Evaluation of Hip Disorders and Ruling Out the Lumbosacral Spine Richard Erhard, PT,DC University of Pittsburgh erhardre@upmc.edu 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
7. Imaging decisions based on clinical findings 8. Clinical decisions a. Referral b. Consultation c. Intervention 2
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
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
d. Strength Issues e. Return to Function i. Balance ii. Ambulation/ADLs iii. Competition/Occupation 3
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 15282 412-396-1811 (fax)412-396-4399 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
4) Evaluation A) Lumbar/sacral pathology B) Extra-articular vs. Intra-articular C) Classifying intra-articular pathology 5) Case Studies 2
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), 505-514. American Academy of Orthopedic Surgeons. (1996). Individual clinical guidelines: Hip pain (non-traumatic), Phase 1. Retrieved September 23, 2004, from www.aaos.org. Beck, M., Leunig, M., Parvizi, J., Boutier, V., et al. (2004). Anterior femoroacetabular impingement. Part II: Midterm results of surgical treatment. Clinical Orthopedics, 418, 67-73. 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), 1139-1145. 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, 347-351. 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), 308-315. 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, 459-467. 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, 256-263. 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), 1020-1037. Margo, K. Drezner, J. & Motzkin, D. (2003). Evaluation and management of hip pain: An algorithmic approach. The Journal of Family Practice, 52(8), 607-617. Philippon, M.J. (2002). Debridement of labral tears with associated thermal capsulorrhapy. Operative Techniques in Sports Medicine, 10, 215-218. 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, 54-60. 3