Untitled Quiz

Ortho - Hip Exam Breakdown

• Pathology/Presentation (slides 6-9): Covers assessment of pathologies, movement compensations, and case studies.
• Hip Dysplasia: Characterized by a shallow acetabulum (socket) and decreased femoral head coverage. More common in women.
• Developmental Dysplasia of the Hip (DDH): Involves ligament laxity, intrauterine crowding, or breech position.
• Adult Presentation: Characterized by insidious onset, moderate to severe groin pain, and decreased activity tolerance. Can involve catching or pain with impingement signs.
• Intervention (DDH): Includes Pavlik harness (birth to 6 months) and hip spica cast (3-6 months) to address instability.
• Adult Intervention: Aims to reduce early osteoarthritis risk by focusing on physiotherapy (PT) which includes progression from isometric to eccentric exercises, activity modification, and neuromuscular control.
• Slipped Capital Femoral Epiphysis (SCFE): Presents with displacement of femoral head in relation to femoral neck. More frequent in males (12-15 years). Categorized as stable or unstable and involves a femoral head slipping inferiorly and posteriorly.
• Legg-Calvé-Perthes: Idiopathic avascular necrosis/collapse of the femoral head. More common in males (4-10 years).

Osteoarthritis

• Pathology: Primary aging/genetics (>50). Secondary factors include previous injuries and metabolic abnormalities (e.g., SCFE, LCP).
• Presentation: Features include morning stiffness (<60 minutes), decreased hip IR (<24 degrees), hip pain during active hip flexion or hip extension, hip pain exacerbated by squatting, and limping.
• Intervention: Focuses on flexibility, strengthening, endurance exercises, manual therapy, functional gait and balance training, modalities, and patient education. Weight loss is beneficial.

Rheumatoid Arthritis

• Pathology: Systemic autoimmune condition affecting synovial lining, cartilage, and bone. Commonly affects age 15-50.
• Presentation: Includes groin pain, swelling, redness, increased temperature in other joints, feeling fatigued, weight loss, fever, and respiratory symptoms, morning stiffness lasting > 1 hour. Rheumatoid factor presence is also typically observed.
• Intervention: Management includes pain management, supportive devices, education to prevent further damage, and synovectomies. A THA might be needed (but is more complex)

Other Hip Conditions

• Femoral Acetabular Impingement Syndrome (FAIS): Characterized by abnormal acetabular and femoral head/neck morphology. CAM or pincer deformities are prevalent. Often presents in active young adults with slow-onset, persistent groin pain, decreased range of motion (ROM), and symptoms exacerbated by activities like squatting, driving, and prolonged sitting.
• Greater Trochanteric Pain Syndrome (GTPS): An umbrella term encompassing bursitis, tendinopathy, or mechanical loads. Presents with insidious, chronic, or intermittent pain in the proximal lateral hip (often radiating to distal thigh), pain with palpation over the greater trochanter, inability to lie on the affected side, limping, pain with sit-to-stand transfers and stair climbing, difficulty sitting with legs crossed, and a positive 30-second single-leg stand test.
• Labral Lesions: Associated with osteoarthritis or other conditions. Labral tears manifest as anterior hip/groin pain, catching or locking, clicking sensations, and limitations in ROM.
• Iliotibial Band Syndrome: Lateral hip or knee pain often in conjunction with pain related to weak hip abductor strength, hip lag, or trendelenburg sign.
• Iliac Crest/Avulsion Fractures: Commonly in boys 14-17, presents with sudden hip pain, reduced hip mobility, and weakness. Ischemic Necrosis of Femoral Head (AVN) occurs when the femoral head blood supply is interrupted, leading to groin pain worsening over time (with weight-bearing). Pain is relieved with rest.
• Coxa Saltans/Snapping Hip: Intra-articular or extra-articular condition. Intra-articular involves internal impingement (iliopsoas tendon) or external impingement (IT band). Extra-articular is often associated with muscular lesions. Symptoms include snapping/clicking and possible pain.
• Gluteal Syndrome: Cluster of complex pain generators related to the piriformis and sciatic nerve. Possible entrapment of the sciatic nerve or surrounding tissues. Presents as buttock pain, worsening with prolonged sitting or activity. Assessment involves tests like the FAIR test, slump test, and hamstring origin.
• Athletic Pubalgia/Core Muscle Injury (CMI): Chronic abdominal/groin pain (sometimes radiating). Results from muscle imbalance or repetitive forceful movements. Common in athletes, particularly those with high-stress activities like kicking, cutting, and sprinting. Risk factors include delayed abdominal recruitment, imbalance of adductor to abductor strength, and structural abnormalities or joint dysplasia.