Hip Boney pathology

Question 1

why does avascular necrosis occur?

Answer 1

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

Question 2

how does avavascular necrosis present?

Answer 2

• full ROM RULES OUT

- pain with weight bearing=rest

Question 3

how do we manage a patient with avascular necrosis?

Answer 3

refer

often needs hip replacement

Question 4

how do stress fractures happen?

Answer 4

fatigue: normal bone subject to abnormal stress
insufficiency: abnormal bone subject to normal stress

common locations:

• fem neck
• pubic rami
• acetablum
• fem head
• sacrum

Question 5

what are the risk factors of stress fractures?

Answer 5

• female, amenorrhea
• low fitness starting intense exercise
• overuse
• smoking
• steroids

Question 6

what are the subjective complaints of a stress fracture?

Answer 6

exercise induced
poorly localized deep hip, grtoin, thigh pain
gradual onset

Question 7

what are the objective complaints of a stress fracture?

Answer 7

• pain at extreme ranges of hip ROM (IR)
• palpation tenderness inguinal area
• active ALR

median time to diagnosis is 30 days

Question 8

how do you manage a stress fracture?

Answer 8

• 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

Question 9

what happens with fractures of the fem neck?

Answer 9

• 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

Question 10

what are the risk factors of a hip dislocation?

Answer 10

-falling, instablity, laxity, structural abnormalities, reudced muscle mass, THA

Question 11

how do hip dislocations happen?

Answer 11

• 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

Question 12

what are the implications for a hip dislocation

Answer 12

trauma=medical emergency

Question 13

what is the patient presentation of a dislocation?

Answer 13

pain,swelling,deformity,immobility,inability to WB

Question 14

what are common sites of avulsion fractures?

Answer 14

ASIS
AIIS
lesser troch
ischial tub

Question 15

what is the patient presentation of avulsion fracture?

Answer 15

• pain at time of injury
• boney tenderness
• muscle bulging away from attachment
• swelling

Question 16

how do we manage a patient with an avulsion fracture?

Answer 16

• early: immob, PROM, prevent atrophy

- later: functional movement retraining, strength, proprio

Question 17

what is the most common cause of hip pain?

Answer 17

OA

Question 18

why does OA occur?

Answer 18

-progressive deterioration of articular cartilage
due to:
repertivie trauma, prior pathology
aging
obesity
congential abnorms

Question 19

what is the subjective patient presentation of OA?

Answer 19

• anterior groin pain or lateral C sign
• anterior thigh L3 dermatome
• stiffness post prolonged rest

Question 20

what is the objective patient presentation of OA?

Answer 20

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

Question 21

what is the Clinical prediction rule for clinical diagnosiss of hip OA?

Answer 21

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

Question 22

what is the rehab for OA?

Answer 22

• 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

Question 23

what are the predictors of response to PT in OA?

Answer 23

> 3 factors present:

• unilateral vs bilateral hip pain
• age <58 years
• pain > 6/10
• 40m SPWT of < 25.9 sec
• symptoms < 1 year