The Hip

Differential Diagnosis & Treatment

Mazyad Alotaibi

Capsular Lesions

• Most loss of medial rotation

• Less of flexion and abduction

• Least of extension

Osteoarthritis

• OA most common joint disorder

• Risk factors – family history, obesity, injury, occupation, elite athletes

• A- joint space narrowing

• B- marginal osteophytes

• C- marginal sclerosis

• D- cystic changes in the head of the acetabulum

Osteoarthritis

• Treatment• Stage 1) heat + slow

stretches into MR, ext, abd and flex

• +hep• Stage 2) steriod injec

+ rest• Stage 3) surgery

Non capsular

Loose Body

• Pain on lat rot with abd or flex with springy end feel

• Twinges of pain

• Refer to surgeon for opinion re: EUA

Contractile lesions

Hamstrings, adductor longus and rectus femoris

• Resisted test painful• Sudden onset –

overstreching• Hams and rec fem due to

combined movts over 2 joints

• Hamstrings• Rectus Femoris• Adductor Longus• Treatment – deep friction

and rest or steriod injec and rest

Bursa

Trochanteric Bursitis

• Resisted hip abd in side lying

• Direct trauma

• Treatment – injec or electrotherapy + rest

Psoas Bursitis

• Test with passive flex 90 degrees and add

• Also resisted hip flex• Overuse • Occasional trauma

• Treatement –injec or electrotherapy + rest

Gluteal Bursitis

• Pain on passive flexion, add and abduction

• Pain on resisted abduction and extension

• Sup and post to trochanter

• Overuse

• Treatment – injec or electrotherapy + rest

Sign of the Buttock

• Indicates possible neoplasm, abcess, fracture, osteomyelitis, sepsis

• Pain on: trunk flexion

passive hip flex with empty end feel

SLR

resisted hip movements

Groin Pain

Groin Pain

• Psoas bursa• Sportsman’s Hernia• OA Hip, perthes disease, loose body• L3• Ref from SIJ• Osteitis pubis• Slipped epiphysis• Gynae/ genito urinary