The Focused Hip Examination of the Pre-arthritic, Athletic Patient. Adam Anz, MD Andrews Institute Gulf Breeze, Florida
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1 The Focused Hip Examination of the Pre-arthritic, Athletic Patient Adam Anz, MD Andrews Institute Gulf Breeze, Florida
2 Correct Diagnosis: - 35% History - 30 % Physical Exam - 30% Plain X-rays - 5% MRI
3 Anatomy Think Anatomy by Layers: Skin Nerves Muscles Joint - Osseous Anatomy - Soft Tissue Structures
4 Anatomy Think Anatomy by Layers: Skin Nerves Muscles Joint - Osseous Anatomy - Soft Tissue Structures
5 Anatomy Think Anatomy by Layers: Skin Nerves Muscles Joint - Osseous Anatomy - Soft Tissue Structures
6 Anatomy Think Anatomy by Layers: Skin Nerves Muscles Joint - Osseous Anatomy - Soft Tissue Structures
7 Anatomy Think Anatomy by Layers: Skin Nerves Muscles Joint - Osseous Anatomy - Soft Tissue Structures
8 Femoroacetabular Impingement Pincer Deformity: Lateral Shelf of Acetabular Bone Diffuse- Coxa Profunda/Acetabuli Protrusio Localized- Pincer Shelf Acetabular Retroversion Injury Pattern Anterior- Labral Damage Circumferential- Cartilage Strip Posterior- Contra Coup Cartilage Femoral- Pincer Groove 8 Ganz CORR 2008
9 Cam Lesion: Abnormality at Femoral Head/Neck Junction Congenital Femoroacetabular Impingement Undiagnosed SFCE Rotational Stress Reaction at Capital Epiphysis Alpha Angle 76 degrees 9 Ganz CORR 2008
10 Femoroacetabular Impingement Cam Lesion: Injury Pattern Labral Injury: Bruising => Tear Anterior Superior to Lateral Cartilage Delamination 10
11 Femoroacetabular Impingement Anatomy 11
12 Femoroacetabular Impingement Anatomy Activity 12
13 Femoroacetabular Impingement Anatomy Activity When the moderate extreme of both overlap, femoroacetabular impingment occurs 13
14 Femoroacetabular Impingement Anatomy Activity When the moderate extreme of both overlap, femoroacetabular impingment occurs 14
15 Femoroacetabular Impingement Anatomy Activity When the moderate extreme of both overlap, femoroacetabular impingment occurs 15
16 History
17 History Mechanism- Activity? Trauma? Length of Pain- Occupation
18 Pain- History Location- Anterior Groin (85%), Deep Buttock (51%) Onset- Acute Onset? Quality- Sharp with Provoking Maneuvers, Constant Ache Severity- Mild at baseline, Increased with Activities Aggravating Factors- Sitting Long Periods, Riding in Cars, Squatting Alleviating Factors- Associated Symptoms- Popping?, Radiating Pain!?!
19 Physical Exam
20 Hip Pain
21 Treatment I. Make Correct Diagnosis and Education Patient II.Activity Modification a. Avoid At Risk Positions Hill Running No Inclined Treadmill Flexed Bicycle III.Treat Synovitis a. Rest b. NSAIDs c. Injection IV. Strengthen Hip Girdle and Core a. Physical Therapy b. Low/No Impact Exercise
22 Arthroscopic Treatment for FAI Access Central Compartment Synovectomy Cartilage Debridement Acetabuloplasty- PINCER Labral Repair Access Peripheral Compartment Femoral Neck Osteoplasty- CAM Capsular Closure 22
23 Arthroscopic Treatment for FAI Access Central Compartment Synovectomy Cartilage Debridement Acetabuloplasty- PINCER Labral Repair Access Peripheral Compartment Femoral Neck Osteoplasty- CAM Capsular Closure 23
24 Arthroscopic Treatment for FAI Access Central Compartment Synovectomy Cartilage Debridement Acetabuloplasty- PINCER Labral Repair Access Peripheral Compartment Femoral Neck Osteoplasty- CAM Capsular Closure 24
25 Arthroscopic Treatment for FAI Access Central Compartment Synovectomy Cartilage Debridement Acetabuloplasty- PINCER Labral Repair Access Peripheral Compartment Femoral Neck Osteoplasty- CAM Capsular Closure 25
26 Arthroscopic Treatment for FAI Access Central Compartment Synovectomy Cartilage Debridement Acetabuloplasty- PINCER Labral Repair Access Peripheral Compartment Femoral Neck Osteoplasty- CAM Capsular Closure 26
