Week 6 Category 1

Activity 1
Write 2-3 simple mechanical differential diagnoses (use the Dx template).

1. Chronic, constant, moderate-severe, right groin strain/sprain

Reasoning: pain in upper and medial thigh; dull ache (5/10) pain that then 'catches' in
groin area causing 9/10 pain; pain worse on activity

2. Chronic, constant, moderate-severe, right hip acetabular labral tear

Reasoning: commonly presents with groin pain; pain can radiate into lower back (he
complains of lower back stiffness); pain made worse with physical activity; pain worse in
squatting position; can be due to degeneration in older population;

3. Chronic, constant, moderate-severe, right hip osteoarthritis, with associated groin pain

Reasoning: elderly; gradually worsening; constant dull pain, usually 5/10; no specific
onset; general stiffness; played a lot of sport in youth (i.e. degeneration); pain in groin
region sharp and 9/10

Activity 2

Perform an appropriate examination for a patient with a suspected simple mechanical

diagnosis.
• Gait
• Assess gait on A-P and sagittal view
• Observe for abnormal gait, arm swing, posture, analgia
o Possible affected gait on affected hip side
• Observation
• Assess for any atrophy of muscles, swelling, joint & limb position
o Swelling & ecchymoses may be observed on affected side
• ROM
• Perform AROM on hip, lumbar spine & knee
• Perform PROM on hip, lumbar spine & knee
• Perform RROM on hip, lumbar spine & knee
• Static Palpation
• Palpate the following regions, looking for tenderness, pain, swelling, etc
o Hip capsule
o Femur/femoral head
o Greater trochanter
o Musculature (Gluteus maximus/Medius; Rectus femoris; adductors; quadratus
lumborum; semimembranosus/semitendinosus; ITB; etc)
o General screen of lumbar spine
o General screen of knee

• Orthopaedic tests
• Belt test - differentiates between hip & lumbar pathology
• Gaenslen's test
• SI compression/distraction
• Trendelenberg's test
• Yeoman's test
• Ober's test
• Patrick Fabere test
• Thomas test
• Scour test

• Muscle tests
• Adductors
• Abductors

• Neurological tests
• Assess the sensory and motor components of the L5 & S1 nerve roots
• Assess reflexes of L5 & S1
Including how do you differentiate (via history & examination) a lumbosacral radiculopathy
from a hip pathology (perhaps make a comparison table – radiculopathy v’s hip pathology)

Hip Pathology Lumbosacral radiculopathy

History/presentation

Local pain at hip Begins initially with low back pain

Dull ache Pain then refers down the leg into

hip/buttock/leg

Sharp/stabbing pain

Follows dermatomal pattern

Examination

Obers test Braggards test

Patrick fabere test Djerines triad test

Yeomans test Kemps test

Thomas test Kernigs test/sign

SLR

Slump test

Negative SMR results Positive SMR results

Outline a complete management plan for your simple MSK diagnosis.

Management plan for groin sprain/strain

• RICE (rest, ice, compression, elevate) for the first 48-72 hours during acute phase
• Patient education
o Educate on proper warm-up and stretching
o Ensure patients do not stress muscle until healing complete

• Avoid painful activities

• NSAID's
• Mobilisation/manipulation of compensatory misalignments (i.e. hip, SIJ, lumbar)
• Massage
o Contraindicated in acute phase!

• Rehab
o Begin with PROM, then progress to isometric contractions
 o Strengthen hip flexors & abdominal muscles

• During the acute phase, managing pain and inflammation is key. Massage is not recommended
in acute phase. Muscle is not to be stretched during acute phase