(2) HIP ADOLFO JOINT DISORDER

What condition is this?

• Bones of the hip are abnormally shaped; decreased joint clearance

• Sharp ANTERIOR groin pain

• Types:

  • Cam

  • Pincer

• Management:

  • Reduce anteriorly directed forces on the joint

  • Develop a length/strength balance in the muscles of the hip

  • Conservative treatment involve modification of activity to avoid the impingement positions and NSAIDs

A. Femoroacetabular Impingement

What condition is this?

• MOI:

  • Young: ER in hyperextended hip

  • Elderly: person with hip/acetabular dysplasia, or result of repeated twisting

  • Pivoting and twisting movements

• Dx:

  • Arthrography like an xray

  • MRI

  • Arthroscopy

• Signs and Symptoms:

  • Pain in the anterior hip/groin or buttocks

  • Locking, buckling, clicking, giving way at the hip, and restricted ROM

  • It is suspected when radiograph is normal and patient complains of anterior hip pain with clicking with passive hip flexion, adduction, and internal rotation

Pathognomonic - main clinical manifestations FAddIR

Acetabular Labral Tear

A TYPE OF ANTERIOR LABRAL TEAR

Flexion, adduction, and internal rotation – Most common site of tear

a. Anterior-superior tear -

A TYPE OF ANTERIOR LABRAL TEAR

Passive hyperextension abduction and external rotation

b. Posterior tear

A TYPE OF ANTERIOR LABRAL TEAR

Acute hip flexion with ER and full abduction, followed by extension, abduction, and IR

c. Anterior tear -

Special test that can be used for Anterior Labral Tear

McCarthy Hip Extension Sign

What condition is this?

• Death of the bone cells

• Etiology: Traumatic and Non-traumatic

A. Osteonecrosis

What condition is this

• Clinical Features

  • Limp and hip spasm (children)

  • Pain in the groin (adults)

  • Pain referred to thigh and knee

  • LOM in flexion, IR and abduction

  • Coxalgic gait

• Treatment:

  • Conservative (children)

  • Surgical (adult)

Osteonecrosis of the Femoral Head

What condition is this

• Most common inflammatory disorder affecting pubic symphysis

• Causes:

  • Overuse

  • Trauma

  • Pelvic surgery

  • Childbirth

• Self-limiting

• May go aways on its own

• Symptoms:

  • Exercise induced pain in the lower abdomen & medial thigh

  • Tenderness over the pubic symphysis

  • Pain provoked by active adduction or sit-ups

  • Popping in the pubic region with ambulation

  • Pain on scrotum

  • Pain is described as “groin burning”

• Dx:

  • Plain films

  • MRI bone scan

  • Hop test

  • Adductor Stretching and strengthening

  • Abdominal, core mm strengthening

Osteitis Pubis

A type of hip disclocation that’s the most common and caused by MVA: major cause of traumatic dislocation – dashboard injury

Posterior hip dislocation

A type of hip dislocation that’s caused by a fall from a great height

o Central fracture/dislocations

What type of hip dislocation is this?

• Most common

• MOI: force to flexed knee in an adducted position

• Presentation: lower extremity shortened, flexed, adducted, IR at hip

Posterior Hip Dislocation

What type of hip dislocation is this?

• MOI:

  • Superior/pubic = force to an extended and externally rotated

  • Inferior/obturator = force to a flexed, abducted and externally rotated

Anterior Hip Dislocation

In anterior dislocation, what structure will be affected if the MOI is: force to an extended and externally rotated

• Superior/pubic

In anterior dislocation, what structure will be affected if the MOI is: force to a flexed, abducted and externally rotated

• Inferior/obturator

Classifications of Femoral Head Fracture?

• Intracapsular

  • Subcapital

  • Transcervical

  • Basicervical b.

• Extracapsular most common

  • Intertrochanteric – most common in men

  • Subtrochanteric – common in women

Special tests used for femoral head fracture?

Patellar-Pubic Percussion Test

Fulcrum Test

treatment for intracapsular fractures of the femoral neck?

hip arthroplasty

treatment for extracapsular fractures of the femoral neck?

- Compression-type screw, pin or nail and laterally-placed side-plate (ORIF)

- Intramedullary nails are also used for fixation