Hip pain: A comparison of Osteoarthritis and Femoroacetabular Impingement Kristine Flais, PT, DPT

Hip pain: A comparison of Osteoarthritis and Femoroacetabular Impingement Kristine Flais, PT, DPT

Most common cause of hip pain in older adults Prevalence of Hip OA

Age Gender Race Developmental disorders Genetics Occupation Sports exposure Previous injury Body mass index Leg length discrepancy Risk Factors

Entire joint structure is affected: Joint capsule shortening thickening& lengthening Osteophytes/spur development Sclerosis of subchondral bone Muscle weakness Pathoanatomical Features of OA

Joint space narrowing Osteophytes/spurs Subchondral sclerosis Imaging Findings

4 out of the 5 indicates a strong prediction of OA + LR 24.3: Probability of OA 91% Squatting increased symptoms Lateral hip pain with active hip FLEX Scour test with ADD causes lateral hip/groin pain Pain with active hip EXT PROM IR < to 25º Clinical prediction rule for OA

Patient profile: Greater than 60 y/o Pain description, location, behavior: Morning stiffness hip & groin Improves in less than an hour Lateral hip pain hip flexion weight bearing Posterior hip pain with squatting Aggravating factors: Walking Standing Squatting Stairs Kneeling Patient Profile

Assess hip ROM and joint mobility Limited passive hip joint motion in at least 3 of 6 motions Hip flexion < 115 Hip IR < 25º Examination

Assess hip strength SLR x 4 Hip IR/ER MMT Examination

Trendelenburg sign/ lurch https://www.youtube.c om/watch?v=iueekzqs fmk&feature=player_d etailpage Examination

Patrick s test + if reproduces pt s sx https://www.youtube.c om/watch?v=wpzbow KG7lc&feature=player _detailpage Examination

Scour test + scour test with adduction causes lateral hip or groin pain https://www.youtube.c om/watch?v=wob2es GaPLM&feature=play er_detailpage Examination

OA progresses slowly with THR/THA the primary clinical endpoint Dependent upon the severity and progression of OA Prognosis

Patient Education Gait & Balance training Manual treatment Hip joint mobilizations Caudal glide with hip flexion Lateral glide with IR FABER mob Long Axis Distraction Interventions

Caudal glide with hip FL Lateral glide w/hip IR FABER mobilization Long-axis distraction Hip mobilizations

Exercise Stretching techniques of shortened muscles Aerobic conditioning Strengthening hip abductors Interventions

Single Knee to chest self mobilization technique

Abnormal contact between the femoral head/neck and the acetabular margin Femoroacetabular Impingement

Pincer impingement: Acetabular abnormalities Cam impingement: Femoral head/neck abnormalities Combination: Most common Categories of Impingement

Genetics Sex Pincer lesions 30-40 y/o active women Cam impingement 20-30 y/o athletic men Sports Hockey players Goalies Butterfly style Risk Factors

Pincer Impingement: Increase acetabular depth Coxa Profunda Acetabular Protrusion Decreased acetabular depth Acetabular retroversion Radiographic Findings

Cam Impingement: Increased femoral neck diameter Increased thickness of femoral head-neck junction Radiographic Findings

Patient profile: Healthy active 25-50 y/o Involved in athletics Pain description, location, behavior: Anterior groin pain Sharp, catching, pinching C sign Aggravating factors: Running Excessive hip flexion Worst after/with sitting Squatting Twisting maneuvers Recumbent bike Patient Profile

Swayback posture Lengthened external oblique & iliopsoas Shortened rectus femoris and tensor fascia latae Disuse atrophy Gluteal musculature: Examination: Posture

Limited hip flexion, IR, &/or adduction compared to opposite side Insufficient posterior glide/joint play during hip flexion Examination: ROM

MMT: Iliopsoas, Gluteus medius, Gluteus maximus, Hamstrings, TFL Commonly iliopsoas long & weak TFL short Glut max short & weak Examination: Muscle Length/Strength

FADIR impingement test: Hip & knee flexion 90º combine with hip adduction and IR + sign sudden, sharp pain which replicates sx https://www.youtube.co m/watch?feature=player_ detailpage&v=zde_0vn Pjkw Examination: Special Tests

Thomas test https://www.youtube.c om/watch?v=nbrxinzvjs Ober s test https://www.youtube.c om/watch?v=3iz57sm 17-M Examination: Special Tests

Forward Bending Single leg stance Single leg step down SLR hip extension Quadruped rock back Gait Analysis Walking & running Examination: Movement analysis

FAI is proposed to contribute to OA Surgical management Arthroscopic procedures Labral tear resection or repair Clinical Course

Physical Therapy Manual therapy Stretching Strengthening Neuromuscular Re-ed Activity modification: Avoid activities that place the hip joint in positions that create impingement End range flexion, internal rotation, and adduction Interventions

Improve ROM Hip mobs Strengthen hip musculature Prone hip extension with knee flexion Side-lying hip lateral rotation Side -lying hip abduction with ER Ckc: lunges, standing hip hikes, single leg squats, forward step ups Correct faulty movement patterns Increasing step rate Decreased hip extension at terminal Use softer surfaces Avoid treadmill or narrow trail Dynamic warm-up Do NOT run consecutive days for 1st month Cross train Conservation Treatment Goals

Hip OA Greater than 60 y/o Morning stiffness hip & groin Lateral hip pain with WB and/or hip flexion (Trendelenburg gait) Squatting increased symptoms Lateral hip pain with active hip FLEX Scour test with ADD causes lateral hip/groin pain Pain with active hip EXT PROM IR < or = to 25º FAI 25-50 y/o Involved in athletics Anterior groin pain Sharp, catching, pinching No lateral thigh pain Worst after/with sitting Pinching Limited hip flexion, IR &/or adduction compared to opposite side +Impingement test (FADIR) Final Comparison

Questions?

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