Urgent Hip Pathologies

Red Flag Pathologies

Septic Hip Arthritis

• Urgent pathology marked by inflammation of the joint caused by bacterial infection.
• Presents with acute onset of joint pain, swelling, tenderness, and loss of motion.
• Physical examination reveals warmth, swelling, and redness.
• Patients are unwilling to bear weight on the joint and experience rapidly intensifying pain with movement.
• Affected risk factors include adults with abnormal synovium and immunosuppression from chemotherapy, HIV, or diabetes mellitus that's poorly controlled.
• Other risk factors are alcohol or drug use, and chronic renal failure.

Femoral Neck Fracture

• Urgent pathology indicated by a rapid onset of pain in the hip area.
• Characterized by an inability to weight bear through the leg.
• Common in young athletes, endurance runners and military personnel.
• Also found in elderly individuals with osteoporosis.

Avascular Necrosis (Osteonecrosis)

• Urgent condition involving the death of bone and bone marrow components due to loss of blood supply.
• Initially presents as mild, intermittent pain that rapidly progresses.
• Pain may refer to the groin, thigh, or medial knee.
• Condition worsens with weight bearing (WB).
• Global loss of movement includes internal rotation (IR), flexion, and adduction.
• Reports indicate slowly progressive stiffening of the joint.
• Femoral head is the most common site, with prolonged history of corticosteroid use.
• History of AVN in the contralateral hip is also noteworthy, with 'Crescent sign'.

Inguinal Hernia

• Varies in urgency; marked by pain during position changes or coughing, indicating increased abdominal pressure.
• 75% of all hernias affect about 25% of men.
• Tenderness is present in the area of the inguinal canal, often causing pain in the groin and/or testicles.

Appendicitis

• Emergent condition with right lower quadrant pain, potentially associated with anorexia, nausea, vomiting, and low-grade fever.
• The Nature of pain is constant and intensifies with increased abdominal pressure from coughing, walking, or bending over.
• Pain may radiate to the right thigh or testicle.
• A positive rebound tenderness at McBurney's Point.

Colon Cancer

• Varies in urgency; individuals above the age of 50 are usually most common.
• Presents with bowel disturbances, unexplained weight loss, anorexia, and general malaise.
• Possible family history of colon cancer influences risk.
• The pain is unchanged by position may hear hypoactive or hyperactive bowel sounds.
• Abdonminal pain, bleeding, constipation, or obstruction, and ascites in severe cases.

Oarian Cysts

• Varies in urgency; includes some abdominal heaviness, pelvic groin, low back or buttock pain, breast tenderness not associated with an increase in density.
• May include some dysmenorrhea, which is issues with their periods, or they may have lasting or recurrent genital pain (dyspareunia) that occurs just before, during, or after sex.
• Impacts women of childbearing age (3-7% affected).
• Risk factors include taking infertility medication, pregnancy, endometriosis, or severe pelvic infection.

Legg-Calve Perthes Disease

• Urgent condition; avascular necrosis of the proximal end of the femur.
• Presents with insidious onset of limp with hip pain.
• Pain may be in the groin and along obturator nerve path, often referring to the knee.
• Tenderness over the hip capsule is pinpoint.
• Aggravation with weight bearing and activity.
• Symptoms relieved with rest.
• Affects children, primarily boys, ages 5-8.

Slipped Capital Femoral Epiphysis (SCFE)

• Urgent condition involving posterior and inferior slippage of the proximal femoral epiphysis on the femoral neck through the epiphyseal plate.
• These pathologies necessitate referral to another appropriate healthcare provider.

Self-Report Measure

Lower Extremity Functional Scale (LEFS)

• Measures a person's ability to complete everyday tasks.
• Includes 20 questions; patients select from a scale for each activity indicating difficulty level ranging from extreme to none.
• Minimal Detectable Change (MDC) - 9 points (out of 24).
• Minimal Clinically Important Difference (MCID) - 9 points (out of 24).

International Hip Outcome Tool (I-HOT12)

• Contains 12 questions with 4 subscales.
• Subscales: Symptoms/function, Sports/recreation, Job-related concerns, Social/lifestyle.
• Verified for reliability, validity, and responsiveness.
• MDC & MCID not specified.

Copenhagen Hip and Groin Outcome Score (HAGOS)

• Assesses pain, symptoms, ADLs, physical function in sport/recreation, participation in activities, and quality of life.
• Contains questionnaires.
• Scored out of 100.
• MDC & MCID not specified.

Hip Disability and Osteoarthritis Score (HOOS)

• Assesses symptoms, pain, ADLs, sports/recreation, and hip-related quality of life.
• Scored our of 100.
• MDC - between 6-8 for each subscale -MCID - not specified.

Western Ontario and McMaster Universities Arthritis Index (WOMAC)

• Assesses pain, stiffness, and physical function with 24 questions.
• Higher scores indicate worse pain, stiffness, and functional limitations.
• MDC and MCID calculated.

