Hip Flashcards
hip disorders 0-2 yo
- developmental dysplasia of the hip
- septic arthritis
hip disorders 2-12 yo
- acute transient synovitis
- leg- calve-perthes
hip disorders 8-17 yo
SCFE
hip disorders 5-30 yo
osteoid osteoma (femoral neck)
normal torsion
- 8-15
- 40 degrees at birth
- normal at 16 years old
anteversion
torsion >15
in-toeing, excessive IR
retroversion
torsion <8
toe out, excessive ER
craigs test
- tests verison of hip
- prone, knee in 90 flex
- rotation hip IR and ER, find greater troch at parallel to table, measure ankle of leg
developmental dysplasia
- 1/100 births
- 6:1 girls:boys
- 80% unilateral, 20% bilateral
- mechanical: position in the womb
- physiological: estrogen and relaxin in utero
- environmental: cultural positioning of infants
- limited and asymmetric abduction
- asymmetric thigh folds
- positive galeazzi sign (unequal knee height in supine hips to 90)
- positive ortolani sign(relocating dislocated hip)
- telescoping
developmental dysplasia treatment
birth to 9 months
- abduction diapers
- pavlik harness
9 months or older
- abduction orthosis (double diaper)
- surgical intervention
septic arthritis
- acute, rapidly progressing infection
- <2 years old
- pyogenic bacteria
- irritability
- hip held in open packed position
- fever, sweating, chills, tachycardia
- loss of appetite
treatment
- aspiration, IV antibiotics
acute transient synovitis
- inflammation of synovial lining
- self limiting
- often preceded by upper respiratory infection
- up to 5% later develop AVN
- unknown cause
Features:
- hip pain, limp, refuse to walk
- decreased hip ROM >IR
- fever possible (<101)
- radiographs will be normal
Management
- relative rest
- PWB crutches
- radiographs
Legg-calve Perthes
- AVN of femoral head
- 3-12 most common (9-12)
- males >females
- whites > blacks
- 95% unilateral
legg-calve perthes presention
- hip and knee pain at night
- ROM decreased abduction and ER; flexion contracture common
- abnormal growth patterns: forearm and hands short, feet short
- psoatic limp: worse late in day
- often very active
- correlated with ADD
legg- calve perthes treatment
- reduce hip irritability
- restore and maintain hip mobility
- regain a spherical femoral head
- prevent ball from extruding or collapsing
SCFE
- posterior and inferior displacement of femoral head
- 2:1 boys:girls
- 10-16 yo most common
- 50% are bilateral
- obese
- black > white
SCFE presentation
- gradual hip pain and limp
- medial sided knee pain
- hip extension and IR limited
- passive flexion presents with abd/ER
- 3-12 months before diagnosis
treatment is ORIF
OA subjectively
- older patient >60
- groin pain, postero/lateral hip, anterior thigh pain
- commonly refers pain to the knee
- high frequency associated with Lspine DJD
two clusters of OA
(SN of 8%, SP 75%)
- hip pain
- IR <15
- pain with IR
- morning stiffness >60 min
- age over 50
- IR<15
- flexion <115
- stiffness >60 min
- pain in hip
labral tears
- complaint of pain, clicking, locking, catching, instability, or giving away
- anterior groin pain in 96-100%
- MOI: hip external rotation +extension
EXAM
- FABER SN .88
- femroal acetabular impingement test
- imaging gold standard is arthroscopy
AVN
- 4th decade of life
- nonspecific leg pain
- steroid usage, renal disease, alcoholism, sickle cell disease, gout, previous trauma
EXAM
- hip AROM WNL
- radiographs findings do not occur until 3 months
- MRI highly specific/sensitive
iliopsoas bursitis
Subjective
- anterior hip pain
- worse with hip extension
- overuse
- may complain of snapping
Exam
- present in hip flexion and ER for relief
- pain with passive hip extension
- pain with resisted hip flexion
- bursa tender to palpation
- (+) snapping hip maneuver
- (+) supine heel raise
femoral neck stress fracture
Subjective
- stress fx: 10% of all injuries seen in sports
- femur is 4th most common site of fracture
- overuse vs insufficiency
- females > males
- groin, thigh, or knee pain
- often occurs after change in activity
- risk factors: female, amenorrhea >6months, family history of OP, smoker, eating disorder
EXAM
- pain at extreme ROM
- pain with weight bearing
- positive hop test (70% accurate)
- positive heel tap
- positive FABER, scour, quadrant
- positive fulcrum
- bone scan 100% sensitive
osteitis pubis
- gradual onset of pain in pubic region
- following bladder or prostate surgery
- long distance runners, weightlifters, fencers, soccer players, football players
EXAM
- tenderness along pubis
- PROM hip adductors limited w pain
- RROM hip adductors weak with pain
obturator nerve entrapment
- activity induced entrapment
- can be due to pelvic fx, hematoma, retroperitoneal masses, intrapelvic tumors
