Day 3 Hip and Pelvis Ortho Conditions PDF

HIP ORTHO CONDITIONS SOFT TISSUE DISORDERS Snapping Hip/Coxa Saltans - External form → snapping occurs lateral to the hip joint, over the region of the greater trochanter, attributed to movement of the ITB over the greater trochanter. - Internal form → the snap occ...

HIP ORTHO CONDITIONS SOFT TISSUE DISORDERS Snapping Hip/Coxa Saltans - External form → snapping occurs lateral to the hip joint, over the region of the greater trochanter, attributed to movement of the ITB over the greater trochanter. - Internal form → the snap occurs in the anterior region of the hip joint and is attributed to movement of the iliopsoas tendon. - Intra-articular → snap occurs inside the hip joint. - Surgery can be done as last such TB or Iliopsoas release Hip Pointer - Pain upon resisted Hip Flexion and Passive Hip Extension due to the iliopsoas which originates at the iliac fossa - May walk with Trendelenburg Gait since G. med originates at the outer surface of ilium Apophyseal injuries - inflammation at the site of a major tendinous insertion onto a growing bony prominence - Common among adolescents and athletes - Severity can range from being an inflammation to fractures Lesser Trochanter Apophyseal Injury - (+) Ludloff's sign: lift leg with knee extended in sitting→ deep groin pain = Iliopsoas affectation Iliotibial Friction Syndrome - Avoid downhill running or running on pitched (non level ground) - Use of soft, new running shoes rather than hard shoes. - For cyclists: avoid the use of excessive bike seat height and internally rotated cleats. - ITB stretch: hip ext, add, ER Hamstring Strain - Prone to strain as it is also prone to passive insufficiency - The most common activities that cause ischial avulsion are gymnastics, hurdling and dance. Quadriceps Strain - patient may complain of a feeling of a "pulled" muscle - MOI: Indirect trauma → missing a soccer ball and striking the ground with forced stretching of the contracting quadriceps muscle. JOINT DISORDERS Femoroacetabular Impingement - Elicited on full flexion, adduction and medial rotation - caused by jamming of an abnormal femoral head (e.g., from pistol grip deformity) into the acetabulum with increasing hip flexion OR - pincer impingement →when the acetabular rim contacts the femoral head-neck junction at end range of flexion. - During FAddIR test, femur hits acetabulum, which is painful Acetabular Labral Tear - If (+) clicking, lesion is most likely labral in nature. - Radiographs/X rays cannot detect labral tears SPECIAL TEST FOR ANT & POST LABRAL TEAR FADDIR Test (Ant) - patient is in supine, and the hip and knee are flexed to 90 degrees. - the hip is then internally rotated and adducted as far as possible - (+) test: production of pain, the reproduction of the patient’s symptoms with or without clicking or apprehension - Indicates Anterior Impingement/Labral tear/Iliopsoas tendinitis Posterior Labral Test - 1st position: FAddIR - Then take leg into ExAbER - (+) test: production of pain, the reproduction of the patient’s symptoms with or without clicking or apprehension - (+) test is an indication of a labral tear, anterior hip instability, or posterior–inferior impingement - Anterior hip instab happens as anterior glide occurs during ExAbER McCarthy Hip Extension Sign - patient lies supine with both hips flexed. - The examiner then takes the hip and extends it from the flexed position, the non-test leg is kept in flexion - First with the hip in ER, and then repeats the test with the hip in IR. - Reproduction of the patient’s pain and a “pop” would be a positive test. - (+) test Indicates a labral tear of the hip Hip OA - Occurs on weight bearing joints - Risk Factors: Aging, Trauma, Obesity, Developmental disorders, malalignment, etc. - For patients with hip OA, assistive devices should be held CONTRALATERALLY - (+) Coxalgic gait → Lateral trunk lean to affected side (this is to dec work of abductors on painful hip) PT Interventions: - Joint/bone protection strategies - Maintain/improve joint mechanics & connective tissue functions - Aquatic programs OSSEOUS DISORDERS Osteitis Pubis - Seen as normal for the first 2 to 3 weeks in the plain film - Flamingo Test will will have a (+) result FRACTURE AND DISLOCATIONS Femoral Neck Fx - Subcapital Neck Fx →femoral head & neck junction - Transcervical → mid portion of femoral neck - Basicervical → base of femoral neck - Intertrochanteric → most common d/t weak location; between greater and lesser trochanter SPECIAL TEST FOR FEMORAL FRACTURES Patellar Pubic Percussion Test - Supine, with knees extended - Auscultate using bell on symphysis pubis - Tap each patella - Compare pitch and loudness - N = equal / clear - (+) duller = bone patho (ex: fracture) break in the bone Tests for Femoral Stress Fractures (Shaft) - Microscopic disruption or break in bone - Sitting dangling - One arm - under thigh (fulcrum arm) - Other hand: apply pressure at knee while moving fulcrum arm - (+) sharp pain / apprehension - when fulcrum arm is at fracture site Salter and Harris - a method used to grade fractures that occur in children and involve the growth plate and Distal femur - II → most common - III → affects bone growth - IV → bone growth stops, - Epiphyseal plate is in charge of creating new bone length PEDIATRIC DISORDERS - DDH → unstable malformed, subluxed or dislocated hips. SPECIAL TEST FOR DDH Ortolani’s Sign (Relocatable hip) HAND PLACEMENT & POSITIONING - With the newborn supine - the clinician places the tips of the long and index fingers over the greater trochanter, with the thumb along the medial thigh. - The infant’s leg is positioned in neutral rotation with 90 degrees of hip flexion and is gently abducted while lifting the leg anteriorly. EXECUTION - With abduction one can feel a clunk, as the femoral head slides over the posterior rim of the acetabulum and into the socket. RESULT - This is the clunk originally described by Ortolani, and is called the sign of entry, as the hip relocates with this maneuver. Barlow’s Sign (Dislocatobarlow) POSITIONING & EXECUTION - Maintaining the same position (abducted), the leg is then gently adducted, while gentle pressure is directed posteriorly on the knee RESULT - a palpable clunk is noted as the femoral head slides over the posterior rim of the acetabulum and out of the socket. - This clunk was originally described by Barlow, and is called the sign of exit, as the hip dislocates with this maneuver. Galeazzi’s Sign - For unilateral DDH - may be used in infants from 13 to 18 months - Lower leg is the affected leg DDH BRACING - Pavlik Harness - Von Rosen Splint - Ilfeld Brace - Frejka Pillow - All these braces position the infant’s hips into FAbER since this position relocates the femoral head into the acetabulum. Legg Calve Perthe Disease - Osteonecrosis in pedia - Most constant early sign → psoatic limp (hip is in FAddER with a decreased swing through & excess trunk & pelvic motion) - LOM: Hip AbIR Slipped Capital Femoral Epiphysis - Separation of the head from the femur at the growth plate of the bone. - LOM: Hip FAbIR - On passive flexion of the hip, the patient will frequently externally rotate the leg. → this is their posture for comfort - Risk factors: Puberty, Males & Obese NERVE SYNDROMES Piriformis Syndrome - the possible cause of sciatic nerve compression secondary to piriformis muscle overuse. SPECIAL TEST FOR PIRIFORMIS - Patient in sidelying with test leg uppermost - flex the hip to 60° with knee flexed - Beyond 60 degrees, Piriformis is an Internal rotator of the hip - (+) tightness → pain in the piriformis - (+) sciatica → piriformis is pinching the sciatic nerve - FADIR causes pain aggravation - Use Ultrasound setting: 1 Mhz - Flex hip to 60 and IR to stretch Piriformis