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Hip - Greater Trochanteric Pain Syndrome
Hip - Greater Trochanteric Pain Syndrome
Physical Therapy
Evaluation:
Medical History:
Previous repetitive strain/overuse involving lower extremities
Trauma (LE)
Calcifications found in hip region tendons or bursae
Arthritis of ipsilateral/contralateral hip, knee, ankle, or lumbar
spine
Lumbar spondylosis
Leg length discrepancy
Autoimmune disease
Respiratory, cardiovascular, renal disorders and/or depression may affect the patients
overall tolerance and ability to perform and participate in the rehabilitation of this
condition.
Subjective:
Capture functional impairment using, for example, the Lower Extremity
Functional Scale (LEFS), devised by Binkley et al. (7)
Capture pain rating w/ visual analog scale (VAS), and pain location w/ a
body diagram
Assessment:
Problem List (Identify Impairment(s) and/ or dysfunction(s)):
Limited function (see subjective portion of examination)
Knowledge deficit condition; self-management; home program;
prevention
Decreased ROM
Decreased muscle strength or impaired muscle performance
Posture dysfunction
Pain
Prognosis:
Goals:
Short Term
Independent self-management of pain, posture, joint protection, and home
exercise program
Increase ROM
Increase strength
Decrease pain
Long Term
Maximize function and return to previously active lifestyle
Improve gait efficiency and quality
_X_ No
Established Protocol
_X_ No
Manual therapy for the treatment of any identified hip, lumbopelvic, knee, ankle,
and/or foot joint and soft tissue restrictions that have a mechanical potential of
negatively influencing the lateral hip.
Interventions Contd:
Adjunctive Modalities
-Moist heat/Ice for pain & symptom management
-Efficacy for TENS / iontophoresis / phonophoresis / and US have not been strongly
established in the current literature, but selected application may be indicated for this
patient population.
Frequency & Duration:
Largely dependent on severity, irritability, and stage of healing process
~1-2x/wk for 4-6 weeks as a general guideline
Expected range of number of visits per episode of care: 6-15.
After 2 re-evaluations, actively follow-up with
recommendations or referrals
Patient / Family Education:
Joint protection techniques
Proper use of assistive device
Posture and Positioning
Home exercise program
Pain self-management
Recommendations and referrals to other providers:
Orthopedist
Orthotist
Pain Management Clinic
Physiatrist
PCP
Rheumatologist
Re-evaluation
Discharge Planning
Commonly expected outcomes at discharge:
Non-antalgic gait
Strong and painless hip abduction on muscle testing or repeated functional
squatting, stair climbing, and (age appropriate) one-leg stance
proprioceptive and muscular endurance testing
Full and pain free hip active and passive ROM
Resolved palpable edema or tenderness to lateral hip palpation
Patients discharge instructions:
Continue with maintenance home program until symptom free for ~2 to 3
months, and gradual return to previous level of activity and sport per
physical therapy general guidance instructions.
Periodically (~every few months) have patient self-check endurance of
hip rotator cuff muscles with repeated resisted exercises and address with
previously issued strengthening program.
Authors:
Amy Jennings
Janice McInnes
Marie-Josee Paris
05/10/04
Revised:
Nick Karayannis
12/13/07
Reviewers:
Ken Shannon
Heather Renick-Miller
Reviewers:
Janice McInnes
REFERENCES
1. Walker, Peter FRACS(Orth); Kannangara, Siri FRACP; Bruce,
Warwick JM FAOrthoA; Michael, Dean FRCS (Tr & Orth); Van der
Wall, H PhD. Lateral Hip Pain: Does Imaging Predict Response to
Localized Injection? [Section II: Original Articles: Hip].
Lippincott Williams & Wilkins, Inc., 2007.
2. Fagerson, Timothy L. The Hip Handbook. Boston; ButterworthHeinemann. 1998: pp. 66-67.
3. Adkins, SB and Figler, RA. Hip pain in athletes. American Family
Physician. 61(7):2109-18, 2000 Apr 1.
4. Chung CB, Robertson JE, Cho GJ, Vaughan LM, Copp SN, Resnick D.
Gluteus medius tendon tears and avulsive injuries in elderly women: imaging
findings in six patients. American Journal of Roentgenology. 173(20:351-3,
1999 Aug.
5. Hoeksma HL, Dekker J, Ronday HK, Heering A, Van der Lubbe N,
VelC, Breedveld FC, Van den Ende CH. Comparison of manual therapy and
exercise therapy in osteoarthritis of the hip: a randomized clinical trial.
Arthitis and Rheumatism. 51(5):722-9, 2004 Oct 15.
6. Macdonald CW, Whitman JM, Cleland JA, Smith M, Hoeksma HL.
Clinical outcomes following manual physical therapy and
exercise for hip osteoarthritis: a case series. Journal of Orthopaedic
and Sports Physical Therapy. 2006 Aug; 36(8): 588-99.
7. Binkley, et. al. The Lower Extremity Functional Scale (LEFS): Scale
Development, Measurement Properties, and Clinical Application. Physical
Therapy: Vol. 79, No.4, April 1999, pp 371-383.
8. Magee, David J. Orthopedic Physical Assessment. Philadelphia; W.B.
Saunders Company, 1992.
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