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Hip

The hip region is located lateral to the gluteal region (i.e. the buttock), inferior to the iliac crest (top of the pelvis), and overlying the greater trochanter of the thigh bone (most prominent bone on the side of your leg). In adults, three of the bones of the pelvis have fused into the hip bone which forms part of the hip region. The hip joint, scientifically referred to as the acetabulofemoral joint is the joint between the femur and acetabulum of the pelvis and its primary function is to support the weight of the body in both static (e.g. standing) and dynamic (e.g. walking or running) postures.

 

Hip Fractures

Classification

Many subtypes of fractures about the hip joint are colloquially known as 'hip fractures'. Although a true hip fracture involves the joint, the following four proximal femur fractures are commonly referred to as hip fractures. The differences between them are important because each is treated differently.

Femoral head fracture
Denotes a fracture involving the femoral head. This is usually the result of high energy trauma and a dislocation of the hip joint often accompanies this fracture.
Femoral neck fracture (sometimes Neck of Femur (NOF), subcapital, or intracapsular fracture)
Denotes a fracture adjacent to the femoral head in the neck between the head and the greater trochanter. These fractures have a propensity to damage the blood supply to the femoral head, potentially causing avascular necrosis.
Intertrochanteric fracture
D enotes a break in which the fracture line is between the greater and lesser trochanter on the intertrochanteric line. It is the most common type of 'hip fracture' and prognosis for bony healing is generally good if the patient is otherwise healthy.
Subtrochanteric fracture
A ctually involves the shaft of the femur immediately below the lesser trochanter and may extend down the shaft of the femur.


Signs and symptoms

The classic clinical presentation of a hip fracture is an elderly patient who sustained a low-energy fall and now has pain and is unable to bear weight. On examination, the affected extremity is often shortened and externally rotated.

 

Authors:

Lake Washington Physical Therapy

Benjamin Wobker, PT, DPT

 

References:

Orthopedic Physical Assessment, 4th Edition. David J. Magee, 2006.

Healthy Hip

 

 

 

Hip Fractures

 

Femoral Neck Fx

 

Knee Anatomy

ITB

 

 

Iliotibial Band Syndrome

IT Band Syndrome (ITBS) is another condition often causing knee pain. This syndrome involves non-contractile soft tissue located on the outside of the leg running from the hip to below the knee known as the Iliotibial Band. ITBS is one of the most common causes of lateral knee pain in runners and cyclists. Dysfunction of this band of soft tissue often causes friction and irritation to various structures on the outside of the knee such as the lateral epicondyle of the femur, or the fat pad and bursa in between. Symptoms of ITBS include lateral knee pain when running (worse downhill), palpable pain on the outside of the knee joint, or pain when climbing stairs.
Possible Treatments:

IT Band Strap: to reduce friction and irritation at the lateral aspect of the knee.
Orthotics: improve biomechanical alignment of the lower extremities and allow for improved gait mechanics.
Stretching and Soft Tissue Massage: of IT Band and hamstrings
Strengthening: hip abductor, hip internal/external rotators, and quadriceps strengthening
Ice and other modalities: to reduce pain and inflammation

 

Authors:

Lake Washington Physical Therapy

Benjamin Wobker, PT, DPT

 

Foam Roll Link: (Click Here)

 

References:

Orthopedic Physical Assessment, 4th Edition. David J. Magee, 2006.

 

Labrum

Labral Tear

 

Labral Tear MRI

 

 

Labral Tears & Femeroacetabular Impingement

What is the hip labrum?

The acetabular labrum is a ring of fibrocartilage around the edge of the bony socket of the hip joint. The function of the labrum in the hip is primarily to help lubricate the joint surface with synovial fluid and provide a “suction seal” to the hip joint. Tears of the acetabular labrum are more commonly diagnosed now because our ability to recognize the symptoms and imaging studies have both improved.

What are the causes of labral tears?

Hip labral tears can be degenerative or acute. Degenerative labral tears are chronic injuries that occur as a result of repetitive use and activity and can be seen in the early stages of hip arthritis. Acute labral tears usually result from a sports injury, fall, or accident. They are commonly associated with sudden, twisting maneuvers that cause immediate pain in the hip. Most labral tears, however, are chronic and due to repetitive injury over time in the setting of a condition known as femoroacetabular impingement. Femoroacetabular impingement occurs when the bone of the femoral head (thigh bone) pinches against the labral and bone of the acetabulum (hip socket). This can be due to one of two different reasons. Either there is extra bone present near the femoral head, which impinges against the hip socket (cam type impingemement), or there is extra bone around the hip socket, which impinges against the femoral head and neck (pincer type impingement). This repetitive trauma over time is thought to be a major cause of hip arthritis.

What are the symptoms?

The symptoms of a hip labral tear and femoroacetabular impingement are, essentially, the same. Most people feel pain in the groin, which can radiate to the buttock. The pain can be worse with activity but can also be aggravated by prolonged sitting. Twisting movements are also frequently painful. Some people may feel a catching sensation in the hip, as well.

