Question

The patient is a 38 year old male plant manager and new long distance runner presenting with complaints of left anterolateral hip and thigh pain. He was referred to physiotherapy from his orthopedist, who diagnosed him with greater trochanteric bursitis.
His onset of symptoms was 6 weeks prior to the initial evaluation, after running a marathon (26.2 miles). By the end of the race, he was in intense, constant pain, rated at a 5/10 that remained constant for 3 days after. His symptoms became intermittent, and have not changed much since that time. His plan was to run 4 marathons in the next year, but he has stopped running completely, as every time he runs the pain comes back to the same intensity it was immediately after the race.
Since becoming symptomatic he has tried many stretches and strengthening exercises he researched on the internet. He has also received advice from his massage therapist. However, the same pain comes back when he runs. He has good shoes, and changes them every 250-300 miles, per industry recommendations. Because of all of his research, he is concerned that this is an issue that is going to keep him from running altogether.
When asked if the patient had any imaging, he replied “only an xray”. Then he said, “Why, do you think I need an MRI?” Sensing fear of life-altering structural damage, the patient was assured that one of the goals of physiotherapy is to determine the right place for them. With a careful assessment over 2-3 visits, we should know if further testing is necessary.


1. Given the history, anatomy and function of the hip, which structures are you going to examine? Explain why and how you will perform the examination of these structures.
2. What functional activities would you assess and how would you establish these    functional baselines. How vigorous can you be in your examination?
3. What examination tests would you use, and why would you use them?
4. What other subjective information would you get from this runner?

Answer 1

Anterolateral pain may be causes of labral tear,osteoarthritis,osteonecrosis in intra-articular invovled and snapping hip and inguinal disruption in extra-articular hip invovled but patient's diagnosed to the case Trochanteric bursitis.

Trochanteric bursitis is a common type of chronic hip pain,Trochanteric bursitis is inflammation of the bursa at the part of greater trochanter.when this bursa becomes irritated or inflamed due to causes pain in the hip

Causes of greater trochanteric bursitis-

-Trauma...A history of falls or bumping the hip

-Poor posture

- Previous surgery

- Bone spurs or calcium deposits

- overweight

Symptoms of greater trochanteric bursitis-

- hip pain (anterolateral side) worse at night

- pain increase in walks up the stairs

- Pain increase in activity

- swelling

- tenderness

- stiffness

Examination of the greater trochanteric bursitis-

hip movements are more effect to the internal and external rotation  

Physical examination of the 'OBER'S TEST'

Posiition of the patient-side lying

Procedure-patient in side lying with hip and knrr of lower leg flexed and  stabilize pelvis.Passively abduct and extend upper leg with knee extended or flexed to 90 degree ,then allow it to drop towards plinth.

Possitive sign-upper lrg remains abducted and does not lower to plinth

Examination to the range of motion of the hip-Flexion,Extension, Abduction,Adduction, internal rotation and external rotation

Manual muscle testing for lower limp muscles

Treatments of the greater trochanteric bursitis

Acute phase-medications for pain relieves-Nonsteroidal anti-inflammatory drug,Analgrsic and steroids

rest

ice packs

Chronic phase-above medicine to be continue

Physiotherapy treatment-

Active exercise of the hip joint

sretching exercise of the tight structure

electrotherapy treatment-ultrasound (pulse mode-intensity 1.0 m/A2 and time 8 to 10 min)

strenghtening exercise of quadriceps mainly and including all lower extremity muscles