Download Ulnar nerve entrapment/Cubital tunnel syndrome

Shoulder
Rotator Cuff Tear
 MOI: fall on shoulder, trauma, progressive tear over time without trauma
 Etiology: usually male over 60 yo
 c/o: unable to initiate abduction, experiences pain if partial tear; cannot initiate abduction and will shrug shoulder instead if
complete tear
 Best exam findings:
o Complete Tear
 MSTT: weak and painless
 MMT: grade 0/5
o Partial Tear
 Palpation for condition (swelling)
 MSTT: weak and painful
 P for T: pain over RTC tendon
o Positive Special Tests: empty cans, ER/IR lag signs, drop arm
SLAP Lesion (Superior Labral Anterior Posterior)
 Tear in labrum from anterior to posterior on superior aspect disrupting suction cup effect within GH joint, which lessens
stability
 MOI: FOOSH or deceleration with throwing
 Involves Long Head of Biceps Tendon
 Best exam findings: MLT, MMT (anything lengthening biceps tendon)
 Special test: comp with rotation , biceps load test I/II, OBRIEN’S
Impingement Syndrome
 MOI: postural/functional, nerve, trauma, disease
 Humeral head is bumping into acromion when arm is raised – joint space decreased
 Signs & Symptoms:
o Structural: spurs, shape of acromion, thickened rotator cuff tendon, increased prominence of greater tuberosity of
humerus
o Instability/laxity: humeral head does not sit in glenoid causing poor arthrokinematics, increased muscular effort,
anterior/posterior/inferior hypermobility, Bankart lesion (etc).
o Hypomobility: capsular pattern (er>abd>ir) of restriction (hypomobile inferior direction), adhesion commonly in
inferior capsule
o Muscle imbalance (tightness/weakness)
 Weakness posteriorly: rotator cuff, scapulothoracic musculature, humeral head depressors
 Tightness anteriorly: pec minor/major, shoulder internal rotators
o Structural inspection: increased thoracic kyphosis, forward head, rounded shoulders, anterior scapula with
internally rotated humerus
o Tx: stretch, posture, activity mod, after 6 weeks tx refer to MD if not improved
Tendinosis / tendinitis of biceps or any of the rotator cuff muscles
 Best exam findings:
o Palp for cond: warmth, redness, swelling at biceps tendon OR supraspinatus
o MSTT: strong and painful with flex and supination (biceps) OR ER and abd (supra)
o MLT: pain with lengthening
o Palp for tenderness over tendon
 Treatment: calm inflammation, trans-friction massage, effleurage, eccentric exercises, US, treat source of pain
Subacromial bursitis
 c/o: pain over lateral brachial region of shoulder, usually gradual onset, Hx of tendonitis/osis, comfort in loose-packed
position (20 flex/20 abd)
 Best exam findings:
o Palp for cond: warmth/swelling over bursa
o PROM: pain in any direction that compresses bursa
o AROM: pain in any direction when contracting muscle is over bursa
o Palp for tenderness: painful over bursa
Hypo or hypermobility/instability of GH joint
Dislocations
 Anterior GH Joint Dislocation
o Complications include: long head of biceps tear, RTC tear, axillary nerve (delt, teres min) injury, AC joint
dislocation, SC joint dislocation
Adhesive capsule
 Etiology:
o Gradual insidious onset
o Result of immobilization or other pathology
o Inflamed capsule that adheres to humeral head
o Capsule can become fibroticshoulder stuck and ball bearing movement no longer is fluid
o Occurs in perimenopausal women, diabetes, trauma, prolonged immobilization
o c/o of sore to sleep on side, difficulty with doing hair and fastening bra
 Clinical manifestations:
o Passive ROM limited in capsular pattern:
 Classical ROM: ER > Abd > IR
 Accessory ROM: anterior glide > inferior glide > posterior glide
 5 best exam findings:
1. AROM: decreased ER > Abd > IR
2. PROM Classical – quantity: ER > Abd > IR
3. PROM Accessory – quantity: anterior glide > inferior glide > posterior glide
4. PROM Classical – quality: capsule tightness end-feel
5. PROM Accessory – quality: capsule tightness end-feel
Peripheral nerve entrapments
