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How do you determine the aggravating factors of the hip?
- - likely direction of restricition
- - movts the pt is avoiding
- - irritability
- * pain intensity
- * how quickly it comes on
- * how quickly it eases
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Area of pain for pts with hip problems?
- - groin and lower back pain- need to think L2 (if pins and needles/ numbness- from lumbar spine)
- - arthritic hips sometimes present with knee pain
- - slipped femoral capepiphosis- boys 10-14 sometimes present with knee pain
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What are some easing factors for those with hip problems?
- - taking wieght off leg
- - lying position of ease- on back
- - movement- general movement
- - heat
- - medication
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What are the aggravation factors for hip problems?
- - sitting
- - crossing legs
- - getting in and out of your car
- - up and down stairs
- - squat
- - on/ off bicycle
- - gardening
- - putting socks on
- - starting to walk after period of immobility
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Mechanical features of hip problems?
- - stiff like heat
- - panadol
- - worse activity
- - daily pattern
- - eases with rest
- - short term stiffness in morning <1hr
- - worse end of day- stiff
- Joint- OA- stiffness
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Inflammatory features of hip problems?
- post injury:
- - antiinflammatory- RA- systemic- night pain, bilateral systems, other jts- chornic pain- likes heat
- - Worse 1-2 hrs
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Night pain for people with hip problems?
- difficulty getting to sleep
- best/ worse position
- wake during the night eg moving
- how often
- how long does it take to get back to sleep
- pillows- easing factor
- matress
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Special questions?
- - tumor that sits in the middle of the back presents like a mm
- - recent cold and flu- could be systemic
- - general health
- - unexplained weight loss
- - past history of cancer
- - surgery
- - FH (family history) of rheumatoid
- - diabetes, heart problems
- - kidney usually lower back
- - urinary problems- usually can present groin
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What is the 24hr behaviour?
- Morning
- - effect of rest
- - morning stiffness > 30 min- inflam or OA hip
- Evening
- - activity levels
- - eased with rest
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What investigations for hip problems?
- - XR
- - MRI
- - Arthrogram-joint die, leaking
- - Bone scan- whole body- hotspots- blood supply where it shouldnt
- - screening for urogenital, intestinal function
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History of hip problem pts?
- - gradual or sudden
- - overuse/ misuse- standing on one hip
- - sudden eg twist on one leg, labral tear (soft cartilage- makes jt deeper), mm, lig tear
- - history of LBP (lower back pain) 1st
- -referred pain- hip only refers down
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