Referred Pain and Nerve injury in Hip joint; causes, treatment

REFERRED PAIN AND NERVE INJURY

The hip is innervated primarily from the L3 spinal level; hip joint irritation is usually felt along the L3 dermatome reference from the groin, down the front of the thigh to the knee.

Major Nerves Subject to Injury or Entrapment

Sciatic nerve. Entrapment may occur when the sciatic nerve passes deep to the piriformis muscle (occasionally it passes over or through the piriformis).

Obturator nerve. Isolated injury is rare, although uterine pressure and damage during labor may occur.

Referred Pain and Nerve injury


Femoral nerve. Injury may result from fractures of the upper femur or pelvis, during reduction of congenital dislocation of the hip, or from pressure during a forceps labor and delivery.

Common Sources of Referred Pain in the Hip and Buttock Region

If painful symptoms are referred to the hip and buttock region from other sources, primary treatment must be directed to the source of the irritation. Common sources of referred pain into the hip and buttock region include: Nerve roots or tissues derived from spinal segments L1, L2, L3, S1, and S2 Lumbar intervertebral and sacroiliac joints

Hip Muscle Function During Gait

Hip Flexors

The hip flexors control hip extension at the end of stance, then contract concentrically to initiate swing.105 With loss of flexor function, a posterior lurch of the trunk to initiate swing is seen. Contractures in the hip flexors prevent complete extension during the second half of stance; the stride is shortened. To compensate, a person increases the lumbar lordosis or walks with the trunk bent forward.

Hip Extensors

The hip extensors control the flexor moment at initial foot contact, and the gluteus maximus initiates hip extension.With loss of extensor function, a posterior lurch of the trunk occurs at foot contact to shift the center of gravity of the trunk posterior to the hip. With contractures in the gluteus maximus, some decreased range occurs in the terminal swing as the femur comes forward, or the person may compensate by rotating the pelvis more forward. The lower extremity may rotate outward because of the external rotation component of the muscle, or the gluteus maximus may place greater tension on the iliotibial band through its attachment, leading to irritation along the lateral aspect of the knee with excessive activity.

Hip Abductors

The hip abductors control the lateral pelvic tilt during swinging of the opposite leg. With loss of function of the gluteus medius, lateral shifting of the trunk occurs over the weak side during stance when the opposite leg swings. This lateral shifting also occurs with a painful hip because it minimizes the torque at  The tensor fasciae latae also functions as an abductor and may become tight and affect gait with faulty use.

Effect of Musculoskeletal Impairments on Gait

Bony and joint deformities change alignment of the lower extremity and therefore the mechanics of gait. Painful conditions cause antalgic gait patterns, which are characterized by minimum stance on the painful side to avoid the stress of weight bearing. These impairements result in various hip pathologies which are the leading cause of pain among older adults.

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