 Suprascapular nerve entrapment (supra or infra mm)
o Entrapped under suprascapular ligament or at tight, bony suprascapular notch
o Presentation: pain with insidious onset; deep, dull aching pain at posterior shoulder; shoulder weakness,
specifically of supraspinatus
o Best exam findings??:
 MSTT: strong and painful ER and abd
 Palp for tenderness: discomfort over midpoint of superior scapular border
Elbow
Lateral Epicondylitis/tendinosis (Tennis elbow)
 Repetitive use injury that involves overuse of extensors; muscles primarily involved: ECRL, ECRB and ED – ECRB tendon is
usually most inflamed
 Symptoms: pain over tendon, pain at lateral epicondyle, loss of function, pain with gripping
 Best exam findings
o Positive P4C over lateral epicondyle (warmth, redness, edema); -osis will be unremarkable
o Strong and painful MSTT for elbow/wrist extension, especially for ECRB (middle finger)
o MLT: pain and limitation with lengthening involved muscles (extensors)
o Positive P4T over ECRB tendon, lateral epicondyle
o Other Exam findings
 Pain over lateral aspect of the elbow with radiating pain down the forearm
 Decreased strength with pain, especially while grasping something
 Rule out radial nerve (test supinator )
Medial Epicondylitis/tendinosis (Golfer’s elbow)
 Typically involves FCR and pronator teres muscles; occasionally palmaris longus, FCU and FDS
 Symptoms: pain and tenderness over involved muscles, loss of function
 Best exam findings
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Positive P4C over medial epicondyle (warmth, redness, edema); -osis will be unremarkable
Strong and painful MSTT for wrist flexion
MLT: pain and limitation with lengthening involved muscles (flexors)
Positive P4T over medial epicondyle and involved muscles
Other Exam findings
 Pain over medial aspect of the elbow with radiating pain down the forearm
 Loss of function when picking something up with elbow flexion
Biceps tendonitis/tendinosis
 Best exam findings
o Positive P4C over tendon insertion (warmth, redness, edema); -osis will be unremarkable
o Strong and painful MSTT for elbow flexion and possibly shoulder flexion as well as well as supination
o MLT: pain and limitation with lengthening of biceps muscle
o Positive P4T over biceps tendon
Triceps tendinosis/tendonitis
 Usually results from a sudden severe strain to the triceps; could also be an overuse injury
 Best exam findings
o Positive P4C over tendon insertion at the elbow (warmth, redness, edema); -osis will be unremarkable
o Strong and painful MSTT for elbow extension and shoulder extension
o MLT: pain and limitation with lengthening of triceps muscle
o Positive P4T over tendon
Myositis Ossificans
 Heterotopic bone formation between muscle fibers that results from trauma/bleeding in area; commonly seen in brachialis
muscle with supracondylar fractures, posterior dislocations of elbow, and aggressive stretching of elbow flexors
 Best exam findings
o P4C – increased warmth over muscle
o Decreased A/PROM – going further into range is painful
o Normal accessory PROM – the muscle is limiting, not the capsule
o MSTT/MMT – resistance causes increased pain
o Positive P4T over muscle, may feel a mass
 NO stretching, massage or possibly use US with caution, use pulsed settings
Hypomobility due to prolonged immobilization
 Following surgery, injury/fracture
 Best exam findings
o Decreased A/PROM with capsule tightness end-feels
o Decreased accessory mobility
Ulnar nerve entrapment/Cubital tunnel syndrome
 Can be the result of a fracture, dislocation or subluxation at elbow
 Motor to hypothenar muscles and small, deep muscles in hand (Interossei), adductor policis
 Sensory to the ulnar side of the hand, pinky and ulnar half of ring finger
 Best exam findings
o If motor – decreased muscle strength (MMT) and possible positive MSTT
o If sensory – diminished sensation in distribution, positive ULTT (shld dep, 10 abd, elbow flex ,sup, ER, wrist ext,
ulnar dev) ulnar n.
