8] Adv. Hip Diagnosis And Treatment Flashcards
What’s more common in men
Leg calve perthes disease
SCFE
What’s more common in women
Hip dislocation
Congenital dysplasia of the hip cause
Unknown
Increased incidence of congenital dysplasia
First born females, breech
Sign for Cong dysplasia
+ ortoloni’s/Barlow
What is + ortoloni/Barlow
Hip is ADD then depressed/dislocated then ABD and you hear a clunk
Treatment for congenital dysplasia 1st 4-6 months
Pavlik harness
Treatment if more than 6 months
Closed reduction
Spica cast
Treatment is more than 1 year
Open reduction
Cast
Characteristics of congenital dysplasia of hip
Less femoral head coverage Decreased surface area Coxa valgus (more than 125 deg) Femoral anterversion Associated with labral tears and early OA
Patho of LCP disease
Osteonecrosis of femoral head
Who does LCP happen to and which side?
3-10 year old boys and usually uni
LCP clinical findings
Restricted in IR stiff Spasm of ADD, limiting ABD atrophy Short Leg length discrepancy “Frog leg”
Treatment for LCP
Early stage: abduction braces
Later: surgery
SCFE patho
Displacement of epiphysis off femoral head
Who does SCFE happen to
Pre-pubescent overweighted
Or tall, thing athletic boys
What’s usually the only Sx fo SCFE
Medial knee pain
May include a history of trauma or abnormal/excessive exertion
SCFE
Clinical findings of SCFE
Decreased IR and flex Weak IR Rolls into ER when supine Antalgic gait \+ trendelenburg
Treatment for SCFE
Pinning
PWB
Amb with AD for 4-6 weeks or until callus
Labral tears often occur inw hat direction
Anterior or anterosuperior
MOI for labral tears
Trauma: ER with hyperext
Receptive microtrauma: pivoting and twisting
Flexion, ABD, ER followed by ext, ADD, IR
Anterior labrum
Usually no pain in FABER
Anterior labrum
Passive flexion, posterior load
Posterior labrum
Symptoms fo labral tears
Shard deep pain
Click lock catch
Unstable, gives way
Pain in anterior groin region
Testing for labral tears
No gold standard but MRA is good
Anatomy of labrum
Inner 2/3 avascular
Only outer 1/3 has potential to heal
Surgery for labral tears
Arthroscopic removal
Debridement
Treatment for labral tears
Pain free ROM and strength
Impingement type treatments : mobs and traction
Define FAI
Impingement b/w femoral neck and lateral acetabulum
FAI results in
Chondral lesions, labral tears and progressive OA
Non spherical femoral head or abnormalities at head neck junction
CAM
Femoral head neck forced into contact with acetabular rim
CAM
CAM more common in
Young active males
Abrasion of cartilage, avulsion of labrum
CAM
What’s more common: CAM or pincer
CAM
Over coverage of the femoral head by an abnormally deep or retroverted acetabulum
Pincer
Results in labral injury with less cartilage involvement
Pincer
What’s pincer more common in
Middle aged active women
Deep acetabulum, with over coverage of neck and posterior inferior sublux
Pincer
Abnormality at neck forced into rim with flexion
CAM
Reduced ROM for impingement
Reduced IR, flex, ADD
With hip repairs, how long do you wait until strengthening
Week 6
PWB for 10-14 days
Avoid excessive flex and ABD
Labral repair
Clinical milestone for labral repair
Full PROM at 2 weeks
Soft tissue release precaution
Guided by pain
Avoid stressing and leg lifts for 4 weeks
Soft tissue repair precaution
TTWB x 6 weeks
Abd brace
Important clinical milestones for sof tissue repair etc
6 week strengthening starts
Return to running when bilateral hip strength is good
Anterior capsule modification precaution
Avoid forceful ER and ext
Posterior capsule modification precaution
Avoid forceful IR and flexion
Milestone for capsular mod
Full PROM at 4-6 weeks
Non spherical portion of femoral head removed
Osteoplasty
Precaution of osteoplasty
PWB 4-6 weeks
Avoid too much flex/abd/IR
Caution with SLR b/c of hip flex tendinitis
Milestone for osteoplasty
2 week full PROM
For medium sized, full thickness lesions of hip joint
Used to reach blood supply of subchondral bone
Microfracture
Precaution for microfracture
PWB 4-8 weeks
Avoid flex/abd
Caution with SLR b/c of compressive forces
Clinical milestone for microfracture
2 weeks full PROM
Return to sport for combined procedures which is the most stringent time frame
10-32 weeks