Lecture 1: Overuse Injuries At Hip- Trochanteric Bursitis

Front 1

What are extrinsic causes of hip pain?

Back 1

1. Viscerogenic Sources of Hip Symptoms:
a. Sites: kidneys, ureter, urinary tract, Ileitis, Crohn's ds
b. Systemic Symptoms: abdominal spasms, urinary freq/urgency, decreased urinary output, fever, chills, HA, HTN, nausea, vomiting
2. Somatic Sources of Hip Symptoms: L3, L4, L5

Front 2

What is Trochanteric Bursitis?

Back 2

1. Pain secondary to compression of bursa
a. Mm contraction (agonist contraction)
b. Mm stretch ( agonist lengthened)
c. Ext force compresses bursa
2. Deep, dull achy pain
3. Grtr trochanteric area
4. Increases with activity
5. Decreases with rest

Front 3

Incidence, Site, and Contributing factors of Trochanteric Bursitis?

Back 3

1. Incidence: 4th and 5th decade
2. Site: Posterior aspect of grtr troch
3. CONTRIBUTING FACTORS: SHORT ITB (NOT CAUSE)
{Lengthen the short ITB (the what)...and Identify the reason for the shortness and eliminate it (the why)}

Front 4

Short ITB and Trochanteric Bursitis?

Back 4

Short ITB, ONLY when its length is challenged contriButes to trochanteric bursitis
So...
ITB Shortness
+
activity that challenges the length of the short ITB
=
Repetitive compression of the bursae -> troch bursitis

Front 5

What is Trochanteric Bursitis?

Back 5

1. Pain secondary to compression of bursa
a. Mm contraction (agonist contraction)
b. Mm stretch ( agonist lengthened)
c. Ext force compresses bursa
2. Deep, dull achy pain
3. Grtr trochanteric area
4. Increases with activity
5. Decreases with rest

Front 6

Incidence, Site, and Contributing factors of Trochanteric Bursitis?

Back 6

1. Incidence: 4th and 5th decade
2. Site: Posterior aspect of grtr troch
3. CONTRIBUTING FACTORS: SHORT ITB (NOT CAUSE)
{Lengthen the short ITB (the what)...and Identify the reason for the shortness and eliminate it (the why)}

Front 7

Short ITB and Trochanteric Bursitis?

Back 7

Short ITB, ONLY when its length is challenged contriButes to trochanteric bursitis
So...
ITB Shortness
+
activity that challenges the length of the short ITB
=
Repetitive compression of the bursae -> troch bursitis

Front 8

CAUSES of:
ITB adaptively shortens when?

Back 8

1. Structural causes:
a. Biomechanical abnormailities that result in CKC LE overpronation due to- anterior pelvic tilt and hip flexed, IR
b. LLI- low side in abd
2. Functional:
a. TFL dominance 2nd to muscular imbalance
b. Lateral knee instability

Front 9

ITB shorteness due to...

Back 9

TFL dominance:
TFL acts to concentrically flex, IR, ABD
a. Contributory factor: adaptive shortening- "overpronator" and leg length discrepancy

Front 10

ITB shortness and TFL dominance cycle

Back 10

If its short...,
Then it will fire first and foremost...,
Which will make it shorter...,
Which perpetuates the cycle of TFL dominance and ITB tightness and...

Front 11

CAUSES of:
ITB adaptively shortens when?

Back 11

1. Structural causes:
a. Biomechanical abnormailities that result in CKC LE overpronation due to- anterior pelvic tilt and hip flexed, IR
b. LLI- low side in abd
2. Functional:
a. TFL dominance 2nd to muscular imbalance
b. Lateral knee instability

Front 12

ITB shorteness due to...

Back 12

TFL dominance:
TFL acts to concentrically flex, IR, ABD
a. Contributory factor: adaptive shortening- "overpronator" and leg length discrepancy

Front 13

ITB shortness and TFL dominance cycle

Back 13

If its short...,
Then it will fire first and foremost...,
Which will make it shorter...,
Which perpetuates the cycle of TFL dominance and ITB tightness and...

Front 14

Aggravating activity: that challenges the length of the short ITB?

Back 14

1. Uneven surfaces (hi side in ADD- road cahmber, shore line, indoor track
2. Crossed leg posture (ADD the TFL)

Front 15

Assymetries in Trochanteric Bursitis?

Back 15

Tender to palpation of posterior trochanter

Front 16

Range, Resistance, Reactivity of Trochanteric Bursitis?

Back 16

1. Mm Contraction: pain with ABD
2. Mm stretch: pain and limitation with A/PROM ADD at the endrange
Note: Passive ABD will not cause pain b/c not active contraction
3. STTT:
a. Pain with resisted ABD (midrange)
b. Pain with active ABD (highly reactive)
c. Pain with AROM and PROM ADD (endrange)- stretch

Front 17

Tissues Characteristics (Tests) with Trochanteric Bursitis?

Back 17

1. Length: (+) Ober and 2 jt. hip flexor- TFL
2. Weakness 2nd to pain
3. Play?
4. Tone?

Front 18

Management of Trochanteric Bursitis?

Back 18

1. PRICE
2. Flexibility
3. Strengthening...what's long and weak??
4. Leg length
5. Gait
6. Posture
7. Activity patterns
8. Shoes

Front 19

Diagnostic Groupings*?

Back 19

Based on a cluster of signs and symptoms
Bursitis: local pain 2nd to bursal compression
a. Isometric resistive contraction
b. Lengthening of same muscle

Front 20

Differential Dx?

Back 20

Trochanteric bursitis or lumbar radiculopathy?
At what level?
What aspects of the exam an you use o differentiate btw the two dx's?
DERMATOMAL!!!