Median nerve entrapment/Pronator syndrome (sld dep, abd, elb flex-sup, ext wrist, er shld, ext elbow, abd)
 Motor to APB, OP, FPL, FPB, FDS, palmaris longus, FDP 1 & 2, lumbricals 1 & 2
 Sensory to palmar surface of thumb, index and middle fingers
 Best exam findings
o If motor – decreased muscle strength (MMT) and possible positive MSTT
o If sensory – diminished sensation in distribution, positive ULTT for median n.
 Anterior interosseous nerve branch
o Entrapped at the elbow by pronator teres and MOTOR only
o Innervates: FPL, FDP, PQ
o Unable to do pinch grip test
Radial nerve entrapment/Radial tunnel syndrome
 Can be following trauma such as a fracture to the radial head
 Deep branch is motor only – EPL, EPB, APL; commonly entrapped at supinator muscle belly
 Superficial branch is sensory to the dorsal aspect of the hand; common entrapment at ECRB
 Best exam findings
o
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If motor – decreased muscle strength (MMT)/positive MSTT for supination, decreased MLT and + P4T of supinator
If sensory – diminished sensation in distribution, positive ULTT (shldr, abd, pron, wrist flex, ulnar dev,) for radial n.,
MSTT/MMT reproduces symptoms, MLT – parasthesia with lengthening, + P4T at ECRB
UCL- 0-60: ANT POSTION OF ANT BUNDLE/ POST PORTION OF ANT BUNDLE 60-120/ POST BUNDLE MOST TAUT AT 90-140
-P4C
-PROM
-SPECIAL TEST: MOVING VALGUS, MILKING, VALGUS- 0 DEG OSSEOUS, MM, LIG/ 30 DEG MORE ANT PORTION OF ANT, MORE POST
FAT PAD: flex fat pat in fossa, as it ext fat pad has to move out to let olecranon move in
-differentiat from triceps tendonopathy
Wrist and Hand
 Carpal tunnel syndrome
o Diagnosis: some irritation of the Median N at the wrist; decreased sensation and motor involvement from the wrist up
o Best Exam findings
 Neurovascular: paresthesia in median nerve sensory distribution, derm, myo, ULTT
 MMT
 History: c/o night pain
o Other exam findings
 History: aggravated by any movements of the wrist
 Weakness/atrophy of thenar muscles (esp. AbdPB)
o Causes
 Trauma: fracture/fall, disease, space occupying lesion (cyst)
 Ergonomics: “overuse” of typing position with bad posture
 Displaced lunate: FOOSH injury
 Edema: increased intra-capsular fluid
 Flexor retinaculum tightness
 Tight flexors
 Pronator teres syndrome
 C5-T1 nerve root scalenes
 Hypomobility due to prolonged immobilization
o Usually follows surgery or fracture/injury
o Best exam findings
 Decreased A/PROM with capsule tightness end-feels
 Decreased accessory mobility in the direction of limitation with capsular tightness end feel
 Lateral epicondylitis/osis (aka: tennis elbow)
o Repetitive use injury that involves overuse of the extensor muscles
o Primary muscles involved: ECRB**, ECRL, ED
o Best exam findings
 P for C: -itis: will have positive results; -osis: will not have any results
 MSTT: strong and painful elbow extension and wrist extension
 MLT: pain and limitations while lengthening ECRL, ECRB, ED
 P for T: tenderness just distal to lateral epicondyle and/or ECRB muscle
o Other Exam findings
 Pain over lateral aspect of the elbow with radiating pain down the forearm
 Decreased strength with pain, especially while grasping something
 Medial epicondylitis/golfer’s elbow
o Primary muscles involved: FCR and pronator teres (occasionally palmaris longus, FCU and FDS)
o Best exam findings
 P for C: same as lateral epicondylitis
 MSTT: strong and painful elbow flexion and wrist flexion
 MLT: pain and limitations while lengthening FCR and pronator teres
 P for T: tenderness just distal to medial epicondyle
o Other Exam findings
 Pain over medial aspect of the elbow with radiating pain down the forearm
 Loss of function with picking something up with elbow flexion
 De Quervain’s syndrome
o Tenosynovitis on the APL and EPB
o Pain in thumb with flexion and (+) Finkelstein’s test
o Possible causes: tight pronators, hypermobility
