BELOW IS A RECENT UPDATE REGARDING HIP PAIN. IT IS A CONGLOMERATE OF MEDICAL TERMS TO BASICALLY RELATE THAT HIP PAIN CAN COME FROM MANY SOURCES. IT CAN COME FROM THE LOW BACK, HIP ARTHRITIS, BURSITIS, NECROSIS OR A HOST OF OTHER SOURCES. KNOWING HOW TO TEST THESE CONDITIONS IS MOST PARAMOUNT TO SPEEDY RECOVERY AND APPROPRIATE TREATMENT.
In this featured post, WPT therapists summarize how to help your patients with hip pain return to ADLs (as adapted from Clinical Conduit Ed Mulligan).
Over ten years ago, an MRI study by Bird , et al (Arthritis Rheum. 2001. 44:2138-45) showed that swelling of the bursa was present in a very small percentage (less than 10%) of cases and did not occur in the absences of a gluteal tendinopathy. The authors of this study found that a positive Trendelenburg’s sign was the most accurate predictor of the pathology. A subsequent study in Arthritis Rheum by Lesquesne , M, et al, found two tests that have high predictive value in recognizing this tendinopathy syndrome . They found that reproduction of symptoms within 30 seconds of a standing on a single leg or resistance to external rotation from a hip flexed and internally rotated position were an accurate gauge of the condition. The single limb stance test was 97% sensitive and had perfect specificity . The resisted de-rotation test was almost as good at 88% sensitivity and 97% specificity.
Our collective clinical experience seems to indicate that these patient s have a notable asymmetry in their active and passive hip abduction range which would be a classic sign of a contractile injury. Our DPTs have further noted that L4-S 1 nerve roots compressed from lumbar derangement or or other radicular causes can contribute to pain and dysfunction that looks like trochanteric bursitis.
Ed Mulligan (an ortho PT guru at UT Southwestern) recently wrote that he wondered if, much like a torn rotator cuff in the shoulder, if these patients would consistently demonstrate a lag when the lower limb is placed in an anti-gravity position . From the following article, it appears others wondered the same thing. We will provide a brief overview of their findings but this article is in an open access journal so anyone can download the entire article if interested. CLICK HERE
To evaluate the presence of hip abductor damage the authors developed a study to evaluate if the hip lag sign could be a reliable and valid predictor of gluteal tendon tears. The study was a blinded , prospective , single-clinic design with 26 patients who underwent an MRI- examination as the reference standard on the status of their tendon. About 38% of the hips had a positive lag sign and the other 62% were negative.
Given the prevalence of 38% in this study it would have shifted the possibility to the point where you’d only have about a 5% chance of having a false positive or negative. In addition, the reliability between examiners was extremely high. While this is just a preliminary study I think it deserves further investigation. The original author of the Clinical Conduit has plans with his team to see f they can replicate their findings and decrease the need for MRI evaluation. Identifying this pathology is a great start in planning the appropriate treatment , especially considering the implication s for physical therapy and how one diagnosis may alter treatment drastically.
Using the mantra of diagnose before you prescribe, our clinical success rates have been significant for recovery of function. When therapy is somewhat generically applied for hip pain, the success rates drop as clinically measured compared to high skilled levels of diagnosis from the DPT. Please call Bryan at 208-736-2574 or email bryan@wrightpt.com for any further information on this subject.