What is the treatment? The symptoms of hip labral tears can sometimes be improved by physical therapy to strengthen the muscles around the hip. If this does not lead to improvement, surgery may be necessary. This usually involves either an open or arthroscopic procedure to either repair or debride (clean up) the torn labrum and to address any femoroacetabular impingement that may be present.

 

Authors:

Proliance Surgeons

Ron Gregush, MD

Lake Washington Physical Therapy

Benjamin Wobker, PT, DPT

 

References:

Orthopedic Physical Assessment, 4th Edition. David J. Magee, 2006.

Groin

Groin Strain

 

Piriformis

Muscle Strain & Piriformis Syndrome

Muscle Strain:

Commonly strained muscles of the lower extremity include the hamstrings, adductor longus, iliopsoas, and rectus femoris. All of which contribute to the mechanics of the hip. Muscle strains have three categories:

1st degree strain – mild and will often resolve itself without treatment and without residual disability.

2nd degree strain – moderate and most often seen for physical therapy. Caution must be used or may progress to a 3rd degree strain

3rd degree strain – severe and involves total disruption of the muscle.

Causes

Overstretching the muscle
Overloading the muscle

 

Piriformis Syndrome:

Another condition that causes pain in the buttock is called Piriformis Syndrome. This is also known as periarthritis of the anterior sacroiliac joint. The piriformis muscle is important in abducting and externally rotating the thigh (moving the thigh away or rotating it away from midline). The sciatic nerve passes inferior and deep (and sometimes through) the piriformis muscle. If this muscle is in spasm it can cause pain in the distribution of that nerve. This would be pain in the gluteal area, posterior thigh and leg and lateral foot.
Runners can have hypertrophy of this muscle which can lead to pain. This can occur if the hip moves into too much internal rotation due to poor arch support in the shoe during the gait cycle. This muscle has to control this movement and gets overworked. It can also become inflamed from direct trauma to the mid-buttock or prolonged sitting (ie truck drivers orbleacher sitting).

 

Authors:

Lake Washington Physical Therapy

Benjamin Wobker, PT, DPT

 

Foam Roll Link: (Click Here)

 

References:

Orthopedic Physical Assessment, 4th Edition. David J. Magee, 2006.

Total Hip

 

Total Hip

 

Total Hip

 

Total Hip

 

 

Total Hip Replacement

Total Hip Replacement (THR or THA) Total hip arthroplasties (THR) are one of the most common joint replacement surgeries, second only to total knee replacements. In 2004, 234,000 THR’s were performed in the United States alone. The primary goal is to restore function, decrease pain, and regain muscle control to enable the patient to return to previous, or improved levels of function. The post-operative management of THR’s is determined by multiple factors such as the type of prosthesis, the surgical technique and approach. For example, a patient with cemented joint replacements can weight-bear as tolerated (unless the procedure involves a soft-tissue repair or internal fixation of bone), whereas patients with cementless joint replacements are put on partial weight bearing or toe-touch weight bearing for several weeks.


There are several precautions that must be followed following a total hip replacement although they may vary and be individualized per patient at the request of the surgeon.

• Keep knees apart: do not cross legs, put a pillow between knees when sleeping or laying on side

• Avoid turning your leg inward: keep toes of operated leg pointed forward, back into your car seat to avoid twisting operated leg.

• Do not raise your knee higher than hip level: sit only on elevated chairs or toilet seats.

• Do not bend forward past 90 degrees: do not bend over to pick up objects or tie your shoes.

 

Physical Therapy Treatment:

Initial treatment includes patient education regarding post-op precautions, therapeutic exercise, transfer and gait training, and instructions in their activities of daily living. Once an adequate level of function is achieved and surgical precautions are released, a regular strengthening/flexibility program is established which is crucial for long-term outcomes and return to previous levels of activity. The goal of Physical Therapy is to get the patient back to as many of their pre-operative activities as possible while at the same time respecting the new prosthesis and it's long term preservation.

Total Hip

 

 

 

 

 

 

 

 

 

 

Authors:

Lake Washington Physical Therapy

Benjamin Wobker, PT, DPT

Bellevue Bone & Joint
Dr. Jonah Hulst, MD

 

References:
Physical Rehabilitation: Assessment and Treatment, 4th Edition. Susan B. O’Sullivan and Thomas J. Schmitz, 2001. www.emedicine.medscape.com/article/320061-overview

Trochanteric Bursitis

Trochanteric Bursitis

Hip bursitis is a common problem that causes pain over the outside of the upper thigh. A bursa is a fluid filledsac that allows smooth motion between two uneven surfaces. The bursa in the hip rests between the bony prominence over the outside of the hip (the greater trochanter) and the firm tendon that passes over this bone (IT band). When the bursal sac becomes inflamed, pain results each time the tendon has to move over the bone. This pain is deep, aching, intermittent, and diffuse at the greater trochanter and may radiate down the outside of your leg to your knee.

Causes

Recurrent blows and falls sustained to the bony prominence of the greater trochanter
Repetitive adduction (e.g. repetitive inside kicks with soccer)

 

Authors:

Lake Washington Physical Therapy

Benjamin Wobker, PT, DPT

 

References:

Orthopedic Physical Assessment, 4th Edition. David J. Magee, 2006.


 

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