MOD 4 Hip Pathology Flashcards
What is avascular necrosis?
pathology where blood supply to femoral head is compromised and the bone degenerates and dies
What are the risk factors of avascular necrosis?
- alcohol use
- steroid ue
- hip BMI
How does avascular necrosis present?
- limited ROM (full range in all directions rules out)
- pain with weight bearing and even at rest
How do you treat avascular necrosis?
refer
What is a fatigue stress fracture?
normal bone subject to abnormal stress
What is an insufficiency stress fracture?
- abnormal bone subject to normal stress
What are the common stress fracture locations of the hip?
- femoral neck
- pubic rami
- acetabulum
- femoral head
- sacrum
What is the location of a stress fracture if it occurs on the tension or compression side of the femoral neck?
- tension: superior, unstable
- compression: inferior, stable
What are the risk factors of hip stress fracture?
- female
- low fitness starting intense exercise
- overuse
- smoking
- steroid use
How do patients with a hip stress fracture present?
- pain during exercise, poorly localized in deep hip, groin, and thigh pain
What are the common objective findings for a patient with hip stress fractures?
- pain t extreme range of hip IR
- palpation tenderness of inguinal area
- positive active leg raise
How should a hip stress fracture be managed?
- cease weight bearing and obtain imaging
- tension: NWB 6 weeks, partial WB 6 weeks, return 3-6 months
compression: 6-8 weeks of limited WB - return 12-28 weeks
What is the mechanism of hip fracture?
compression trauma, direct lateral impact (fall or collision)
What are the common hip fracture locations?
- neck
- intertrochanteric
- subtrochanteric
What type of injury (intra-capsular vs extra-capsular) is a hip fracture?
- intracapsular
What are the implications since a hip fracture is intra-capsular?
- healing less certain due to blood supply being damaged
- high mortality risk
- high risk for avascular necrosis
How do you treat hip fracture?
ORIF, hemiarthoroplasty, and total hip replacement
rehab early
What are the guidelines for a hip fracture rehabilitation?
- early mobilization (24-48)
- high intensity PT with 3 daily session
- functional mobility and endurance
post acute:
- gait and balance 6-9 months
- muscle strength
- HEP
What are the risk factors of a hip dislocation?
- falling, chronic instability, laxity, structural abnormalities, reduced muscle mass
What is the mechanism of hip dislocation?
compression trauma: blunt force to bent knee and flexed hip
rotational trauma: extreme IR with hip flexed (skiing)
What is the most common site of hip dislocation?
posterior
How does hip dislocation present?
- pain
- swelling
- deformity
- immobility
- inability to WB
How do you manage a hip dislocation?
- surgical: open reduction
- conservative: closed reduction
after immobilization 2-3 months, impairment driven
What are avulsion fractures?
violent contraction of muscle, pulling boney attachment from bone
What are the common sites of hip avulsion fractures?
ASIS, AIIS, lesser trochanter, ischial tuberosity
How do hip avulsion fractures present?
- pain at injury
- boney tenderness
- muscle bulging away from attachment
- swelling
How do you manage hip avulsion fractures?
- early: immobilization, PROM, atrophy prevention
- later: functional movement retraining, strength, proprioception
What is the most common cause of hip pain in people over 50?
osteoarthritis
What is osteoarthritis?
progressive deterioration of articular cartilage which leads to narrow joint space
How will people with osteoarthritis present?
anterior groin or lateral groin pain (C sign)
anterior thigh pain (L3 dermatome)
stiffness after prolonged rest
What are some related impairments with osteoarthritis?
- loss of quad strength
- gait asymmetry, slow speeds
What are the CPG diagnosis for hip osteoarthritis?
- older than 50
- moderate anterior or lateral hip pain in WB
- morning stiffness for longer than an hour
- hip IR < 24 deg or hip IR and flexion < 15 compared to other limb
and/or hip pain with passive IR
What is cluster 1 in Altman’s criteria for hip OA?
- hip pain
- hip IR < 15 deg
- flexion < 115 deg
What is Altman’s cluster 2 for hip OA diagnosis?
- painful hip IR
- older than 50 y.o
- morning hip stiffness <60 min
What would direct you to use Altman’s cluster 2 over Altman’s cluster 1?
if hip IR is greater than or equal to 15 deg
What is the clinical prediction rule for hip OA diagnosis?
if 4 or more present
- squating aggravates symptoms
- active hip flexion = lateral hip pain
- scour test: lateral hip or groin pain
- active hip extension causing pain
- passive IR less than or equal to 25 deg
What is conservative management for hip OA?
- NSAIDs and corticosteroid injections
- modalities: heat and ultrasound
What is the rehab management of hip OA?
- manual therapy 1-3x week, 6-12 weeks
- exercise 1-5x week, 6-12 weeks
- working strength, balance, flexibility, coordination
What is surgical management for hip OA?
- total hip
- partial hip
- joint resurfacing
What are the predictors someone will respond well to PT with hip OA?
if 3 or more present
- unilateral vs bilateral hip pain
- younger or equal to 58 y.o
- pain more or equal to 6/10
- 40m SPWT of less or equal to 25.9 sec
- symptoms less than a year
What provides better outcomes with hip OA?
manual therapy is better than exercise alone
What are the PT management strategies to be used for hip pain?
- manual therapy + exercise
- impairment driven
- adequate challenge for strength gains
- strength linked to functional tasks
- CV and physical activity counseling