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Rule out scaphoid fx and superficial radial nerve damage
Exam findings
 Wrist pain that radiates proximally up the forearm and distally towards the thumb
 P for T: over APL and EPB tendinous sheath and radial styloid process
 Pain with contraction and/or lengthening of the two muscles
 (+) Finkelstein’s test
Dupuytren’s contracture
o Contracture of palmar fascia  flexion deformity of MCP and PIP of 4th and 5th digit
o Insidious onset
o No muscle involvement
o No sensory involvement
Ulnar nerve entrapment
o Three main areas of entrapment: cubital tunnel, guyon’s canal and forearm flexors
o Motor to: FCR, FDP (medial half), ODM, AbdDM, FDM, 3rd/4th lumbricals, D/P interossei, AddP, PB
o Sensation to: ulnar side of hand, ½ ring finger, pinkie
o MOI:
 Direct trauma- fall on elbow
 Traction of nerve, changes in carrying angle
 Degeneration
 Fracture in area
 Dislocation and/or subluxation of elbow
o Best exam findings
 If motor- decreased muscle strength (MMT) and possible positive MSTT
 If sensory- diminished sensation in distribution, positive ULTT for ulnar N.
Medial nerve entrapment/Pronator teres syndrome
o Sites of entrapment: carpal tunnel, scalene, medial humeral condyle, pronator teres, biceps aponeurosis, ligament of
Struthers, cubital fossa
o Motor innervation: AbdPB, FPL, FPB, lumbricals ½, PL, FDS, FDP, PT, FCR, PQ, OP
o Sensory innervation: palm of thumb, first and second finger
o Found in MLT
o Anterior interosseous nerve branch
 Entrapped at the elbow by pronator teres and MOTOR only
 Innervates: FPL, FDP, PQ
 Unable to do pinch grip test
Radial nerve entrapment
o Entrapped by the supinator or ECRB (usually atraumatic)
o Direct trauma- fracture to radial head or direct blow to area
o Deep branch- motor only
 Entrapment at the supinator muscle belly
 (+) exam findings
 MSTT/MMT: weak contraction of the supinator
 MLT/PROM: pain with lengthening supinator
 P for T: at supinator
o Superficial branch- sensory only to dorsal aspect of hand
 Entrapment at ECRB or CMC area
 (+) exam findings
 MSTT/MMT: reproduces symptoms with contraction of ECRB
 MLT: reproduces symptoms with lengthening of ECRB
 P for T: at ECRB
o Intersection syndrome
 Differentiate
 Sx: 2nd tunnel
 Mstt, mlt, p4t, possible special test
Foot & Ankle
Hypermobilities resulting in excessive pronation
 Pronation involves DF, abd, and eversion

Hypermobilities would present during joint accessory mobility:
o A/P glide of talus on tib/fib
o Medial glide of talus on tib/fib
o Lateral arc glide of calcaneus
Plantar Fasciitis
 MOI: increased hindfoot pronation (stressed/overworked/stretched) OR supination (tight/stressed when walking)
 Best exam findings:
o MLT of plantar fascia (ankle and great toe DF)
o Palp for tenderness: calcaneal insertion (medial calcaneal tubercle)
 Treatment:
o Usually over-pronated so strengthen arch supporters, tapeorthotics or arch support, ionto, deep tissue
stretching
Hallux valgus
 Lateral deviation of 1st MTP, bone not properly aligned
 Difference between structural and positional hallux valgus: if structural, the valgus position will not be changed, the joint
can’t maintain proper alignment
 MOI: Impairments that can cause hallux valgus:
o Hypermobility of capsule
o Effusion/edema
o Muscle weakness
o Muscle tightness
Bunions
 Prominence of MT head at 1st MTP; exostosis and callus may form
 Causes: hallux valgus, instability at first TMTrotation of MT shaft=prominence
Tendinosis/tendinitis of tibialis posterior
 MOI: overuse/overactivity, could be gradual onset
 Presentation:
o Pain and swelling, loss of arch and development of flatfoot, inability to stand on toes
 Best exam findings:
o Palp for cond: warmth, swelling, redness over medial ankle
o MLT: pain with DF and eversion
o MSTT: strong and painful for PF
o Palp for tenderness: at medial ankle behind medial malleolus
