systemic causes of pelvis and LE pain

7 signs which if positive could indicate serious hip/gluteal pathology (osteomyelitis, neoplasm, fracture, abscess, infection) and require medical referral?

1.Passive hip flexion more limited/painful than SLR. 2.Limited and painful SLR 3.Limited trunk flexion 4.Painful weakness of hip extension 5.Swelling, tenderness in buttock 6.Empty end feel with hip flexion 7.Noncapsular pattern of hip movement restriction

what does the log rolling test indicate?

Hip rotation in supine can be used to differentiate between intraarticular vs extraarticular hip pathology.

extraarticular hip pain patterns ?

Lateral side or posterior aspect of hip bursitis trigger points

leg pain can be caused by?

Leg pain is most often caused by injury, inflammation, tumor, altered peripheral circulation, deep venous thrombosis or neurologic impairment

intraarticular hip pain pattern?

Posteriorly deep within the buttock or anteriorly in the groin, sometimes radiating down the anterior thigh

pelvic diseases can refer pain or symptoms to?

abdomen, low back, buttocks, thigh

would hip rotation be decreased or increased with intra articular problems?

decreased

primary causes of pelvic pain include?

musculoskeletal, neuromuscular, gynecological, infectious, vascular, cancer, GI

would hip rotation be increased or decreased with extra articular problems?

normal but painful hip rotation

Pelvic pain and symptoms can be referred to?

pelvis from the hip, sacrum/SI, or lumbar spine

Low back or sacral pain radiating around the flank could suggest?

renal or urological system

pelvic pain risk factors for males?

sexual assault, anal intercourse, prostate infection, prostate or colon cancer in advanced stages, bladder or kidney infection, and sexually transmitted disease

low back or sacral pain radiation to the buttock or legs suggests?

suggests a vascular source.

Aggravating SI joint activities?

•Aggravated by sitting, lying, or weight-bearing on the affected side; prolonged driving or riding in car; the Valsalva maneuver; and trunk flexion with legs straight.

•Gynecological causes of pelvic pain?

•H/O gynecologic disorders such as ovarian cysts, endometriosis, pelvic inflammatory disease •Associated signs & symptoms such as missed/irregular menses, cyclic nausea/vomiting, vaginal discharge. •Pelvic pain (or low back pain) soon after missed menstrual cycle (be aware of signs of ectopic pregnancy).

SI joint referral pain patterns?

•Over the posterior SI joint and buttock •Usually unilateral, but could be bilateral •Referred to lower lumbar spine (true SI pain rarely extends above the L5 spinous process or presents as midline lumbar pain), buttocks, upper thigh.

most common msk groin cause of pain? What activities can cause this?

•strain of the adductor muscles, most often involving the adductor longus. H/o specific trauma or repetitive motion is present. repetitive movements (e.g., kicking) and rapid change of direction

Signs and sx of vascular claudication?

⁃Diminished/absent pulse ⁃Trophic changes ⁃Normal DTRs ⁃Positive bicycle test

neurogenic claudication signs and sx?

⁃No change in pulse ⁃No trophic changes ⁃Diminished/absent DTRs, e.g., ankle jerk ⁃Positive shopping cart sign

neurogenic claudication pain pattern?

⁃Usually bilateral, could be unilateral. Burning & dyesthesia. ⁃Low back, buttocks, thigs, calves, feet ⁃Increases with spinal extension, decreases with spinal flexion. ⁃Increases with activity, unaffected by standing, sometimes relieved by prolonged rest.

Vascular claudication pain pattern?

⁃Usually bilateral, no dyesthesia ⁃Usually felt in calves, may involve buttocks, thighs, or feet ⁃Present in all spinal movements. ⁃Increases with activity, relieved by standing or rest

systemic causes of SI/ sacral pain?

-Insidious onset or unknown cause (True SI pain is usually associated with a history of trauma or overuse). -Red flags in the history (e.g., previous infection, GI disease, infection etc.) Lack of objective findings to implicate SI joint/sacrum as the cause of pain. Pain Presentation: -Central pain while rising from sitting is likely diskogenic while unilateral pain is suggestive of SI joint pain. -Pain relieved by passing gas or bowel movement may indicate GI disease. -Anterior pelvic, suprapubic, or low abdominbal pain at the same level as the sacrum could indicate systemic causes. -Low back or sacral pain radiating around the flank could suggest renal or urological system while radiation to the buttock or legs suggests a vascular source. -Constitutional symptoms such as fever, chills.