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Common orthopedic hip dysfunction - Coggle Diagram
Common orthopedic hip dysfunction
strains: grade 1,2,3
glute medius strain: common in runners and swimmers, leg length discrepancy increases risk, pain is commonly just proximal to GT, may coexist with trochanteric bursitis
bald trochanter: rupture/retraction of glute med/min from GT (degenerative in nature), treatment includes using cane/NSAIDs, surgery may be an option
groin strains: adductors in sports with quick acceleration/deceleration
treatment: 8-12 weeks strengthening program. adductors should be within 80% of abductor strength
hamstrings are most frequently strained muscle due to uncontrolled stretch or forceful contraction
-true grade 3s are rare
-most often occur early or late in sporting event
-rehab shoulder include agility/trunk stabilization, although strength deficits are predictor of reinjury
quad strains are uncommon, most often occur during rapid deceleration, RF is most frequently involved, most often pain is in middle of thigh or 8cm distal to ASIS
obliques may become strained at insertion on iliac crest, MOI of forceful contraction of abdominals with trunk laterally flexed (most common in contact sports)
trochanteric bursitis:
-more common in women
-more common in middle age/elderly and runners
-mostly report gradual onset with aching over trochanter and lateral thigh
-running on banked surfaces, leg length discrepancy, runners who cross midline
-direct blows to hip in contact sports
symptoms:
-snapping at lateral hip if ITB involved
-provoked with stairs and laying on involved side
-pain may radiate to ipsilateral lumbar region
-stretching glute max with full flexion, add, IR reproduces pain
-hip abd, ext, and ER may be painful
-TTP over post aspect of GT
treatment: rest, ice, NSAIDs, using pillow between knees, avoid laying on involved side, avoid stairs, stretching ITB, hamstrings, glutes if warranted, strengthening
iliopectineal/iliopsoas bursitis
-bursa lies deep to iliopsoas and ant to hip joint
overuse with sports including rowing, weightlifting, uphill running, and comp track and field
clinical findings:
-insidious onset
-passive hip flexion with add, ext are painful
-hip flexor MMT may be painful, ER may be weak
treatment: gentle stretching, US, IFC, ER strengthening, local injections
ischial tuberosity bursitis: bw isch tub and glute max
-usually occurs in those that have sedentary occupations or direct fall
-pain worsens with sitting, may refer to post thigh
-hamstring stretching is painful, decreased hip extension at terminal stance
-rest/NSAIDs usually successful
-avoid sitting or use well cushioned seats
sign of buttock
contusions in athletes
-grade 1: minimal discomfort, should not limit participation in competition
-grade 2: more painful, limits ability to perform at extremes of ROM/strength
-grade 3: more pain, swelling, bleeding
hip pointer: contusion of lateral hip
-results from a blow to iliac crest
-TFL muscle belly impacted in most cases
-may involve tearing of EO at iliac insertion, periostitis of IC, or contusion to GT
clinical findings:
-athlete immediately disabled by pain, trunk flexed fwd and to side of injury
-abrasion/swelling of iliac crest, immediate or delayed bruising
-initially RICE
-ice massage, light stretching
-pain-free exercise
-RTS is one week for grade 1, 6 weeks for 2-3
radiographs to rule out fracture