Tendinosis/tendinitis of Achilles tendon
 MOI: running, jumping, gradual onset
 Best exam findings:
o Palp for cond: warmth, swelling, redness over posterior ankle
o MLT: pain with DF (knee flexed)
o MSTT: strong and painful for PF
o Palp for tenderness: at distal tendo-Achilles
Compartment syndrome
 MOI: increased pressure within a closed location results in increased pressure on neurovascular and muscle structures
o Acute (trauma)chronic (exercise induced)
 Best exam finding:
o Neurovascular: myotomes, dermatomes, capillary refill
 Compartment Contents:
o Anterior compartment: Deep peroneal nerve (anterior tibialis, EHL, EDL, peroneus tertius), anterior tibial artery
and vein
o Lateral compartment: Superficial peroneal nerve (peroneals)
o Deep posterior compartment: Tibial nerve (flexor digitorum, posterior tibialis, FHL), posterior tibial artery and vein,
peroneal artery and vein
 Posterior tibial exertional compartment syndrome:
o Common MOI: rearfoot pronation
o Treat inflammation firect then decrease aggravating activity; maybe arch supports/orthotics
 Antero-lateral compartment syndrome:
o Common MOI: trauma to anterior tibia; weak DF, tight gastroc/soleus
 Medial tibial stress syndrome:
o Tibial periositis at medial soleus or posterior tibialis
o Palp for tenderness: distal post-med border of tibia
Ankle sprains
 Anterior talofibular
o MOI: PF with inversion
o Blends with joint capsuleleading to joint effusion
 Calcaneofibular
o MOI: neutral PF/DF with inversion
o Common injury to peroneal tendon
 Posterior talofibular
o MOI: inversion
 Anterior tibiofibular (“high ankle sprain”)
o MOI: ER/IR with eversion; talus driven up between tib/fib on landing
o Fibular fractures common
 Deltoid ligament
o MOI: eversion force, rarely damaged
o More likely to avulse part of tibia before spraining this ligament
Stress fractures
 Uni-malleolar fracture
 Bi-malleolar fracture
 Trimalleolar fracture: both malleoli and other structure, usually posterior distal aspect of tibia
o Usually surgically resolved
 Pott’s fracture/dislocation
o Any dislocation and fracture of malleoli
 Impairments: atrophy, capsule tightness, decreased ROM, swelling
 MD Treatment : closed reduction or ORIF, casted/immobilized
o Complications: decreased ROM, swelling, malunion
o Possible end-feels for classical DF s/p immobilization for distal tib/fib: abnormal muscle, tight muscle, swelling,
capsule tightness
Morton’s Neuroma
 c/o: pain over metatarsals; change in sensation in webspace of toes
 Best exam findings:
o Palp for tenderness: between the metatarsal heads
 Cause: bundle of nerves inflamed
o e.g. tight toe box in shoes, high heels
 Diff between neuroma and interdigital nerve entrapment:
o If pressure removed from interdigital nerve the symptoms will dissipate, but there will be no change if it is a
neuroma
Shin Splints
 Causes: overuse, stress fractures, overpronation/flat feet
 Usually seen in runners
 c/o: dull, aching pain in anterior lower leg
Anterior Compartment Syndrome
Pain increases with exercise
No pain at rest
MSTT (-)
Neurovascular symptoms
Shin Splints/Anterior Tendonitis
Pain decreases with exercise
Pain remains after stopping activity
MSTT (+)
No neurovascular symptoms
Knee
ACL/PCL Injuries (pre-surgical) – I did what I could with this one based on the notes
 ACL tear symptoms: feeling of “giving way” while walking, possible effusion and hemarthrosis
 PCL tear – common MOI is a dashboard injury or falling on a flexed knee
 ACL tear best exam findings
o Decreased A/PROM for knee extension
o Positive anterior drawer/Lachman’s/anterolateral pivot shift tests
 PCL tear best exam findings
o Positive posterior sag test and Godfrey’s test
ACL reconstruction
 Performed if patient is an athlete or is high-functioning; this diagnosis would be obvious if they are coming from the doctor;
treatment would follow protocol
MCL Injury
 MOI: valgus stress with or without a combined rotational stress
