Hip and Groin Flashcards
Describe the pubic clock and the groin triangle
Pubic clock: 12 - inguinal canal/rectus abdominus 9 - inguinal ligament 6 - adductor longus 3 - pubic symphysis
What are risk factors for groin pain?
- Sudden increase in training load
- Deconditioned on RTS
- Mm imbalance
- Reduced hip mobility
- Past hx of groin injury
What are groin pain causes NOT TO BE MISSED?
SCFE Perthes Tumor AVN Arthropathy
What causes hip OA?
- Intraarticular pathology
- changes in alignment/contact forces (FAI)
- AVN
- CHD
- Genetics!
In THR - what is the Birmingham Implant?
A surgery done to preserve the femoral head and neck; these are shaved off just enough to cap off with a prosthesis
- good for young physically active patients
Describe THR
- posterolateral (more common) or anterolateral approach
- very painful procedure!
- femoral head+neck is replaced
- STAY AWAY FROM ADD+FLEXION > 90º (+ IR) - DISLOCATION risk
- last 15-25 yrs
- each prosthesis talilored for the individual to prevent risk of disloc + LLD
THR - post surgical - describe what happens/priorities
- NO add/flexion/IR - dislocation risk (no crossing legs, sleep with pillow in legs)
- WBAT - ASAP
- usually sent to rehab after 2 days acute care
- usually discharged 5/7 post surgery
- think about CP interventions as well, glute strengthening, ankle pumps
What might a NOF # present with
ER + shortened on affected side
If dislocation - IR + lengthened
What are the different classifications of femoral #’s and which is most common?
NOF - most common
Intertrochanteric
Subtrochanteric
What is the typical management of hip fractures?
- ORIF
- Dynamic Hip Screw (another type of fixation)
- Proximal femoral nail
- WBAT - Asap
Subtrochanteric fractures
- always require ORIF + intramedullary nail
- higher rate of malunion
- may be in combo with shaft/intertrochanteric fractures
What is physio management of post op hip #?
- address CP - chest/breathing post op
- circulation (foot pumps)
- strengthening for quads/glutes
- flexion, abd exercises on board
- weight bearing within 24-48 hrs
- multidisciplinary!(falls prevention, delerium, comorbidities etc)
Briefly describe AVN
- loss of blood supply to the femoral head
- softening, damage and collapse
- deformity and seperation of overlying cartilage
- early OA
What is OA?
- articular cartilage covers the contact regions in the bones that form a joint; smooth - hard - lubricated with synovial fluid
- wear and tear or injury can cause cartilage loss + exposed bone
- exposed subchondral bone = pain sensitive
What are precautions for imaging?
- avoid in genital region
- avoid in young
- ## don’t use only for exploratory reasons
How to determine whether OA is treated surgically or not (hip)?
- age (31% are <65)
- disability
- degree of joint destruction
What are principles of treating groin pain?
- Relative rest/reduce load
- Technique analysis
- Graded RTS/asymptomatic loading
Describe the femoral neck fractures (Garden classifications)
*Marnee spent NO time on this but know it anyway
Garden 1: incomplete/non displaced Garden 1: valgus impaction Garden 2: complete, undisplaced Garden 3: complete, partially displaced Garden 4: complete, completely displaced
- completeness refers to whether fracture is through the entire NOF or just partially (incomplete)
- displaced = whether there’s seperation of NOF from HOF
Epidemiology of hip fractures?
22,000/yr and $1.2B in cost
<50% return to pre injury living conditions
5% die in hospital
1 in 10 die in 30 days
after injury - other injuries/comorbidities develop
What is the function of the acetabular labrum?
- Deepens the joint
- Increases contact area - so reduced stress
- Maintain IAP
- Only outer 1/3 vascularized - so tear into inner 1/3 won’t heal
What are the 2 types of acetabular labral tears?
Type 1 tears - detachment of labrum from articular hyaline cartilage at acetabular rim
Type 2 tears - cleavage tears within the substance of the labrum
(Brukner+Khan)
What are the symptoms of labral tears hip?
- diffuse ant hip/groin pain/posterior buttock?
- clicking
- sensation that joint is giving way/instability
- +ve quadrant test (FADIR+FABER good to rule out - high sens; thomas test also)
What are the most common causes of labral tears?
- Twisting
- DJD
- FAI
- Hip dysplasia
- Laxity
What are exercise treatment strategies for labral tears?
Focus on PROGRESSION
- significant reduction in pain
- significant reduction in use of assistive device
- 3x10 reps of hip exercises - flexion/extension/adduction/abd
- functional ex - squat/lunge/single leg squat/balance ex
- mobs - Grade 1-4 depending on irritability