- presents as medial thigh pain with exercise
- pain continues with activity, recedes with rest
EXAM
- paresthesias medial thigh
- adductor muscle weakness (no pain)
- pain may be reproduced with weightbearing hip ER and adduction
- EMG diagnostic
ilioinguinal nerve entrapment
- supplies cutaneous innervation to groin, scrotum, or labia
- c/o pain in from inguinal region to genitals
- risk factors: abdominal muscle hypertrophy, pregnancy, prior iliac crest bone graft harvesting, overtraining athletes
- reproduction of symptoms with hip hyperextension
signs of buttock
- limited straight leg raise
- limited hip flexion to the same extent as SLR
- limited trunk flexion to the same extent as hip flexion
- painful weakness of hip extension
- noncapsular pattern of restriction at the hip
- swollen buttock
hip outcome measures recommendation
Level A: hip outcome score, copenhagen hip and groin outcome score, interneational hip outcome tool
labral debridement protocol
- early PROM
- CPM use (6-12 hours/day for 3-4 weeks)
- overcoming inhibition of posterior hip musculature is an important key to progression
- AD should be continued until gait is normal
- aquatic walking or deweighing treadmill
- avoid normal treadmill to prevent forced extension
- avoid excessive early flexion and abd to prevent inflammation
labral repair (anterior/superior) protocol considerations
- limit PROM to 90 flexion for 10 days and 25 degrees abduction, gentle external rotation and extension for 3 weeks
- PWB for 10-28 days\
- avoid excessive early flexion and abd to prevent inflammation
osteoplasty rehab considerations
- limited impact activities for 8 weeks
- flexion limited to 90 for 10 days,
- foot flat weightbearing for 4 weeks
- slightly slower progression
- avoid excessive early flexion and abd to prevent inflammation
microfracture rehab considerations
- flexion is limited to 90 deg for 10 days
- size and location of lesion affects WB adn tolerance
- slower progression, 6-7 weeks of limited weight bearing
- avoid excessive early flexion and abd to prevent inflammation
sports hernia
- insidious onset
- gradually worsening
- diffuse
- unilateral groin pain that may radiate to perineum and upper medial thigh
- mainly males mid 20’s
main causes of chronic groin pain
- adductor longus dysfunction
- osteitis pubis
- sport hernia
- pathological condition of the hip joint
sports hernia rehab
- avoid sharp movements
- focus on core and leg inflexibility, weakness, , endurance
- jogging at 3-4 weeks
- 6-8 weeks for full return
sports hernia rehab
- avoid sharp movements
- focus on core and leg inflexibility, weakness, , endurance
- jogging at 3-4 weeks
- 6-8 weeks for full return
hamstring reinjury risks
- persistent weakness in injured muscle
- reduced extensibility of the musculotendon unit due to residual scar tissue
- adaptive changes in the biomechanics and motor patterns of sporting movements
rehab for hamstring strains overall
- eccentric strength training
- neuromuscular control of lumbopelvic musculature
- progressive agility and trunk stabilization has better outcomes versus stretching and strengthening
- early mobilization
phase 1 hamstring rehab
- protection
- ice
- NSAIDs
- lumbopelvic musculature, SLB, short stride frontal plane stepping (grapevine), avoid isolated resistance training
Progression criteria
- normal walking stride without pain
- very low speed jogging without pain
- pain- free isometric contraction against submax resistance during prone knee flexion
phase 2 hamstring rehab
- avoid end range HS lengthening if weakness persists
- ice
- neuromuscular control, agility, trunk stabilization
Progression criteria
- full strength without pain during 1 rep max
- forward and backward jogging at 50% max speed without pain
phase 3 hamstring rehab
- ice if needed
- sport specific drills
- progress hamstring strength to end range motion
Return to sport
- all strength and mobility be preformed without pain
- less than 5% difference
cam impingement
- when the femoral head has an abnormally large radius with loss of the normal spherical junction between the femoral head and neck
- usually in anterosuperior labral and chondral lesion
- young athletic males
pincer impingement
- abnormal acetabulum with increased overcoverage
- leads to posteroinferior chondrol lesions
- more common in middle-aged women in athletics
where to labral tears commonly happen and refer
- anterior or anterosuperior
- anterior groin
tests for intra-articular hip pain
- Faber, scour, patrick, resisted straight leg raise
- Faber is sensitive in ruling out labral
hip precautions with THA posterior
- avoid hip flexion past 90, adduction past midline
- cemented THA is not limited in weightbearing