 Symptoms
o 1st degree sprain: pain with palpation and positive valgus stress test
o 2nd degree sprain: severe pain with palpation and ligament stressing, swelling within 24 hours
o 3rd degree sprain: ligament ruptured, knee unstable, no activity, fluid inside and/or outside of joint
LCL Injury
 MOI: varus stress
 Symptoms
o 1st degree sprain: pain with palpation and positive varus stress test
o 2nd degree sprain: severe pain with palpation and ligament stressing
o 3rd degree sprain: ligament ruptured, knee joint becomes unstable
Meniscus tears
 Common injury with forced ER during flexion or forced IR during extension; also hyperflexion
 Symptoms: acute joint line pain, joint effusion gradually develops, pt. may complain of buckling or giving way of knee,
difficulty with full knee extension, “locking” of knee experienced at 20-45°, squatting is painful
 Best exam findings
o Decreased A/PROM
o Positive McMurray’s and Apley’s compression
ITB Syndrome
 Symptoms: pain WITH activity, not at rest; anterior, lateral and “deep” knee pain
 Best exam findings
o Positive P4T over Gerdy’s, lateral retinaculum and/or lateral epicondyle
o Positive Nobles compression or Patla’s variation of Nobles test
Unhappy Triad
 Injury to the knee that consists of all of the following: ACL tear, MCL tear and meniscus tear
 You would see signs and symptoms of all of the above
Patellar tracking disorders
 Patellofemoral syndrome is a generic name for anterior knee pain of gradual onset, especially while sitting or descending
stairs; common with a lateral tracking patella
 Some causes of compression of lateral patellofemoral articulation: rotary limb mal-alignment (increased Q-angle), abnormal
position of tibia relative to femur (genu varus/valgus), knee hyperextension (patella alta), increased foot pronation 
medial tibial rotation…, abnormal tracking and crepitus in weight-bearing, soft tissue restrictions such as a tight lateral
retinaculum, VMO atrophy, pelvic instability, and where the medial retinaculum attaches (pain with lateral glide of patella)
 Any of these characteristics can lead to the anterior knee pain caused by compression at the lateral patellofemoral
articulation
 Best exam findings with a lateral tracking patella:
o Pain with active knee extension and passive knee flexion
o Hypomobile medial glide of the patella
o Strong and painful MSTT for knee extension
o Positive patella compression special test
o Positive P4T over medial retinaculum, patellar tendon, distal ITB and biceps femoris tendons
Patellar tendon injuries
 Patellar tendonitis can be caused by excessive jumping, hip/foot problems (altered mechanics), or muscle imbalances
 Symptoms: pain with jumping/running, decreased pain with rest, pain with stairs, pain that limits function, some swelling
 Best exam findings
o Positive P4C over knee (warmth, redness, edema)
o Strong and painful MSTT for knee extension
o Positive Thomas test (MLT)
o Positive P4T over tendon
 Note – patellar tendonitis and Osgood Schlatter’s disease present the same; look at age and imaging to confirm
Quadriceps and Hamstring injuries – FYI: I kind of made these up after reading through the notes

Best exam findings will vary depending on the injury, but the most common theme will be:
o Positive P4C over the site of injury
o Decreased A/PROM with probable abnormal muscle end-feel
o Strong and painful MSTT
o Decreased MLT due to pain or inability to get into test position
o Muscle weakness
Osteoarthritis
 Best exam findings – not in the actual notes, but these were the best I came up with
o Pain, especially with prolonged activity
o Positive P4C – inflammation
o Decreased A/PROM
o Muscle weakness
Knee Arthroplasty
 Straight-forward diagnosis coming from the doctor; treatment will follow protocol
Hip
 OA
o Best exam findings
 Pain especially with prolonged activity
 P for C: inflammation
