Hip Pathologies

Hip Pathologies

1. Hip OA

   • normal joint space = 3-5 mm <2.5 moderate narrowing <1.5 severe narrowing
   • AM stiffness <1 hr
   • graveling sounds
   • gets better w/activity
   • female
   • BMI >30
   • age >50
   • "C-shaped" pain
   • capsular pattern
     • IR, flex, ABD
   • pain w/squat
     • painful active hip ext/flex
   • Interventions
     • ice, e-stim
     • mobs to improve IR, flex, ABD
       • capsular pattern
     • stretch hip flexors
     • strengthening
       • often weak hip abductors
     • address underlying impairments
     • weight control
     • gait training
     • patient education
       • -don't cross legs -sleep sidelying with pillow b/t legs -try to avoid hip flexion (when squatting, try to keep affected leg straight and bend w/other) -avoid prolonged sitting/squatting
     • Viscosupplementation
       • -avoid WB for 48 hrs after -includes Supartz, Synvisc, Orthovisc, Nuflex
     • NSAIDs
     • cortisone injections
     • ultimately, THR
       • predictive factors:&nbsp; pain level &gt; ~4.7 moderate osteophytes moderate joint space narrowing previous trial of NSAIDs

2. Snapping hip

   • Ant. - Iliopsoas
   • Post. - Hamstrings
   • Lat. - IT band & glut. max
   • Interventions
     • Stretching
     • Massage
     • address predisposing factors

3. Stress Fracture

   • insidious
   • ant. groin pain
   • overuse
   • young, runners
   • coxa vara
     • b/c femoral angle is closer to 90 deg., which puts more stress at femoral neck
   • pain w/WB
   • decr. ROM, strength, mobility
     • NON capsular pattern
   • female athlete triad
     • low energy/energy deficiency, hormonal imbalances, low BMD
   • pain w/sit to stand
   • special tests
     • fulcrum test, patellar-pubic percussion test, heel thump/leg hop test
   • gold standard?
     • bone scan; also can use radiographs-look for radiopacity due to extra bony growth a few weeks after fracture
   • Interventions
     • Immobilization
     • strengthening
     • assistive device
     • stretching
     • aquatic therapy

4. Labral Tear

   • radial flap and ant.-superior tears are most common
   • usually ant.-sup., or post-sup.
     • if 3 o'clock area is involved, usually caused by iliopsoas pulling on it
   • coxa valga
     • incr. stress on ant.-sup. labrum due to how femoral head is then positioned
   • Cam & Pincer (FAI)
     • bone spurs, leading to FAI (femoral acetabular impingement)
   • acetabular retroversion
     • decr joint space, increasing impingement
   • Down's, Marfan's syndrome
     • instability
   • Femoral Ant. Glide Syndrome
     • insufficient posterior glide of femur during hip flexion; caused by tight ER's and tight posterior capsule, forcing femoral head forward and causing impingement/tear
   • Legg-Calve Perthes
   • mechanical trauma
     • torsion and loading (pivoting and twisting), ER w/hyperextension
   • buckling, clicking, instability
   • ant. groin pain
     • possible referral
       • to medial knee, greater troch region, buttocks region
   • pain w/FADDIR
     • pain w/SLR flex.
       • b/c RF attaches to labrum
   • antalgic gait
   • Interventions
     • joint mobs
       • to increase IR ROM and decr. post. tightness; A/P and inf. joint mob
     • strengthen gluts
       • glut med and glut max can both do ER
     • squats, step downs
     • stretching
     • address posture
       • pelvic tilt
     • proprioceptive training
     • stationary bike
       • if tolerated
     • assistive device
   • Surgery
     • * ER and ext. are precautions for all these surgeries (for 4-8 weeks)! (b/c brings femoral head forward, which is where labral is most often damaged)
     • Labral Repair
       • -protective WB for 4-8 weeks -emphasize trunk/pelvic and hip control -follow MD protocol -avoid ER and EXT (for all)
     • Labral Resection
       • -2-4 wks protected WB -microfracture: 4-8 wks -avoid early ER and ABD -trunk and pelvic strengthening to normalize gait --&gt;GLUT MAX/MED -running &amp; activity-specific 8-10 wks
     • Microfracture
       • recovery: 1+ years -involves drilling so mesenchymal cells leak out from blood, marrow and epithelium -protective WB 8 wks; full WB after that -AAROM and pelvic control for 0-3 wks -use pool for progression -functional running/training after 12 wks

5. FAI

   • Cam, Pincer, Both
     • 50% of ppl have both
   • Femoral ant. glide syndrome
     • femur can't glide posteriorly so it's forced anteriorly during hip flexion; caused by tight posterior capsule/musculature or lax anterior capsule
   • insidious
     • progressive stiffness & pain
   • buckling, locking, clicking
     • painful clicking
   • ant. groin pain
   • hypomobility
   • antalgic gait
   • posterior tightness
   • lumbar pathology
     • could cause hypertonicity of hip ER's, resulting in femoral acetabular anterior glide syndrome
   • ANT pelvic tilt
   • +Thomas, +Ober
     • +Thomas could contribute to anterior pelvic tilt; +Ober could cause excessive ADD and IR, resulting in impingement
   • gluteal vs. hamstring dominance?
     • hamstring dominance will cause excessive ant femoral translation; gluteal dominance will cause posterior translation (i think)&nbsp;

6. Inert lesion

   • MOI
     • twisting motion during WBing
   • non-capsular
   • restrictive ROM
     • acutely
   • pain w/WBing
   • pain w/STS
   • end range apprehension
     • w/end range IR, ext, and inferior glide
   • Interventions
     • rest, ice, massage
     • NSAIDs
     • proprioceptive training
     • strengthening
     • controlled WBing
     • hip SPICA

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