Hip Boney pathology Flashcards
why does avascular necrosis occur?
blood supply to fem head compromised so leads to bone degernation and death
complication following:
dislocations, fractures, chronic synovitis
risk factors:
alcohol, steriods, hip BMI
how does avavascular necrosis present?
- full ROM RULES OUT
- pain with weight bearing=rest
how do we manage a patient with avascular necrosis?
refer
often needs hip replacement
how do stress fractures happen?
fatigue: normal bone subject to abnormal stress
insufficiency: abnormal bone subject to normal stress
common locations:
- fem neck
- pubic rami
- acetablum
- fem head
- sacrum
what are the risk factors of stress fractures?
- female, amenorrhea
- low fitness starting intense exercise
- overuse
- smoking
- steroids
what are the subjective complaints of a stress fracture?
exercise induced
poorly localized deep hip, grtoin, thigh pain
gradual onset
what are the objective complaints of a stress fracture?
- pain at extreme ranges of hip ROM (IR)
- palpation tenderness inguinal area
- active ALR
median time to diagnosis is 30 days
how do you manage a stress fracture?
- cease WB and obtain imaging
- tension side: pinned to prevent displacement, NWB for 6 weeks, partial WB 6 weeks, return 3-6 month post
- compression side: 6-8 weeks limited WB
- PT to address biomech factors 12-28 weeks
what happens with fractures of the fem neck?
- blood supply compromised (intra-capsular)
- healing less certain
- high risk of AVN
- moratlity risk high
treatment: ORIF vs hemiarthroplasty vs total hip replacement
- rehab must begin early
what are the risk factors of a hip dislocation?
-falling, instablity, laxity, structural abnormalities, reudced muscle mass, THA
how do hip dislocations happen?
- compression trauma: blunt force to bent knee when hip is flexed
- rot trauma: severe IR of thigh with hip partially flexed (skiing)
most common site: posterior
what are the implications for a hip dislocation
trauma=medical emergency
what is the patient presentation of a dislocation?
pain,swelling,deformity,immobility,inability to WB
what are common sites of avulsion fractures?
ASIS
AIIS
lesser troch
ischial tub
what is the patient presentation of avulsion fracture?
- pain at time of injury
- boney tenderness
- muscle bulging away from attachment
- swelling
how do we manage a patient with an avulsion fracture?
- early: immob, PROM, prevent atrophy
- later: functional movement retraining, strength, proprio
what is the most common cause of hip pain?
OA
why does OA occur?
-progressive deterioration of articular cartilage due to: repertivie trauma, prior pathology aging obesity congential abnorms
what is the subjective patient presentation of OA?
- anterior groin pain or lateral C sign
- anterior thigh L3 dermatome
- stiffness post prolonged rest
what is the objective patient presentation of OA?
limited ROM + firm end feel (IR), + scour, FABER
- 3 planes limited= rule in
- 1 plane limited= rule out
related impairments:
loss of quad strength
gait asymm: limb, slower speed, pain
what is the Clinical prediction rule for clinical diagnosiss of hip OA?
4 or more present:
- squatting=aggravating
- active HF= lateral hip pain
- scour test=lateral or groin pain
- active hip ext causing pain
- passive IR < 25
what is the rehab for OA?
- manual therapy (1-3x/week, 6-12 weeks)
- exercise (1-5x/week, 6-12 weeks)
- strength, balance, proprio, flexibility, NM coordination, biomechanical correction, cardiovascular (cycle,swim)
- education: temp activity mod, temp assistive device, counsel on weight loss and exercise and sleep
what are the predictors of response to PT in OA?
> 3 factors present:
- unilateral vs bilateral hip pain
- age <58 years
- pain > 6/10
- 40m SPWT of < 25.9 sec
- symptoms < 1 year