 Decreased A/PROM (classical and accessory)
 Muscle weakness
o Other exam findings
 History: pain is worst in the morning, pain and stiff joints
 THA
o THA approaches and limitations
 Anterior: between sartorius/RF/TFL/Glut min-med
 No ABD, extension or IR beyond neutral
 Anterolateral: between glut med and TFL
 No ABD, extension or IR beyond neutral
 Direct lateral: release anterior ABD from greater trochanter
 Posterolateral: combination of posterior approach with distal limb
 No hip flexion >90, ADD past midline and IR past neutral
 Transtrochanteric: involves the osteotomy of greater trochanter
 NO active ABD
o Exam findings
 Depends on the approach
 Probably going to find P for C
 Definitely decreased A/PROM, but don’t do accessory mobility
 Probably weak MSTT
 Definitely decreased length
 Definitely week
 Limited mobility due to hypomobile capsule and/or muscle imbalance
o Decreased A/PROM with hypomobile capsular end feel or abnormal muscle end feel
o Decreased accessory mobility with hypomobile capsular end feel
o Decreased muscle length
o Decreased strength
o ** all of these depend on which direction of tightness and/or what muscles are weak
 Trochanteric bursitis
o Pain assessments: On-set of pain is insidious or associated with particular activity
o History: subjective – what your patient is telling you
 Aggravated by ascending stairs
 Pressure/lying on the involved side- awakened at night due to pain
 Complains of deep aching
 Pain with crossing legs
o Palpation for condition
 One of the BEST exam findings (may not be seen in every patient)
 warmth and swelling seen
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AROM: Pain at end range of active motion
PROM
 Passive ADD will be painful and limited
 Passive flexion with ADD and IR will be painful
 No pain with accessory joint movements
o MSTT: Possible strong and painful for hip ABD, extension and ER due to contraction of muscles that run over the bursa
o MMT: Possible pain
o MLT: Positive Ober’s test with pain and tightness (both regular and modified)
o Palpation for condition: tenderness over greater trochanter
Piriformis syndrome: piriformis muscle has been implicated as a potential source of sciatic symptoms causing buttock and
hamstring pain
o Short piriformis syndrome (hip impingement syndrome)
 Typical symptoms
 No lower back pain
 Butt, thigh and LE paresthesia
 Patient complains of pain in butt which increases with prolonged WB and sitting
 Relief comes with standing or walking
 Structural inspection: standing foot turned out with leg ABD and ER, “flat” back
 Gait: lack of HS, short stride length, and walk with knee bent
 P for T: deep palpation of piriformis will provoke distal symptoms
 MLT: lengthening of piriformis with produce symptoms
 MMT: rotators will
 Neurovascular: (+) SLR and slump test
 Decreased A/PROM (classical and accessory)
Adductor or iliopsoas strains
o Adductor
 Usually the adductor longus
 MOI: most common in sports that involve rapid change in direction; often experienced with squatting, lunging
and twisting; can be chronic from overuse
 Exam findings
 Pain with resisted hip ADD and passive elongation of ABD
Tendinosis/tendinitis of iliopsoas/rectus femoris
o Best exam findings
 Strong and painful MSTT for hip flexion and knee extension
 Positive P for C: over tendon insertion above the patella (warmth, redness, edema); not going to see with
iliopsoas
 Positive P for T over tendon
 MLT: pain and limitation with lengthening of iliopsoas and rectus femoris
ITB syndrome
o Signs and symptoms
 Pain about 2cm above joint line over condyle with 30⁰ flexion
 History: complaint of lateral, deep knee pain, occurs when doing activity and not painful at rest
 Referred pain from the lower back
 Deep knee pain
o Best exam findings
 P for T: at lateral condyle, gerdy’s tubercle and lateral retinaculum
 (+) Noble’s compression and Patla’s version of noble’s