Functional Gait Assessment (FGA)

• Used to measure gait ability and dynamic balance.
• It involves 10 walking tests.
• Assistive devices can be used during testing, if normally needed.

Tests invovled in the FGA

• Walk at a steady pace
• Walk and change speeds when instructed
• Walk with horizontal head turns
• Walk with vertical head turns
• Walk and pivot turn
• Walk and step over obstacles
• Walk with a narrow base of support
• Walk with the eyes closed
• Walk backwards
• Climb stairs. Scoring is determined by the level of function
• 0 indicates the lowest level of function
• The total possible score is 30.
• MDC (minimal detectable change) and MCID (minimal clinically important difference) have been calculated for various diagnoses in geriatric populations
• A score of 22/30 or below may classify as a fall risk in older adults.

Pediatric Hip Pathology

Developmental Dysplasia of the Hip (DDH)

• Unilateral or bilateral hip dysplasia that can be unstable, subluxated/ incomplete dislocation, or completely dislocated.
• Incidence: 1:100 subluxation and dysplasia, 1-5:1000 dislocation
• More common in: Female > Male and Native Americans > White > Black.
• (+) Galeazzi Sign.
• Younger patients are treated with Abduction Bracing, Pavlik Harness dynamic abduction splint for under 6 months.
• For 9 Months or older.
• Usually results from mechanical, physiologic, or environmental factors.

Legg-Calve Perthes Disease

• Avascular necrosis of the proximal end of the femur.
• Characterized by avascular necrosis of the capital femoral epiphysis.
• More common in primarily boys 5:1, usually 5-8 years old.
• Insidious Onset of limp with hip pain presents with groin pain and along obturator nerve path and often refers pain to knee. Pinpoint tenderness over the hip capsule, aggravated with weightbearing and activity
• Reduce pain
• Reduce andrestore hip mobility -Prevents Deformity with Abduction brace, casting, surgery.

Acute Transient Synovitis

• Peak Frequency:Around age 5 or 6
• Bed rest restWB Initially PWB with crutches
• Inflammation of the Synovial Lining of the Hip Joint.

Slipped Capital Femoral Epiphysis (SCFE)

• ~11-16 Years of age that is more prevalent in Males Females (2:1)
• Overweight (80-100th percentile) and more common in black and Polynesian races (~40-50% bilateral)

Muscoloskeletal Conditions

FAI Impingement

• FAI (femoroacetabular impingement) is associated with predisposing factors altering ossesous, may alter femoral head and can lead to hip pain
• Objective and reproducible measure of mobility

Greater Trochanteric Pain Syndrome (GTPS)

• Caused due to the galuteous medius tendonpathy
• The primary cause of lateral is pain due to gluteal and may extend down the thigh
• Occurs over hip, thigh, and change in ultrasounds
• Self questionaires an objective measures to see pain
• Load management, retorative loading, movement etc helps reduce pain

Piriformis Syndrome

• It is a euro mustcular condition from which pain arises from the muscles
• More common in women with 6:1 ratio
• There are exam and findings that aid test the piriformis; if there deep gluteal pain

Hamstring Strain

Hamstring strains consist to quick eccentric where muslces strains,

Post-Opprotive Total Hip Replacement Rehabilitation

Pre-Operative Phase

• Education
• ROM (range of motion) exercises
• Strengthening exercises
• Aerobic conditioning

Phase 1: Protected Motion (Week 0-6)

• Prevent complications, such as deep vein thrombosis (DVT)
• Increase functional mobility -Maintain THA precautions

Phase 2: Progressive Loading, Strengthening (Week 6-10)

• Normalize gait with least restrictive assistive device
• Achieve independence with activities of daily living
• Improve strength and mobility of surgical leg

Phase 3: Functional/Sensorimotor Training (Week 10-16)

• Achieve independence with all activities
• Progressive Strengthening and Range of Motion
• Balance and Proprioception Training
• Post Surgical

Post Opp Rotative Precautions,

Total Hip Arthroplasty (THA) Precautions:

• Depend on surgical app

Postrot Approaches:

No hip flection past 90 deg

• No hip audution,
• no internal notation No Antior Appro: Excessive hip extention,
• Cement is,
• Cemented * weight bearing Weight bear restrictions

Phasion Hip Arthoscopy: Avoid over doing, overdoing, over work of hurt

Exercises

Intra-Articular hip

The intra-articular hip

• Exercise addresses hit to hip joint

Exercises Extra

• Extra atticular
• Addresses hit
• Focus on gentle and trochanting and while keeping forces on the band

Piriformis Sindrome

• Hip and extensor, rotator

Hamstring strain

• This loading what pain

Manual Therapy

• Hip Therapy and joints will aid
• Exercises will help to improve all range of motion in patient
• Used to access tissut
• Palpatation
• And trigger pointer can exist through effect treatment