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Clinical Examination of the Patient with Posterior Hip Pain

  • Hal D. Martin
Chapter

Abstract

Advancements in the understanding of hip joint anatomy and biomechanics have contributed to the improvement of diagnosis and treatment decisions for distal causes of deep gluteal syndrome (DGS). Ischiofemoral impingement, hamstring syndrome, and pudendal nerve entrapment are sources of posterior hip pain that can simulate symptoms of DGS. To evaluate the etiology of posterior hip pain, it is necessary to understand and assess the interaction between the osseous, capsulolabral, musculotendinous, neurovascular, and kinematic levels. The combination of a comprehensive history and physical examination with imaging and ancillary testing is critical to diagnose posterior hip pain. Six key physical examination tests are described to differentiate distal versus proximal sources of extrapelvic posterior hip pain. Differential diagnosis of DGS, IFI, hamstring syndrome, and pudendal nerve entrapment is dependent upon the understanding of the entire anatomy, biomechanics, and clinical presentation of posterior hip pain.

Keywords

Ischiofemoral impingement Hamstring syndrome Posterior hip pain Deep gluteal syndrome Sciatic nerve entrapment Ischial tunnel Hamstring tear 

References

  1. 1.
    Martin HD, Reddy M, Gomez-Hoyos J. Deep gluteal syndrome. J Hip Preserv Surg. 2015;2(2):99–107.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Chambers HG, Sutherland DH. A practical guide to gait analysis. J Am Acad Orthop Surg. 2002;10(3):222–31.CrossRefPubMedGoogle Scholar
  3. 3.
    Martin HD, Savage A, Braly BA, Palmer IJ, Beall DP, Kelly B. The function of the hip capsular ligaments: a quantitative report. Arthroscopy. 2008;24(2):188–95.CrossRefPubMedGoogle Scholar
  4. 4.
    Martin HD, Hatem MA, Kivlan BR, Martin RL. Function of the ligamentum teres in limiting hip rotation: a cadaveric study. Arthroscopy. 2014;30(9):1085–91.CrossRefPubMedGoogle Scholar
  5. 5.
    Martin HD, Khoury AN, Schroder R, Johnson E, Gomez-Hoyos J, Campos S, et al. Contribution of the pubofemoral ligament to hip stability: a biomechanical study. Arthroscopy. 2017;33(2):305–13.CrossRefPubMedGoogle Scholar
  6. 6.
    Gomez-Hoyos J, Khoury A, Schroder R, Johnson E, Palmer IJ, Martin HD. The hip-spine effect: a biomechanical study of ischiofemoral impingement effect on lumbar facet joints. Arthroscopy. 2017;33(1):101–7.CrossRefPubMedGoogle Scholar
  7. 7.
    Gomez-Hoyos J, Martin RL, Schroder R, Palmer IJ, Martin HD. Accuracy of 2 clinical tests for ischiofemoral impingement in patients with posterior hip pain and endoscopically confirmed diagnosis. Arthroscopy. 2016;32(7):1279–84.CrossRefPubMedGoogle Scholar
  8. 8.
    Orava S. Hamstring syndrome. Oper Tech Sports Med. 1997;5(3):143–9.CrossRefGoogle Scholar
  9. 9.
    Patti JW, Ouellette H, Bredella MA, Torriani M. Impingement of lesser trochanter on ischium as a potential cause for hip pain. Skelet Radiol. 2008;37(10):939–41.CrossRefGoogle Scholar
  10. 10.
    Torriani M, Souto SC, Thomas BJ, Ouellette H, Bredella MA. Ischiofemoral impingement syndrome: an entity with hip pain and abnormalities of the quadratus femoris muscle. AJR Am J Roentgenol. 2009;193(1):186–90.CrossRefPubMedGoogle Scholar
  11. 11.
    Young IJ, van Riet RP, Bell SN. Surgical release for proximal hamstring syndrome. Am J Sports Med. 2008;36(12):2372–8.CrossRefPubMedGoogle Scholar
  12. 12.
    Martin HD, Kivlan BR, Palmer IJ, Martin RL. Diagnostic accuracy of clinical tests for sciatic nerve entrapment in the gluteal region. Knee Surg Sports Traumatol Arthrosc. 2014;22(4):882–8.CrossRefPubMedGoogle Scholar
  13. 13.
    Martin HD, Palmer IJ. History and physical examination of the hip: the basics. Curr Rev Musculoskelet Med. 2013;6(3):219–25.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Johnson KA. Impingement of the lesser trochanter on the ischial ramus after total hip arthroplasty. Report of three cases. J Bone Joint Surg Am. 1977;59(2):268–9.CrossRefPubMedGoogle Scholar
  15. 15.
    Hatem MA, Palmer IJ, Martin HD. Diagnosis and 2-year outcomes of endoscopic treatment for ischiofemoral impingement. Arthroscopy. 2015;31(2):239–46.CrossRefPubMedGoogle Scholar
  16. 16.
    Dierckman BD, Guanche CA. Endoscopic proximal hamstring repair and ischial bursectomy. Arthrosc Tech. 2012;1(2):e201–7.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Gomez-Hoyos J, Reddy M, Martin HD. Dry endoscopic-assisted mini-open approach with neuromonitoring for chronic hamstring avulsions and ischial tunnel syndrome. Arthrosc Tech. 2015;4(3):e193–9.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Miller SL, Gill J, Webb GR. The proximal origin of the hamstrings and surrounding anatomy encountered during repair. A cadaveric study. J Bone Joint Surg Am. 2007;89(1):44–8.CrossRefPubMedGoogle Scholar
