THE HIP. Cooler than cool, the pinnacle of what is "it". Beyond all trends and conventional coolness.
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1 THE HIP Cooler than cool, the pinnacle of what is "it". Beyond all trends and conventional coolness.
2 Objectives Hip anatomy Causes of hip pain Hip exam
3 Anatomy Bones Ilium Anterior Superior Iliac Spine Lumbar Spine Sacrum Coccyx Sacroiliac joint Femoral head Greater Trochanter Ischium Pubis Pubic symphysis Femur Anterior Inferior Iliac Spine Lesser Trochanter
4 Anatomy Joint
5 Anatomy Muscles: hip flexion
6 Anatomy Muscles: hip extension
7 Anatomy Muscles: hip adduction
8 Anatomy Muscles: hip abductors along with Glut med and min
9 Anatomy Muscles: Internal rotators with Glut med and min
10 Anatomy Muscles: External rotators
11 Anatomy Muscles: Internal rotators with Glut med and min
12 Anatomy Muscles: Flexes leg
13 Anatomy Muscles: Extends leg
14 Causes of Hip Pain Non-MSK things to rule out Septic arthritis Toxic synovitis Osteomyelitis Tumors; both benign and malignant primary tumors as well as metastasis Sacroiliitis Testicular pathology Renal Intra-abdominal
15 Causes of Hip Pain Intra-articular Slipped Capital Femoral Epiphysis Legg-Calve-Perthes disease Femoral acetabular impingement Labral tear Developmental Dysplasia Dislocation Osteoarthritis Femoral fractures
16 Causes of Hip Pain SCFE Slipped capital femoral epiphysis Pain anywhere from groin to knee Males>females, adolescents during growth spurt (11-16yo), high BMI +/- history of trauma Leg length discrepancy, limping, leg in external rotation Refer to ortho for pinning
17 Causes of Hip Pain SCFE Slipped capital femoral epiphysis
18
19 Causes of Hip Pain Legg-Calvé-Perthes Disease Idiopathic AVN of the femoral head Males>females, age 2-11 Limp, lack of internal rotation Treatment involves containing the femoral head in the acetabulum
20 Causes of Hip Pain Femoroacetabular impingement Risk for early cartilage damage and arthritis Diagnose with MRI
21 Causes of Hip Pain Labral tear Mechanism of twisting, cutting, or planting Mechanical sensation or locking + Scour test Diagnosed with MR arthrography
22
23 Causes of hip pain Femoral neck stress fracture Endurance athletes especially amenorrheic females Antalgic gait and pain with ends of IR and ER May need bone scan to diagnose Compression vs tension side determines treatment
24 Causes of Hip Pain Extra-articular Bursitis Avulsion fracture Muscle strain Piriformis syndrome Osteitis Pubis
25 Causes of hip pain Avulsion fractures From forceful contraction of attached muscle Tenderness at the site and with contraction of the involved muscle Diagnosed with x-ray Pelvic series
26 Causes of Hip pain Avulsion Fractures ASIS
27 Causes of Hip Pain Avulsion fractures AIIS
28 Causes of Hip Pain Avulsion fractures Iliac crest
29 Causes of Hip Pain Avulsion fractures Greater trochanter
30 Causes of Hip Pain Avulsion fractures Lesser trochanter
31 Causes of Hip Pain Avulsion fractures Ischial tuberosity
32 Causes of Hip Pain Bursitis Trochanteric: IT band causing friction with moving from flexion to extension Iliopsoas/Iliopectineal: Iliopsoas causes friction with hip flexion
33 Causes of Hip Pain Piriformis syndrome Presents with sciatica Tender over piriformis Symptoms are reproduced with stretching or activation of piriformis
34 Causes of Hip Pain Osteitis Pubis Inflammation of the pubic symphysis Overuse injury of adductors Tenderness over the pubic symphysis
35 Physical Exam Inspection Palpation Range of Motion Active Passive Resisted Provocative Tests Functional Tests
36 Physical Exam Inspection: Bruising, sitting position, leg length, thigh circumference Palpation ASIS Pelvic crest AIIS SI joint Greater Trochanter Ischial tuberosity Muscles
37 Range of Motion
38 Range of Motion Internal Rotation External Rotation
39 Provocative Tests Patrick s Test; SI joint
40 Provocative Tests Clam shell; piriformis
41 Provocative Tests Impingement
42 Provocative Tests Scour test; labral tear
43 Functional test Single leg squat
44 Summary Remember anatomy Consider non-msk causes of hip pain Use history to narrow differential Use physical exam to help rule diagnoses in or out QUESTIONS???
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