b. Non-arthritic hip (non-capsular patterns)

Transcription

1 Evaluation of Hip Disorders and Ruling Out the Lumbosacral Spine Richard Erhard, PT,DC University of Pittsburgh Differential Diagnosis Lumbar/Pelvis/Hip 1. Subjective examination a. History b. Behavior of symptoms 2. Physical Examination a. Objective findings b. Combination of objective measurements and response from the patient 3. Mechanical versus non-mechanical pain 4. Mechanical Pain - pathology a. Lumbar b. Pelvis c. Hip 5. Mechanical pain - non-pathological a. Rule out pelvis b. Rule out lumbar spine c. Rule in hip 6. Mechanical non-pathologic hip pain a. Arthritic hip (capsular patterns) b. Non-arthritic hip (non-capsular patterns) 1

2 7. Imaging decisions based on clinical findings 8. Clinical decisions a. Referral b. Consultation c. Intervention 2

3 Post Surgical Management of Arthroscopic Hip Surgery Keelan R Enseki, PT, MS, SCS University of Pittsburgh/ Centers for Rehab Services ensekikr@upmc.edu I. Indications a. Subjective reports b. Clinical findings c. Diagnostic testing II. Procedures a. Labral procedures i. Deridement ii. Repair b. Capsular Procedures i. Thermal modification ii. Plication 1

4 c. Osseous/Chondral Procedures i. Microfracture ii. Osteochondroplasty iii. Loose body removal d. Combined procedures III. Rehabilitation a. Immediate post-operative issues i. Control of inflammation ii. Controlled ROM iii. Strength integrity b. Range of Motion Issues c. Weight Bearing Issues 2

5 d. Strength Issues e. Return to Function i. Balance ii. Ambulation/ADLs iii. Competition/Occupation 3

6 Conservative Treatment of Hip Disorders Using a Classification System RobRoy Martin PhD, PT, CSCS Duquesne University Department of Physical Therapy 114 Rangos School of Health Sciences Pittsburgh, PA (fax) martinr280@duq.edu 1) Introduction/Background A) Evaluation algorithms B) Classification-based Treatment C) Review of the literature 2) Anatomical Considerations 3) Classifications A) Primary labral pathology B) Femoral-acetabular impingement C) Capsular laxity D) Degenerative articular cartilage 1

7 4) Evaluation A) Lumbar/sacral pathology B) Extra-articular vs. Intra-articular C) Classifying intra-articular pathology 5) Case Studies 2

8 References Altman, R., Alarcon, G., Apelrouth, D., Bloch, D., et al. (1991). The American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the hip. Arthritis & Rheumatism, 34(5), American Academy of Orthopedic Surgeons. (1996). Individual clinical guidelines: Hip pain (non-traumatic), Phase 1. Retrieved September 23, 2004, from Beck, M., Leunig, M., Parvizi, J., Boutier, V., et al. (2004). Anterior femoroacetabular impingement. Part II: Midterm results of surgical treatment. Clinical Orthopedics, 418, Bierma-Zeinstra, S.M., Bohnen, A.M., Bernsen, R.M., Ridderikhoff, J., & Verhaar, J.A. (2001). Hip problems in older adults: classification by cluster analysis. Journal of Clinical Epidemiology, 54(11), Bijl, D., Dekker, J. van Baar, M.E., Oostendorp, R.A.B., et al. (1998). Validity of Cyriax s concept capsular pattern for the diagnosis of osteoarthritis of hip and/or knee. Scandanavian Journal of Rheumatology, 27, Greenwood, M.J. Erhard, R.E. & Jones, D.L. (1998). Differential diagnosis of the hip vs. lumbar spine: five case reports. Journal of Orthopedic and Sports Physical Therapy, 27(4), Hickman, J.M. & Peters, C.L. (2001). Hip pain in the young Adult: Diagnosis and treatment of disorders of the acetabular labrum and acetabular dysplasia. American Journal of Orthopedics, Jager, M., Wild, A.,Westhoff, B. & Rudiger, K. (2004). Femoroacetabular impingement caused by femoral osseous head-neck bump deformity: clinical radiological, and experimental results. Journal of Orthopedic Science, 9, Kelly, B.T., Williams, R.J., III & Philippon, M.J. (2003). Hip arthroscopy: Current indications, treatment options, and management issues. American Journal of Sports Medicine, 31(6), Margo, K. Drezner, J. & Motzkin, D. (2003). Evaluation and management of hip pain: An algorithmic approach. The Journal of Family Practice, 52(8), Philippon, M.J. (2002). Debridement of labral tears with associated thermal capsulorrhapy. Operative Techniques in Sports Medicine, 10, Siebenrock, K.A., Wahab, K.H.A., Werlen, S., Kalhor, M., et al. (2004). Abnormal extension of the femoral head epiphysis as a cause of cam impingement. Clinical Orthopedics, 418,