Evaluation of the Hip and Knee
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
Common sources Referred back pain Causes of Hip Pain
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
Treatment for Back Pain Scheduled anti-inflammatory Physical therapy -core strengthening,stretching,modalities prn Referral to back clinic for injections, ablation, etc.
Causes of Hip Pain Soft tissue inflammation
Evaluation Soft Tissue Inflammation Point tenderness Sciatic notch - piriformis Trochanter trochanteric bursitis Ilial tibial band - tightness X-ray to r/o arthritis (maybe MRI)
Treatment for Soft Tissue Inflammation Scheduled anti-inflammatory Physical therapy for modalities and stretching Injection
Osteoarthritis Causes of Hip Pain
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
Treatment for Hip Arthritis Manage the pain Scheduled anti-inflammatory Activity modification Walking aids Surgery -total hip arthroplasty
Causes of Hip Pain Labral Tear
Labral Tear Painful but free range of motion Pain in groin Pain with resistance to leg raise Normal x-rays Get MRI
Debridement Treatment for Labral Tear
Causes of Hip Pain Hip Fracture
Evaluation of Hip Fracture Leg length Leg rotation Pain with movement during evaluation x-ray
Treatment of Hip Fracture Immediate non-weight-bearing Surgical fixation Hemiarthroplasty Total hip arthroplasty Evaluation and treatment for osteoporosis
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
Treatment for Avascular Necrosis Wait and See Total Hip Arthroplasty
Imaging Hip arthritis A-P pelvis True lateral Back A-P Spine Lateral Possibly flexion//extension Soft Tissue -labral, bursitis MRI AVN- MRI
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
Osteoarthritis Causes of Knee Pain
Evaluation of Osteoarthritis Gait evaluation Deformity ROM Crepitus Pain X-rays- A-P wt bearing (both sides) Lateral flexion, sunrise view
Treatment for Knee Arthritis Scheduled anti-inflammatory Activity Modification Topical gels Walking aids Braces Injections steroid /viscosupplementation Surgery total knee arthroplasty
Bursitis Causes of Knee Pain
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
Treatment for Bursitis Scheduled anti-inflammatory Activity modification Antibiotic if worried about infection Injection as last resort- morrhyate sodium Do not aspirate as treatment
Causes of Knee Pain Anterior Cruciate Ligament Injury
Evaluate ACL Injury Mechanism of injury (hyperextension) pop Swelling Stabilty MRI if suspicious Evaluation often will have to wait for swelling to subside
Treatment for ACL Injury Physical Therapy Surgical Repair
Torn Meniscus Causes of Knee Pain
Evaluate Meniscal Tear Swelling catching/locking ROM Joint line tenderness X-ray to rule out other issues, MRI if continued sx
Treatment for Meniscal Tear Do nothing Steroid injection Scheduled anti-inflammatory Arthroscopy
Osgood Schlatter Causes of Knee Pain
Evaluation Osgood Schlatter Disease Early teens, rapid growth Pain over tubercle tuberosity Enlargement of tubercle tuberosity
Treatment for Osgood Schlatter Cho-pat band Anti-inflammatory Tincture of time
Causes of Knee Pain Patella-Femoral Syndrome
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
Treatment of Patella Femoral Dysfunction Scheduled anti-inflammatory Physical therapy VMO /quad strengthening Arthroscopy for lateral release
A-P Weight bearing Lateral Flexion Sunrise view Imaging