Evaluation of the Hip and Knee

Transcription

1 Evaluation of the Hip and Knee

2 Causes of hip pain RA Osteoarthritis Psoriatic arthritis Septic arthritis Bursitis Hip fx Labral tear Tendinitis Referred back pain Cancer AVN Legg-Calve-Perthes Paget's disease Osteomyelitis Synovitis Pelvic fx

3 Common sources Referred back pain Causes of Hip Pain

4 Evaluation Referred back pain Back evaluation Lumbar spine flexion/extension Paravertebral muscles /sciatic notch Trochanteric pain/gunslinger pattern Straight leg raise -sitting and laying X-ray then MRI

5 Treatment for Back Pain Scheduled anti-inflammatory Physical therapy -core strengthening,stretching,modalities prn Referral to back clinic for injections, ablation, etc.

6 Causes of Hip Pain Soft tissue inflammation

7 Evaluation Soft Tissue Inflammation Point tenderness Sciatic notch - piriformis Trochanter trochanteric bursitis Ilial tibial band - tightness X-ray to r/o arthritis (maybe MRI)

8 Treatment for Soft Tissue Inflammation Scheduled anti-inflammatory Physical therapy for modalities and stretching Injection

9 Osteoarthritis Causes of Hip Pain

10 Evaluation Osteoarthritis Central pattern arthritis Sciatic pain, inflammatory condition, few osteophytes, wear into the pelvis Anterior pattern arthritis Typical groin pain, osteophytes anterior wear Gait evaluation, ROM, Pain, Trendelenberg sign, X-ray -A-P pelvis and true lateral

11 Treatment for Hip Arthritis Manage the pain Scheduled anti-inflammatory Activity modification Walking aids Surgery -total hip arthroplasty

12 Causes of Hip Pain Labral Tear

13 Labral Tear Painful but free range of motion Pain in groin Pain with resistance to leg raise Normal x-rays Get MRI

14 Debridement Treatment for Labral Tear

15 Causes of Hip Pain Hip Fracture

16 Evaluation of Hip Fracture Leg length Leg rotation Pain with movement during evaluation x-ray

17 Treatment of Hip Fracture Immediate non-weight-bearing Surgical fixation Hemiarthroplasty Total hip arthroplasty Evaluation and treatment for osteoporosis

18 Causes of Hip Pain Avascular Necrosis Causes injury, decreased blood flow to head, Risk factors steroid use, heavy drinking, deep sea diving, fracture. Presentation similar to osteoarthritis Plain x-ray may show collapse of head /or MRI

19 Treatment for Avascular Necrosis Wait and See Total Hip Arthroplasty

20 Imaging Hip arthritis A-P pelvis True lateral Back A-P Spine Lateral Possibly flexion//extension Soft Tissue -labral, bursitis MRI AVN- MRI

21 Causes of Knee Pain ACL injury AVN FX Patella-femoral syndrome Sprain/strain Patella dislocation Gout Bursitis Osgood Schlatter Osteoarthritis Referred pain hip Torn meniscus RA Ligamentous injury

22 Osteoarthritis Causes of Knee Pain

23 Evaluation of Osteoarthritis Gait evaluation Deformity ROM Crepitus Pain X-rays- A-P wt bearing (both sides) Lateral flexion, sunrise view

24 Treatment for Knee Arthritis Scheduled anti-inflammatory Activity Modification Topical gels Walking aids Braces Injections steroid /viscosupplementation Surgery total knee arthroplasty

25 Bursitis Causes of Knee Pain

26 Evaluation of Bursitis Swollen over knee cap or below the knee cap, inner side of knee below joint Causes kneeling, direct blow, infection, obesity and osteoarthritis. Evaluate activities Maybe aspirate if worried about infection

27 Treatment for Bursitis Scheduled anti-inflammatory Activity modification Antibiotic if worried about infection Injection as last resort- morrhyate sodium Do not aspirate as treatment

28 Causes of Knee Pain Anterior Cruciate Ligament Injury

29 Evaluate ACL Injury Mechanism of injury (hyperextension) pop Swelling Stabilty MRI if suspicious Evaluation often will have to wait for swelling to subside

30 Treatment for ACL Injury Physical Therapy Surgical Repair

31 Torn Meniscus Causes of Knee Pain

32 Evaluate Meniscal Tear Swelling catching/locking ROM Joint line tenderness X-ray to rule out other issues, MRI if continued sx

33 Treatment for Meniscal Tear Do nothing Steroid injection Scheduled anti-inflammatory Arthroscopy

34 Osgood Schlatter Causes of Knee Pain

35 Evaluation Osgood Schlatter Disease Early teens, rapid growth Pain over tubercle tuberosity Enlargement of tubercle tuberosity

36 Treatment for Osgood Schlatter Cho-pat band Anti-inflammatory Tincture of time

37 Causes of Knee Pain Patella-Femoral Syndrome

38 Evaluation of Patella-Femoral Dysfunction Often young women Stiff after sitting Trouble after exercise Pain with stairs/squatting/downhill Positive findings with patella examination X-ray Sunrise view

39 Treatment of Patella Femoral Dysfunction Scheduled anti-inflammatory Physical therapy VMO /quad strengthening Arthroscopy for lateral release

40 A-P Weight bearing Lateral Flexion Sunrise view Imaging