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20 Cards in this Set

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  • Back
What are extrinsic causes of hip pain?
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
What is Trochanteric Bursitis?
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
Incidence, Site, and Contributing factors of Trochanteric Bursitis?
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)}
Short ITB and Trochanteric Bursitis?
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
What is Trochanteric Bursitis?
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
Incidence, Site, and Contributing factors of Trochanteric Bursitis?
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)}
Short ITB and Trochanteric Bursitis?
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
CAUSES of:
ITB adaptively shortens when?
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
ITB shorteness due to...
TFL dominance:
TFL acts to concentrically flex, IR, ABD
a. Contributory factor: adaptive shortening- "overpronator" and leg length discrepancy
ITB shortness and TFL dominance cycle
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...
CAUSES of:
ITB adaptively shortens when?
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
ITB shorteness due to...
TFL dominance:
TFL acts to concentrically flex, IR, ABD
a. Contributory factor: adaptive shortening- "overpronator" and leg length discrepancy
ITB shortness and TFL dominance cycle
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...
Aggravating activity: that challenges the length of the short ITB?
1. Uneven surfaces (hi side in ADD- road cahmber, shore line, indoor track
2. Crossed leg posture (ADD the TFL)
Assymetries in Trochanteric Bursitis?
Tender to palpation of posterior trochanter
Range, Resistance, Reactivity of Trochanteric Bursitis?
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
Tissues Characteristics (Tests) with Trochanteric Bursitis?
1. Length: (+) Ober and 2 jt. hip flexor- TFL
2. Weakness 2nd to pain
3. Play?
4. Tone?
Management of Trochanteric Bursitis?
1. PRICE
2. Flexibility
3. Strengthening...what's long and weak??
4. Leg length
5. Gait
6. Posture
7. Activity patterns
8. Shoes
Diagnostic Groupings*?
Based on a cluster of signs and symptoms
Bursitis: local pain 2nd to bursal compression
a. Isometric resistive contraction
b. Lengthening of same muscle
Differential Dx?
Trochanteric bursitis or lumbar radiculopathy?
At what level?
What aspects of the exam an you use o differentiate btw the two dx's?
DERMATOMAL!!!