stabbing | | achy | | +-------------+-------------+-------------+-------------+-------------+ | **Pain | More | More deep | | | | location** | superficial | | | | +-------------+-------------+-------------+-------------+-------------+ | **Sport** | Diving | | | | | | sports (ex. | | | | | | Volleyball) | | | | +-------------+-------------+-------------+-------------+-------------+ | **Aggravate | | Weight | All | | | s** | | bearing | resisted | | | | | | movements | | +-------------+-------------+-------------+-------------+-------------+ | **Palpation | Disproporti | Visible | | | | ** | onate | bony | | | | | pain | prominence | | | | | | within a | | | | | Crepitus | few | | | | | | millimeters | | | | | | from the | | | | | | iliac crest | | | +-------------+-------------+-------------+-------------+-------------+ | **Age** | Thank you | Adolescents | | | | | Jesus - any | | | | +-------------+-------------+-------------+-------------+-------------+ | **Associate | Meralgia | Meralgia | | | | d | paraestheti | paraestheti | | | | with** | ca | ca | | | | | | is unlikely | | | +-------------+-------------+-------------+-------------+-------------+ ***[Osteitis pubis vs. adductor pathology]*** **Finding** **Osteitis pubis** **Adductor pathology** ------------------- ------------------------------------- --------------------------------------------------------------------- **Pain duration** Exclusively chronic/ long-standing Acute OR chronic **Pain location** Right at the pubic symphysis More in the medial thigh/ groin area, away from the pubic symphysis **Population** Kicking athletes (football, soccer) ***[FAI vs. OA vs. labral tear vs. Intra-articular snapping hip syndrome]*** +-------------+-------------+-------------+-------------+-------------+ | **Finding** | **FAI** | **OA** | **Labral | **Intra-art | | | | | tear** | icular | | | | | | SHS** | +=============+=============+=============+=============+=============+ | **Sensation | | Catching, | | | | s** | | locking, | | | | | | clicking | | | | | | are | | | | | | atypical | | | +-------------+-------------+-------------+-------------+-------------+ | **Age** | | Older | | | +-------------+-------------+-------------+-------------+-------------+ | **Pain | Localized | General | General | Localized | | location** | | | | | +-------------+-------------+-------------+-------------+-------------+ | **Special | Scour - | | FABER -- | FABER -- | | tests** | | | springy end | bone-bone | | | FADDIR -- | | block feel | | | | bone to | | | End feel | | | bone end | | FADDIR is | | | | feel | | most | | | | | | affected | | +-------------+-------------+-------------+-------------+-------------+ | **Onset** | | Insidious | | Acute | +-------------+-------------+-------------+-------------+-------------+ | **ROM | FLEX + IR | FLEX + IR | All ROM | Not as | | affected** | are less | are more | | affected | | | likely to | likely to | Going from | | | | be affected | be affected | EXT to FLEX | | | | than OA | | | | | | | | | | | | Going from | | | | | | FLEX to EXT | | | | +-------------+-------------+-------------+-------------+-------------+ | **Joint | Distraction | | | | | play** | reduces | | | | | | pain | | | | +-------------+-------------+-------------+-------------+-------------+ | **Alleviate | | | | Rest | | s** | | | | | | | | | | Muscular | | | | | | interventio | | | | | | ns | +-------------+-------------+-------------+-------------+-------------+ ***[Ischial vs. trochanteric bursitis vs. proximal hamstring pathology]*** +-----------------+-----------------+-----------------+-----------------+ | **Finding** | **Ischial** | **Trochanteric* | **IASHS** | | | | * | | +=================+=================+=================+=================+ | **Location** | Ischial | Lateral thigh | Localized, deep | | | tuberosity | | in the hip | +-----------------+-----------------+-----------------+-----------------+ | **Aggravates** | AROM FLEX | More movements | | | | | than w/ ischial | | | | RIM EXT | | | +-----------------+-----------------+-----------------+-----------------+ | **Amount of | | | None | | swelling** | | | | +-----------------+-----------------+-----------------+-----------------+ | **Sound/ | Snapping at | Snapping at | Catching | | sensations** | posterior thigh | lateral thigh | | | | | | Locking | +-----------------+-----------------+-----------------+-----------------+ ***[Piriformis pathology vs. external vs. internal vs. intra-articular snapping hip syndrome]*** +-----------------+-----------------+-----------------+-----------------+ | **Finding** | **External | **Internal | **Intra-articul | | | SHS** | SHS** | ar | | | | | SHS** | +=================+=================+=================+=================+ | **Location** | Along ITB/ | Anterior hip | Deep groin | | | greater | | | | | trochanter | | | +-----------------+-----------------+-----------------+-----------------+ | **ROM | FLEX, EXT, IR, | FLEX, EXT, ABD, | All | | affected** | ER | ADD | | +-----------------+-----------------+-----------------+-----------------+ | **Pain** | | At 45 degrees | Most commonly | | | | of flex when | | | | | returning from | | | | | EXT! | | +-----------------+-----------------+-----------------+-----------------+ | **Special | Ober's -- | FABER -- | Any | | tests** | superior knee/ | iliopsoas | intra-articular | | | leg not | tightness | pathology test, | | | parallel to | | particularly | | | floor, or | | scour | | | higher than | | | | | that | | | | | | | | | | Kendall's -- | | | | | flaring out of | | | | | the hip/ ABD of | | | | | the hip is | | | | | present, | | | | | because the hip | | | | | is not at 0 | | | | | degrees | | | +-----------------+-----------------+-----------------+-----------------+ | **Sounds/ | | Deep snapping | Clicking | | sensations | | with hip EXT | | | present** | | | Locking | +-----------------+-----------------+-----------------+-----------------+ | **Aggravating** | | | Single leg | | | | | pivot | +-----------------+-----------------+-----------------+-----------------+ ***[Femoral neck vs. femoral shaft stress fracture]*** **Finding** **Femoral neck** **Femoral shaft** ------------------- --------------------------------- ------------------------------------------------------------ **Special tests** Active SLR -- anterior hip pain Fulcrum -- sharp pain + apprehension pain at femoral shaft **Location** Deep in the hip Pain along the length of the femur, at mid-thigh **Aggravates** WB ***[One-sided vs. two-sided iliosacral somatic dysfunction]*** +-----------------------+-----------------------+-----------------------+ | **Finding** | **One-sided | **Two-sided | | | iliosacral somatic | iliosacral somatic | | | dysfunction** | dysfunction** | +=======================+=======================+=======================+ | **Special tests** | Standing flexion -- | Gillet's -- affected | | | affected side moves | side moves less | | | more | | | | | | | | Seated flexion -- | | | | affected side moves | | | | more | | +-----------------------+-----------------------+-----------------------+ | Summary of the rest: | | | | 1 sided -- unilateral | | | | findings, 2 sided -- | | | | bilateral findings | | | +-----------------------+-----------------------+-----------------------+ ***[Anterior vs. posterior vs. sacrotuberous vs. sacrospinous vs. interosseous vs. iliolumbar SI ligament sprain]*** +---------+---------+---------+---------+---------+---------+---------+ | **Findi | **Anter | **Poste | **Sacro | **Sacro | **Inter | **Iliol | | ng** | ior | rior | tuberou | spinous | osseous | umbar** | | | SI** | SI** | s** | ** | ** | | +=========+=========+=========+=========+=========+=========+=========+ | **Pain | Anterio | Posteri | Posteri | Posteri | Posteri | Lower | | locatio | r | or | or, | or, | or | back | | n** | | | between | more | | | | | | | entire | anterio | Narrow | | | | | | sacrum | r | | | | | | | and | and | Central | | | | | | ischial | closer | | | | | | | tuberos | to | | | | | | | ity | ischium | | | | | | | | than | | | | | | | | with | | | | | | | | sacrotu | | | | | | | | berous | | | +---------+---------+---------+---------+---------+---------+---------+ | **Aggra | L spine | L spine | All | All | ~~Press | Rotatio | | vates** | EXT | FLEX | | (mostly | ure | n | | | | | | ROT) | on | against | | | Hip EXT | Hip | | | middle | resista | | | | FLEX | | | of | nce | | | | | | | sacrum~ | | | | | | | | ~ | Bending | +---------+---------+---------+---------+---------+---------+---------+ | **Speci | Gapping | Squish | | | | | | al | (pain @ | (pain @ | | | | | | tests** | SI) | SI) | | | | | | | | | | | | | | | | Hibb's | | | | | | | | (pain @ | | | | | | | | SI) | | | | | +---------+---------+---------+---------+---------+---------+---------+ ***[Upper vs. lower pole SI dysfunction]*** +-----------------------+-----------------------+-----------------------+ | **Finding** | **Upper pole SI | **Lower pole SI | | | dysfunction** | dysfunction** | +=======================+=======================+=======================+ | **Special Tests** | Approximation -- pain | Squish -- pain at SI | | | at SI joint | joint | | | | | | | | Hibbs -- pain at SI | | | | joint | +-----------------------+-----------------------+-----------------------+ | **Pain location** | Upper pole of SI | Lower pole of SI | | | (just posterior and | (just posterior and | | | inferior to PSIS) | inferior to sacral | | | | sulci) | +-----------------------+-----------------------+-----------------------+ | **MOI** | L spine - loading and | Repetitive FLEX/ EXT | | | twisting | | | | | Sitting for prolonged | | | | periods | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ Movements that ligaments limit: 1. Sacrospinous + sacrotuberous -- all but counternutation 2. Anterior SI -- counternutation, anterior translation, posterior translation, nutation 3. Posterior SI -- counternutation, anterior translation + posterior translation 4. Interosseous - counternutation 5. Iliolumbar -- sacral flexion ***[Anteroversion vs. retroversion]*** **Finding** **Anteroversion** **Retroversion** ------------------- -------------------------------------------- ----------------------------------------------- **Craig's** The goniometer measurement is \>15 degrees The goniometer measurement is below 8 degrees **Pelvic tilt** Anterior Posterior **ASIS** Lower Higher **PSIS** Higher Lower **L spine curve** Increased lordosis Decreased lordosis ***[Hamstring vs. iliopsoas vs. rectus femoris vs. ITB/ TFL vs. piriformis vs. gluteus medius vs. sartorius pathology]*** +--------+--------+--------+--------+--------+--------+--------+--------+ | **Find | **Hams | **Ilio | **Rect | **ITB/ | **Piri | **Glut | **Sart | | ing** | tring | psoas | us | TFL | formis | eus | orius | | | pathol | pathol | femori | pathol | pathol | medius | pathol | | | ogy** | ogy** | s | ogy** | ogy** | pathol | ogy** | | | | | pathol | | | ogy** | | | | | | ogy** | | | | | +========+========+========+========+========+========+========+========+ | **Pain | Poster | Could | Anteri | Latera | Poster | Poster | Travel | | locati | ior | go | or | l, | ior | ior | s | | on** | thigh | into | thigh | poster | buttoc | buttoc | from | | | | the | | ior | ks | ks | latera | | | | lumbar | | thigh | | | l | | | | spine | | | | | thigh | | | | | | | | | to | | | | | | | | | medial | | | | | | | | | knee | +--------+--------+--------+--------+--------+--------+--------+--------+ | **Spec | Active | FABER | Kendal | Ober's | Pirifo | Trende | FABER | | ial | SLR -- | -- | l's | -- | rmis | lenbur | - knee | | tests* | below | knee | -- | knee | length | g | fails | | * | 80 | fails | knee | fails | -- | sign | to get | | | degree | to get | extend | to get | pain | presen | to 0 | | | s | to 0 | ed | to 0 | in the | t | degree | | | of | degree | beyond | degree | buttoc | | s/ | | | straig | s/ | 80 | s/ | ks | GAIT | horizo | | | ht | horizo | degree | horizo | or | -- | ntal | | | leg | ntal | s | ntal | lower | trende | to | | | hip | to | of | to the | leg | lenbur | other | | | flexio | other | knee | floor | | g | knee | | | n | knee | flexio | or | | sign | or | | | | or | n | lower | | presen | lower, | | | 90/90 | lower | | | | t | or | | | SLR -- | | Ely's | Kendal | | | pain | | | more | Kendal | -- | l's | | | down | | | than | l's | pain | -- hip | | | the | | | 20 | -- | in | is | | | length | | | degree | | anteri | abduct | | | of the | | | s | Lordos | or | ed/ | | | sartor | | | away | is | thigh, | flares | | | ius | | | from | in | hip | out | | | | | | the | standi | hiking | | | | | | | vertic | ng | , | | | | | | | al | vs | foot | | | | | | | axis | kneeli | is tat | | | | | | | | ng | least | | | | | | | Tripod | -- | 2 | | | | | | | sign | increa | inches | | | | | | | -- | sed | away | | | | | | | archin | when | from | | | | | | | g | kneeli | the | | | | | | | in the | ng | foot | | | | | | | back/ | | | | | | | | | increa | | Lordos | | | | | | | sed | | is | | | | | | | L | | in | | | | | | | spine | | standi | | | | | | | lordos | | ng | | | | | | | is | | vs | | | | | | | observ | | kneeli | | | | | | | ed, | | ng | | | | | | | or | | -- | | | | | | | increa | | increa | | | | | | | sed | | sed | | | | | | | pain | | when | | | | | | | | | kneeli | | | | | | | | | ng | | | | | +--------+--------+--------+--------+--------+--------+--------+--------+ ***[Piriformis pathology vs. true vs. pseudo sciatica]*** +-----------------+-----------------+-----------------+-----------------+ | **Finding** | **Piriformis | **True | **Pseudo | | | pathology** | sciatica** | sciatica** | +=================+=================+=================+=================+ | **Symptom | Exclusively at | Below knee | Above knee | | location** | hip | | | | | | Radiates | At hip and may | | | | starting from | radiate don | | | | the low back | | | | | down the | | | | | posterior thigh | | | | | and leg | | +-----------------+-----------------+-----------------+-----------------+ | **Piriformis** | | May have normal | Hypertrophied | | | | strength and | (short and | | | | length | strong) | +-----------------+-----------------+-----------------+-----------------+ | **Affected | IR, ER, ABD | Differs | | | ROM** | | | | +-----------------+-----------------+-----------------+-----------------+ | **Special | Piriformis | Piriformis | Piriformis | | tests** | length -- | length - | length -- | | | reproduction of | negative | reproduction of | | | pain in the | | pain in the | | | lower leg | | lower leg | +-----------------+-----------------+-----------------+-----------------+ | **Aggravates** | | Coughing and | | | | | sneezing | | +-----------------+-----------------+-----------------+-----------------+ | **Conditions | | | Muscle and | | it's associated | | | joint | | with** | | | dysfunctions | +-----------------+-----------------+-----------------+-----------------+ ***[Adverse neurodynamics of sciatic vs. tibial vs. sural vs. common fibular vs. large disc lesion vs. femoral nerve pathology]*** +---------+---------+---------+---------+---------+---------+---------+ | **Findi | **Sciat | **Tibia | **Sural | **Commo | **Large | **Femor | | ng** | ic | l | nerve | n | disc | al | | | nerve | nerve | AN** | fibular | lesion* | nerve | | | AN** | AN** | | nerve | * | AN** | | | | | | AN** | | | +=========+=========+=========+=========+=========+=========+=========+ | **Sympt | Posteri | Posteri | Lateral | Lateral | Symptom | Anterio | | om | or | or | lower | knee | s | r | | locatio | thigh | lower | leg | | going | thigh | | n** | | leg + | | Lower | from | | | | | sole | foot | leg | spine | | | | | | | | all the | | | | | | | Foot | way | | | | | | | | down | | | | | | | | the leg | | +---------+---------+---------+---------+---------+---------+---------+ | **Speci | SLR \#1 | SLR \#2 | SLR \#3 | SLR \#4 | SLR \#5 | Yeoman' | | al | | | | | | s | | tests** | | | | | | -- | | | | | | | | anterio | | | | | | | | r | | | | | | | | thigh | | | | | | | | AN | +---------+---------+---------+---------+---------+---------+---------+