Musculoskeletal Physiotherapy Questions and Graded Answers, 100%
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Medial-lateral stability - glutei & iliotibili band
Anatomy femoral component - - convex articulating surface
- femoral neck angle 126 degrees to shaft & 12 degrees to frontal plane (angle of femoral
torsion)
- head faces acetabulum medially, cranially & ventrally
Anatomy pelvic component - - concave articulating surface (acetabulum)
- acetabular labrum continuous w/ rim
- transverse acetabular ligament completes circle
- acetabular notch permits vessels & nerves to pass in ligament of head
- articular far pad moves in/out of notch w/ pressure
Tension band - protects femur from excessive medial bending deformation
Loose-packed position - - position in which capsule is most relaxed
- minimal joint contact
- maximal joint play (accessory movement)
- hip: flex: 30d, abd:30d, slight external rotation
Close-packed position - Position in which capsule is most tensed. Maximal joint contact.
Minimal joint play (accessory movement) Hip: max. ext, slight int rotation, slight abd.
Capsular pattern - decreased movements due to entire capsule being shortened e.g. OA
,Hip: gross limitation of flex, abd, int rotation, limitation of ext, little or no limitations of ext
rotation
Extrinsic hip disorders - - hip & groin pain due to urogenital or abdominal organ disease
e.g. appendicitis
- disease of local structures e.g. lymphadenopathy
- referred pain from lumbar spine somatic structures (common), knee jt (rare), SIJ (buttock pain)
- L1 or L2 radiculopathy (rare)
Intrinsic hip disorders - - groin or lateral thigh pain common
- buttock or posterior thigh pain infrequently
- may radiate anteriorly, above knee or to shin (rare)
- extent of referral largely related to degree of inflammation
Intrinsic hip disorders e.g. - osteoarthritis (OA)
Femoro-acetabular impingement (FAI)
Labral tears
Tendinopathies e.g. hams, adds, glut med
- greater trochanteric pain syndrome (GTPS)
- Lateral femoral cutaneous nerve (LFCN) entrapment
Painful hip: elderly person, child
Osteoarthritis (OA) - -common >50yrs
-pain & x-ray changes: poor correlation
-pain related to loading
-may have decreased ROM & muscle wasting
-may develop flex, ER deformity
-antalgic, swinging or Trendelenburg gait
, Osteoarthritis management - -patient education
-weight loss
-passive joint mobilisation: physiological & accessory
-exercise: increase ROM, strengthen glutei, quads, unloaded exercise, e.g. stationary bike,
hydrotherapy
-OT e.g. home modification
-Analgesics, NSAIDs
-walking aids
-operative: THR
Femoro-acetabular impingement (FAI) - -anatomic variation of femoral head, acetabulum
or both
-Cam (cog or bump: young athletic men), pincer (middle-aged women) or mixed types
Cause: ? genetic? due to repetitive twisting forces during growth periods
-20% pop have FAI: ~20% of these have high hip pain
-associated w/ increased risk of intra-articular pathology e.g. labral tears, chondral damage, OA
FAI assessment - Early identification of FAI in sportspeople w/ hip pain important due to
risk of intra-articular injury
-groin/ant hip pain & decrease ROM
- +ve FADIR (flexion/adduction,internal rotation) test->radiological investigation if sportperson
FAI management - Conservative: aimed @ avoiding position of impingement, activity
sport modification, stretch tight structures (muscle or capsule), improve lumbo-pelvic & hip
strength & control
Surgical: if conservative management fails, arthroscopic femoral osteoplasty
Labral Tears - common in athletic population
Guarantee
Medial-lateral stability - glutei & iliotibili band
Anatomy femoral component - - convex articulating surface
- femoral neck angle 126 degrees to shaft & 12 degrees to frontal plane (angle of femoral
torsion)
- head faces acetabulum medially, cranially & ventrally
Anatomy pelvic component - - concave articulating surface (acetabulum)
- acetabular labrum continuous w/ rim
- transverse acetabular ligament completes circle
- acetabular notch permits vessels & nerves to pass in ligament of head
- articular far pad moves in/out of notch w/ pressure
Tension band - protects femur from excessive medial bending deformation
Loose-packed position - - position in which capsule is most relaxed
- minimal joint contact
- maximal joint play (accessory movement)
- hip: flex: 30d, abd:30d, slight external rotation
Close-packed position - Position in which capsule is most tensed. Maximal joint contact.
Minimal joint play (accessory movement) Hip: max. ext, slight int rotation, slight abd.
Capsular pattern - decreased movements due to entire capsule being shortened e.g. OA
,Hip: gross limitation of flex, abd, int rotation, limitation of ext, little or no limitations of ext
rotation
Extrinsic hip disorders - - hip & groin pain due to urogenital or abdominal organ disease
e.g. appendicitis
- disease of local structures e.g. lymphadenopathy
- referred pain from lumbar spine somatic structures (common), knee jt (rare), SIJ (buttock pain)
- L1 or L2 radiculopathy (rare)
Intrinsic hip disorders - - groin or lateral thigh pain common
- buttock or posterior thigh pain infrequently
- may radiate anteriorly, above knee or to shin (rare)
- extent of referral largely related to degree of inflammation
Intrinsic hip disorders e.g. - osteoarthritis (OA)
Femoro-acetabular impingement (FAI)
Labral tears
Tendinopathies e.g. hams, adds, glut med
- greater trochanteric pain syndrome (GTPS)
- Lateral femoral cutaneous nerve (LFCN) entrapment
Painful hip: elderly person, child
Osteoarthritis (OA) - -common >50yrs
-pain & x-ray changes: poor correlation
-pain related to loading
-may have decreased ROM & muscle wasting
-may develop flex, ER deformity
-antalgic, swinging or Trendelenburg gait
, Osteoarthritis management - -patient education
-weight loss
-passive joint mobilisation: physiological & accessory
-exercise: increase ROM, strengthen glutei, quads, unloaded exercise, e.g. stationary bike,
hydrotherapy
-OT e.g. home modification
-Analgesics, NSAIDs
-walking aids
-operative: THR
Femoro-acetabular impingement (FAI) - -anatomic variation of femoral head, acetabulum
or both
-Cam (cog or bump: young athletic men), pincer (middle-aged women) or mixed types
Cause: ? genetic? due to repetitive twisting forces during growth periods
-20% pop have FAI: ~20% of these have high hip pain
-associated w/ increased risk of intra-articular pathology e.g. labral tears, chondral damage, OA
FAI assessment - Early identification of FAI in sportspeople w/ hip pain important due to
risk of intra-articular injury
-groin/ant hip pain & decrease ROM
- +ve FADIR (flexion/adduction,internal rotation) test->radiological investigation if sportperson
FAI management - Conservative: aimed @ avoiding position of impingement, activity
sport modification, stretch tight structures (muscle or capsule), improve lumbo-pelvic & hip
strength & control
Surgical: if conservative management fails, arthroscopic femoral osteoplasty
Labral Tears - common in athletic population