27 Arthroscopic Treatment for FAI Access Central Compartment Synovectomy Cartilage Debridement Acetabuloplasty- PINCER Labral Repair Access Peripheral Compartment Femoral Neck Osteoplasty- CAM Capsular Closure 27
28 Arthroscopic Treatment for FAI Access Central Compartment Synovectomy Cartilage Debridement Acetabuloplasty- PINCER Labral Repair Access Peripheral Compartment Femoral Neck Osteoplasty- CAM Capsular Closure 28
29 Arthroscopic Treatment for FAI Access Central Compartment Synovectomy Cartilage Debridement Acetabuloplasty- PINCER Labral Repair Access Peripheral Compartment Femoral Neck Osteoplasty- CAM Capsular Closure 29
30 Arthroscopic Treatment for FAI Access Central Compartment Synovectomy Cartilage Debridement Acetabuloplasty- PINCER Labral Repair Access Peripheral Compartment Femoral Neck Osteoplasty- CAM Capsular Closure 30
31 Arthroscopic Treatment for FAI Access Central Compartment Synovectomy Cartilage Debridement Acetabuloplasty- PINCER Labral Repair Access Peripheral Compartment Femoral Neck Osteoplasty- CAM Capsular Closure 31
32 Arthroscopic Treatment for FAI Access Central Compartment Synovectomy Cartilage Debridement Acetabuloplasty- PINCER Labral Repair Access Peripheral Compartment Femoral Neck Osteoplasty- CAM Capsular Closure 32
33 Arthroscopic Treatment for FAI Access Central Compartment Synovectomy Cartilage Debridement Acetabuloplasty- PINCER Labral Repair Access Peripheral Compartment Femoral Neck Osteoplasty- CAM Capsular Closure 33
34 Access Central Compartment Synovectomy Cartilage Debridement Acetabuloplasty- PINCER Labral Repair Access Peripheral Compartment Femoral Neck Osteoplasty- CAM Capsular Closure 34
35 Arthroscopic Treatment for FAI Access Central Compartment Synovectomy Cartilage Debridement Acetabuloplasty- PINCER Labral Repair Access Peripheral Compartment Femoral Neck Osteoplasty- CAM Capsular Closure 35
36 Arthroscopic Treatment for FAI Access Central Compartment Synovectomy Cartilage Debridement Acetabuloplasty- PINCER Labral Repair Access Peripheral Compartment Femoral Neck Osteoplasty- CAM Capsular Closure 36
37 Arthroscopic Treatment for FAI Access Central Compartment Synovectomy Cartilage Debridement Acetabuloplasty- PINCER Labral Repair Access Peripheral Compartment Femoral Neck Osteoplasty- CAM Capsular Closure 37
38 Arthroscopic Treatment for FAI Access Central Compartment Synovectomy Cartilage Debridement Acetabuloplasty- PINCER Labral Repair Access Peripheral Compartment Femoral Neck Osteoplasty- CAM Capsular Closure 38
39 Arthroscopic Treatment for FAI Access Central Compartment Synovectomy Cartilage Debridement Acetabuloplasty- PINCER Labral Repair Access Peripheral Compartment Femoral Neck Osteoplasty- CAM Capsular Closure 39
40 Lying on your back with hip in 70 degrees of in a counterclockwise circular pendulum motion for 5 minutes Rehabilitation FAI **Do NOT push into pinch or painful position** Phase weeks Protect Integrity of Repair CIRCUMDUCTION AT NEUTRAL Restore Range of Motion in Safe Zone (WEEK ) No ER for 18 Days No Extension Past 0 for 21 Days on your back2 Weeks with hip and knee No Sitting at 90Lying Degrees for First Diminish Pain and circular Inflammation a clockwise pendulum motion for 5 minutes Phase II 6 weeks to 6 months Lying on your back with hip and knee Normalize Gait counterclockwise circular pendulum motion Regain Full Range of Motion for 5 minutes Develop Neuromuscular Control **Do NOT pull leg into distraction** Phase III 6-9 months Regain Functional Strength and Condition 40
41 Conclusion Understanding the Anatomy is the First Step Femeroacetabular Impingment is an Overlap of Anatomy and Activity Involve the Patient s Perception in the Physical Exam Hip Surgery has take a Leap Forward in the last 10 Years with Hip Arthroscopy (A Good Tool) But Not Every Labral Tear Hurts or Needs a Surgery The Key is to Be Patient Understanding the History, Physical, and Xray/MRI Findings 41
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