  19. 19.
    Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am. 1969;51(4):737–55.CrossRefPubMedGoogle Scholar
  20. 20.
    Byrd JW, Jones KS. Prospective analysis of hip arthroscopy with 2-year follow-up. Arthroscopy. 2000;16(6):578–87.CrossRefPubMedGoogle Scholar
  21. 21.
    Mohtadi NG, Griffin DR, Pedersen ME, Chan D, Safran MR, Parsons N, et al. The development and validation of a self-administered quality-of-life outcome measure for young, active patients with symptomatic hip disease: the international hip outcome tool (iHOT-33). Arthroscopy. 2012;28(5):595–605. quiz 6-10 e1.CrossRefPubMedGoogle Scholar
  22. 22.
    Griffin DR, Parsons N, Mohtadi NG, Safran MR. Multicenter arthroscopy of the hip outcomes research N. A short version of the international hip outcome tool (iHOT-12) for use in routine clinical practice. Arthroscopy. 2012;28(5):611–6. quiz 6-8.CrossRefPubMedGoogle Scholar
  23. 23.
    Martin HD, Shears SA, Johnson JC, Smathers AM, Palmer IJ. The endoscopic treatment of sciatic nerve entrapment/deep gluteal syndrome. Arthroscopy. 2011;27(2):172–81.CrossRefPubMedGoogle Scholar
  24. 24.
    Martin HD, Khoury A, Schroder R, Palmer IJ. Ischiofemoral impingement and hamstring syndrome as causes of posterior hip pain where do we go next? Clin Sports Med. 2016;35(3):469–86.CrossRefPubMedGoogle Scholar
  25. 25.
    Martin RL, Schröder SR, Gomez-Hoyos J, Khoury AN, Palmer IJ, McGovern RP, Martin HD. Accuracy of 3 clinical tests to diagnose proximal hamstrings tears with and without sciatic nerve involvement in patients with posterior hip pain. Athroscopy. 2017;34(1):114–21.CrossRefGoogle Scholar
  26. 26.
    Schroder RG, Reddy M, Hatem MA, Gomez-Hoyos J, Toye L, Khoury A, et al. A MRI study of the lesser trochanteric version and its relationship to proximal femoral osseous anatomy. J Hip Preserv Surg. 2015;2(4):410–6.PubMedPubMedCentralGoogle Scholar
  27. 27.
    Gomez-Hoyos J, Schroder R, Reddy M, Palmer IJ, Martin HD. Femoral neck anteversion and lesser trochanteric retroversion in patients with ischiofemoral impingement: a case-control magnetic resonance imaging study. Arthroscopy. 2016;32(1):13–8.CrossRefPubMedGoogle Scholar
  28. 28.
    Ekstrom RA, Donatelli RA, Carp KC. Electromyographic analysis of core trunk, hip, and thigh muscles during 9 rehabilitation exercises. J Orthop Sports Phys Ther. 2007;37(12):754–62.CrossRefPubMedGoogle Scholar
  29. 29.
    Halbertsma JP, Goeken LN, Hof AL, Groothoff JW, Eisma WH. Extensibility and stiffness of the hamstrings in patients with nonspecific low back pain. Arch Phys Med Rehabil. 2001;82(2):232–8.CrossRefPubMedGoogle Scholar
  30. 30.
    Neumann DA. Kinesiology of the hip: a focus on muscular actions. J Orthop Sports Phys Ther. 2010;40(2):82–94.CrossRefPubMedGoogle Scholar
  31. 31.
    Sullivan MK, Dejulia JJ, Worrell TW. Effect of pelvic position and stretching method on hamstring muscle flexibility. Med Sci Sports Exerc. 1992;24(12):1383–9.CrossRefPubMedGoogle Scholar
  32. 32.
    Cibulka MT, Sinacore DR, Cromer GS, Delitto A. Unilateral hip rotation range of motion asymmetry in patients with sacroiliac joint regional pain. Spine (Phila Pa 1976). 1998;23(9):1009–15.CrossRefGoogle Scholar
  33. 33.
    Ellison JB, Rose SJ, Sahrmann SA. Patterns of hip rotation range of motion: a comparison between healthy subjects and patients with low back pain. Phys Ther. 1990;70(9):537–41.CrossRefPubMedGoogle Scholar
  34. 34.
    Vad VB, Bhat AL, Basrai D, Gebeh A, Aspergren DD, Andrews JR. Low back pain in professional golfers: the role of associated hip and low back range-of-motion deficits. Am J Sports Med. 2004;32(2):494–7.CrossRefPubMedGoogle Scholar
  35. 35.
    Van Dillen LR, Bloom NJ, Gombatto SP, Susco TM. Hip rotation range of motion in people with and without low back pain who participate in rotation-related sports. Phys Ther Sport. 2008;9(2):72–81.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Van Dillen LR, Gombatto SP, Collins DR, Engsberg JR, Sahrmann SA. Symmetry of timing of hip and lumbopelvic rotation motion in 2 different subgroups of people with low back pain. Arch Phys Med Rehabil. 2007;88(3):351–60.CrossRefPubMedGoogle Scholar
  37. 37.
    Hibner M, Desai N, Robertson LJ, Nour M. Pudendal neuralgia. J Minim Invasive Gynecol. 2010;17(2):148–53.CrossRefPubMedGoogle Scholar
  38. 38.
    FitzGerald MP, Kotarinos R. Rehabilitation of the short pelvic floor. II: treatment of the patient with the short pelvic floor. Int Urogynecol J Pelvic Floor Dysfunct. 2003;14(4):269–75.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  • Hal D. Martin
    • 1
  1. 1.Medical and Research Director, Hip Preservation Center, Baylor University Medical CenterDallasUSA

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