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What nerve root levels receive afferent input from the anterior pubic symphysis?
L2 to L4 leading to groin pain.
What nerve root levels receive afferent input from the posterior pubic symphysis?
S3 to S5 leading to genital pain.
Describe the 3 dimensional movement of the hip during flexion.
Femoral head flex, abduct, IR
Describe the 3 dimensional movement of the hip during extension.
Femoral head extension, adduction, ER
Describe the 3 dimensional movement of the hip during abduction.
Femoral head abduction, extension, ER.
Describe the 3 dimensional movement of the hip during adduction.
Femoral head adduction, flexion, ER.
What patholgies may be present in a 4-10 yo with hip pain?
- Transient synovitis
- Legg-Calve-Perthes disease
- Juvenile RA
What age for epiphysolysis?
Age for articular osteochondritis dissecans?
Age for ischemic femoral necrosis and synovial osteochondromatosis?
Age for hip labral lesions?
Age for labral cysts, sacral pathologies, and stress fractures of the femur or pelvis?
Greater than 40 yo, especially in men.
Who is at risk for stress fractures in the proximal femoral region?
Young, athletic females with the female triad (eating disorder, amenorrhea, and osteoporosis).
What conditions are associated with aching pain?
What conditions are associated with sharp pain?
- Labral tears
- Articular loose bodies and pt may complain of giving way or locking
What conditions are associated with burning pain?
Nerve entrapments in the femoral, lateral femoral cutaneous, ilioinguinal, genitofemoral, obturator, and sciatic nerves
What conditions are associated with groin pain?
- Affliction of the hip and labrum
- Symphysis pubis lesion
- Adductor tendopathy
- Iliopectineal bursitis
- Incompetent abdominal wall
- Organic lesions of the abdominal cavity and plvic region
What conditions are associated with buttock pain?
- SIJ dysfunction
- Gluteal bursitis
- Hamstring tendopathy
- Hamstring syndrome
- Lumbar spine
- DJD or labrum
- Posterior symphysis pubis
What conditions are associated with posterolateral pain?
- Trochanteric bursitis
- Gluteal insertion tendopathy or disruption
- Component loosening of THA
- Lumbar spine
What conditions are associated with groin pain with coughing or sneezing?
- Pubic symphyseal affliction
- Tendopathy of the adductor longus or rectus abdominus
What is the capsular pattern of the hip?
Flexion, abduction, and IR
A non-traumatic capsular pattern of the hip in younger individuals may be related to what conditions?
- Reiter syndromme
- Legg-Calve-Perthes disease
What is the best treatment for traumatic synovitis of the hip?
Early mobilization including joint-specific low-velocity mobs into traction.
What is transient synovitis?
It emerges from a viral, autoimmune, or microtraumatic origin and i more common in boys under 6 yo and rare in adults.
Describe the onset of slipped capital femoral epiphysis.
- Boys 2:1 over girls, usually overwieght and underdevelped.
- Acute will have significant groin pain that prohibits wt bearing.
- If gradual, will begin with mild groin or anterior knee pain and muscle guarding will increase with limited IR, increased ER, and Drehman sign.
What is the treatment for slipped capital femoral epiphysis?
Percutaneus pinning in situ followed by partial weight bearing for 4-6 weeks.
What is Legg-Calve-Perthes disease?
Aseptic bone necrosis of the femoral head.
What is the stagging of Legg-Calve-Perthes disease?
- Stage I: 25%
- Stage II: 50%
- Stage III: 75%
- Stage IV: 100%
What conditions can lead to articular loose bodies?
- Osteochondritis dissecans
- Synovial osteochondromatosis
- Villonodular synovitis
- Flake fracture
What are extra-articular causes of snapping hip?
- Thickening of the IT tract at the greater trochanter
- Ilipsoas at the pectin pubis
- Gluteus maximus fibrosis in the posterior hip
- Adventitios bursal formation
What are the areas most likely to have an avulsion?
- Rectus femoris
- Biceps femoris
What areas are most likely to devolop a tendopathy?
- Hamstrings at the ischial tuberosity
- Rectus femoris at the AIIS
- Sartorius at the ASIS
- Ilipsoas over the iliopectineal eminence
- Gluteal muscles at and around the greater trochanter
What position will cause pain with trochanteric (gluteal) bursitis?
Full flexion, adduction, and ER or IR.
What conditions are painful with resisted hip adduction?
- Acute adductor tendopathy
- Chronic adductor tendopathy
- Rectus abdominus
- Obturator nerve
- Osteitis pubis
- Ossifying myositis
- SI joint
What is the most common cause of groin pain?
Increased tendon load during directional change type sports.
Describe the positions where a tendonapathy will be most painful.
Adductor longus and brevis
- Adductor longus and brevis: hip in neutral
- Gracilis: hip in neutral along with painful resisted knee flexion
- Pectineus: hip flexion and adduction with hip in 90deg flexion
What should reproduce true symphyseal pain?
Resisted hip adduction with the hip in 45deg flexion.
What type of treatment is usually needed for osteitis pubis?
- Repeated injections (prolotherapy) or surgical stabilization.
- Conservative treatment typically fails.
What is the best treatment of a sports hernia?
Surgery with open mesh repair appearing superior to laparoscopic repair.
This can produce referred pain in the groin that is difficlt or impossible to clinicall reproduce.
What is typically the type of traumatic labral tear? Degenerative?
- Traumatic: vertical - full substance or partial substance with avulsion
- Degenerative: horizontal - detachment of the fibrocartilaginous labrum from the transition zone at the acetabular cartilage or separation of cartilaginous planes within the substance of the labrum
With what condition may a patient have a completely unremarkable exam other than pain with weigth bearing and maybe the fulcrum test?
Stress fracture in the proximal third of the femur and femoral neck or the pubic ramus.
What condition is likely to be painful with passive hip ER in full flexion?