Hip - Differential Diagnosis, Adolescent conditions, GTPS, Iliopsoas Bursitis

which of the following structures may refer pain to the hip region?

• kidney

• ureter

• intestines

• heart

• stomach

• lungs

• kidney

• ureter

• intestines

which of the following signs/symptoms potentially indicate systemic illness?

• abdominal spasms

• urinary frequency/urgency

• decreased urinary output

• fever

• chills

• headache

• hypertension

• nausea

• vomiting

all of the above

viscerogenic sources of hip pain

• kidney

• ureter

• urinary tract

• ileitis

• chron’s disease

system symptoms

• abdominal spasms

• urinary frequency/urgency

• decreased urinary output

• fever

• chills

• headache

• hypertension

• nausea

• vomiting

somatic sources of pain

• nerve root compression

• L/S facet joint

• sacroiliac joint

source of pain in the hip region

• bone

• musculotendinous

• capsuloligamentous

• intra-articular

• extra-articular

Extra-articular

• bursitis

• tendiopathies

Intra-articular

• OA

• Non-arthritic

  • impingement

    • functional

    • dtructural

Which piece of information MOST assists in establishing a musculoskeletal hip diagnosis in a child?

• activity level

• age

• birth weight

• cesarean section

• length of symptoms

• mechanism of injury

• specific activity/sport

• all should be given equal weight

age!

• all important, but age most

Developmental dysplasia of hip (DDH)

instability of femoral head within the acetabulum

• shallow acetabulum, not developed as much

DDH range

• mild abnormality → complete dislocation

• subluxable hip - hip pulls out and goes back in, still has contact

• dislocatable - hip comes out of acetabulum and goes back in

• dislocated - living outside acetabulum

• dysplastic hip - joint surfaces don’t fit together

DDH incidence

• 1-3 per 1000

• unknown cause

• female: 80-85%

• first born: 60%

• breech position: >40%

• family history

DDH presentation

• abnormal gait

• chronic hip dislocation when starting to WB

• asymmetrical leg creases

• apparent shortening of femur

DDH treatment

• birth

  • pavlik harness

• >6 weeks

  • hip spica and/or pavlik

• >1 yr

  • open reduction (surgery)

Legg-Calve-Perthes Disease (LCPD)

• idiopathic avascular necrosis (AVN) of femoral head

• bone dies

• results in flattening of femoral head