8] Adv. Hip Diagnosis And Treatment

Question 1

What’s more common in men

Answer 1

Leg calve perthes disease

SCFE

Question 2

What’s more common in women

Answer 2

Hip dislocation

Question 3

Congenital dysplasia of the hip cause

Answer 3

Unknown

Question 4

Increased incidence of congenital dysplasia

Answer 4

First born females, breech

Question 5

Sign for Cong dysplasia

Answer 5

+ ortoloni’s/Barlow

Question 6

What is + ortoloni/Barlow

Answer 6

Hip is ADD then depressed/dislocated then ABD and you hear a clunk

Question 7

Treatment for congenital dysplasia 1st 4-6 months

Answer 7

Pavlik harness

Question 8

Treatment if more than 6 months

Answer 8

Closed reduction

Spica cast

Question 9

Treatment is more than 1 year

Answer 9

Open reduction

Cast

Question 10

Characteristics of congenital dysplasia of hip

Answer 10

Less femoral head coverage
Decreased surface area
Coxa valgus (more than 125 deg)
Femoral anterversion
Associated with labral tears and early OA

Question 11

Patho of LCP disease

Answer 11

Osteonecrosis of femoral head

Question 12

Who does LCP happen to and which side?

Answer 12

3-10 year old boys and usually uni

Question 13

LCP clinical findings

Answer 13

Restricted in IR stiff
Spasm of ADD, limiting ABD
atrophy 
Short
Leg length discrepancy 
“Frog leg”

Question 14

Treatment for LCP

Answer 14

Early stage: abduction braces

Later: surgery

Question 15

SCFE patho

Answer 15

Displacement of epiphysis off femoral head

Question 16

Who does SCFE happen to

Answer 16

Pre-pubescent overweighted

Or tall, thing athletic boys

Question 17

What’s usually the only Sx fo SCFE

Answer 17

Medial knee pain

Question 18

May include a history of trauma or abnormal/excessive exertion

Answer 18

SCFE

Question 19

Clinical findings of SCFE

Answer 19

Decreased IR and flex
Weak IR
Rolls into ER when supine
Antalgic gait
\+ trendelenburg

Question 20

Treatment for SCFE

Answer 20

Pinning
PWB
Amb with AD for 4-6 weeks or until callus

Question 21

Labral tears often occur inw hat direction

Answer 21

Anterior or anterosuperior

Question 22

MOI for labral tears

Answer 22

Trauma: ER with hyperext

Receptive microtrauma: pivoting and twisting

Question 23

Flexion, ABD, ER followed by ext, ADD, IR

Answer 23

Anterior labrum

Question 24

Usually no pain in FABER

Answer 24

Anterior labrum

Question 25

Passive flexion, posterior load

Answer 25

Posterior labrum

Question 26

Symptoms fo labral tears

Answer 26

Shard deep pain Click lock catch Unstable, gives way Pain in anterior groin region

Question 27

Testing for labral tears

Answer 27

No gold standard but MRA is good

Question 28

Anatomy of labrum

Answer 28

Inner 2/3 avascular | Only outer 1/3 has potential to heal

Question 29

Surgery for labral tears

Answer 29

Arthroscopic removal | Debridement

Question 30

Treatment for labral tears

Answer 30

Pain free ROM and strength | Impingement type treatments : mobs and traction

Question 31

Define FAI

Answer 31

Impingement b/w femoral neck and lateral acetabulum

Question 32

FAI results in

Answer 32

Chondral lesions, labral tears and progressive OA

Question 33

Non spherical femoral head or abnormalities at head neck junction

Answer 33

CAM

Question 34

Femoral head neck forced into contact with acetabular rim

Answer 34

CAM

Question 35

CAM more common in

Answer 35

Young active males

Question 36

Abrasion of cartilage, avulsion of labrum

Answer 36

CAM

Question 37

What’s more common: CAM or pincer

Answer 37

CAM

Question 38

Over coverage of the femoral head by an abnormally deep or retroverted acetabulum

Answer 38

Pincer

Question 39

Results in labral injury with less cartilage involvement

Answer 39

Pincer

Question 40

What’s pincer more common in

Answer 40

Middle aged active women

Question 41

Deep acetabulum, with over coverage of neck and posterior inferior sublux

Answer 41

Pincer

Question 42

Abnormality at neck forced into rim with flexion

Answer 42

CAM

Question 43

Reduced ROM for impingement

Answer 43

Reduced IR, flex, ADD

Question 44

With hip repairs, how long do you wait until strengthening

Answer 44

Week 6

Question 45

PWB for 10-14 days | Avoid excessive flex and ABD

Answer 45

Labral repair

Question 46

Clinical milestone for labral repair

Answer 46

Full PROM at 2 weeks

Question 47

Soft tissue release precaution

Answer 47

Guided by pain | Avoid stressing and leg lifts for 4 weeks

Question 48

Soft tissue repair precaution

Answer 48

TTWB x 6 weeks | Abd brace

Question 49

Important clinical milestones for sof tissue repair etc

Answer 49

6 week strengthening starts | Return to running when bilateral hip strength is good

Question 50

Anterior capsule modification precaution

Answer 50

Avoid forceful ER and ext

Question 51

Posterior capsule modification precaution

Answer 51

Avoid forceful IR and flexion

Question 52

Milestone for capsular mod

Answer 52

Full PROM at 4-6 weeks

Question 53

Non spherical portion of femoral head removed

Answer 53

Osteoplasty

Question 54

Precaution of osteoplasty

Answer 54

PWB 4-6 weeks Avoid too much flex/abd/IR Caution with SLR b/c of hip flex tendinitis

Question 55

Milestone for osteoplasty

Answer 55

2 week full PROM

Question 56

For medium sized, full thickness lesions of hip joint | Used to reach blood supply of subchondral bone

Answer 56

Microfracture

Question 57

Precaution for microfracture

Answer 57

PWB 4-8 weeks Avoid flex/abd Caution with SLR b/c of compressive forces

Question 58

Clinical milestone for microfracture

Answer 58

2 weeks full PROM

Question 59

Return to sport for combined procedures which is the most stringent time frame

Answer 59

10-32 weeks