The Hip and Pelvis in Sports Medicine and Primary Care (eBook)

Preface 6
Chapter 1: Epidemiology of Hip and Pelvis Injury 14
CLINICAL PEARLS 14
CASE REPORT: PRESENTATION 14
Chief Complaint and History 14
Physical Examination 14
INTRODUCTION 15
AGE 15
SPORT 17
GENDER 18
CASE REPORT: CONCLUSION 18
Assessment and Plan 18
SUMMARY 19
References 19
Chapter 2: Physical Examination of the Hip and Pelvis 21
CLINICAL PEARLS 21
CASE REPORT: PRESENTATION 21
Chief Complaint and History 21
Physical Examination Results 22
INTRODUCTION 23
ANATOMY 23
HISTORY 24
PHYSICAL EXAMINATION 26
Range of Motion 26
Palpation 29
Neurologic Testing 31
Special Tests 32
CASE REPORT: CONCLUSION 46
Assessment 46
Plan 46
Follow-up 46
References 46
Chapter 3: Functional and Kinetic Chain Evaluation of the Hip and Pelvis 49
CLINICAL PEARLS 49
CASE PRESENTATION 49
Chief Complaint and History 49
Physical Examination 50
INTRODUCTION 51
NATURAL HISTORY 52
FUNCTIONAL ANATOMIC CONCEPTS AND NEUROMUSCULAR CONTROL 54
CLINICAL BIOMECHANICS 55
COMMON HIP AND PELVIS DYSFUNCTIONS 63
EVALUATION 70
Functional Diagnostic Imaging 72
PRINCIPLES OF TREATMENT 72
Principles of Sequencing the Exercise Prescription 73
CASE REPORT, CONCLUSION 73
SUMMARY 73
References 74
Chapter 4: Gait Assessment 82
CLINICAL PEARLS 82
CASE PRESENTATION 82
Chief Complaint 82
History of Present Illness 82
Review of Systems 83
Physical Examination 83
Testing 85
GAIT ASSESSMENT 85
THE ELEMENTS OF GAIT 85
THE DETERMINANTS OF GAIT 91
AGE AND DIFFERENCES IN GAIT 92
MALE AND FEMALE GAIT 93
CASE ASSESSMENT AND TREATMENT 93
SUMMARY 95
References 95
Chapter 5: Imaging of Hip and Pelvis Injuries 98
CLINICAL PEARLS 98
INTRODUCTION 98
MODALITIES 99
Radiography 99
US 101
CT 101
Magnetic Resonance Imaging 101
Magnetic Resonance Arthrography 102
RADIOLOGIC DIAGNOSIS OF HIP PAIN IN ATHLETES 103
Osseous 103
Stress Fracture 103
Acute Fracture 107
Articular Pathology 109
Osteoarthritis 110
Developmental Dysplasia 111
Femoroacetabular Impingement 112
Labral Tears 115
Hip Ligaments 117
Tendon 118
Snapping Tendons 119
Sportsman’s Hernia 119
Muscle 120
References 123
Chapter 6: Adult Hip and Pelvis Disorders 125
CLINICAL PEARLS 125
CASE REPORT: PRESENTATION 125
Physical Examination 126
INTRODUCTION 126
ANTERIOR HIP AND PELVIS PAIN 128
Adductor Strain (Groin Pull) 128
Rectus Femoris Strain/Quadriceps Strain 129
Quadriceps Contusion 130
Iliopsoas Strain/Hip Flexor Strain 131
Rectus Abdominis Strain 132
Pubic Symphysis Dysfunction 132
Osteitis Pubis 133
Pubic Ramus Stress Fracture 134
Femoral Neck Stress Fracture 135
Hip Dislocation 137
AVN of the Femoral Head 138
Osteoarthritis 139
Acetabular Labral Tear 139
Femoroacetabular Impingement 140
Iliopsoas/Iliopectineal Bursitis 140
Athletic Pubalgia (Sports Hernia) 141
Internal Snapping Hip 142
LATERAL HIP AND PELVIS PAIN 144
External Snapping Hip 144
Hip Pointer (Iliac Crest Contusion) 145
TFL Syndrome 145
Greater Trochanteric Bursitis 146
Meralgia Paresthetica (Lateral Femoral Cutaneous Nerve Entrapment) 147
POSTERIOR HIP AND PELVIS PAIN 147
Hamstring Strain 147
Ischial Bursitis 149
Gluteus Maximus Strain 149
Gluteus Medius Strain 149
SI Joint Dysfunction/SI Sprain 150
Piriformis Syndrome 151
Coccygeal Injury 152
Other 152
Leg Length Discrepancy 152
CONCLUSION OF THE CASE 153
References 153
Chapter 7: Hip and Pelvis Injuries in Childhood and Adolescence 158
CLINICAL PEARLS 158
CASE STUDY 158
INTRODUCTION 159
DEVELOPMENTAL Dysplasia of the Hip 159
Diagnosis 160
Treatment 161
Legg-Calve-Perthes Disease 161
Diagnosis 162
Treatment 163
TRANSIENT SYNOVITIS 165
Diagnosis 165
Treatment 167
Slipped Capital Femoral Epiphysis 167
Classification 168
Diagnosis 168
Treatment 169
APOPHYSEAL INJURIES OF THE YOUNG ATHLETE 171
DIAGNOSIS 175
Treatment 175
References 176
Chapter 8: Specific Considerations in Geriatric Athletes 180
KEY POINTS 180
CASE VINGETTE 180
AGE-RELATED PHYSIOLOGICAL CHANGES 181
Bone 181
OSTEOPOROSIS EVALUATION 184
MUSCLE 186
CARTILAGE, LIGAMENTS, AND TENDONS 187
BALANCE 188
EXERCISE TO PREVENT INJURY 188
Weight-Bearing Exercise 188
Flexibility Exercise 190
Balance Exercise 190
EXERCISE AFTER HIP SURGERY 190
CASE FOLLOW-UP 193
References 194
Chapter 9: Hip and Pelvis Injuries in Special Populations 196
CLINICAL PEARLS 196
CASE STUDY 196
INTRODUCTION 197
HISTORY OF DISABLED ATHLETICS 202
THE AMPUTEE ATHLETE 203
Overview 203
Running 204
Skiing 206
Water Sports 207
Cycling 208
THE ATHLETE WITH CEREBRAL PALSY 209
THE WHEELCHAIR ATHLETE 210
SUMMARY 212
References 212
Chapter 10: Functional Therapeutic and Core Strengthening 215
CLINICAL PEARLS 215
CLINICAL VIGNETTE 215
INTRODUCTION 216
ANATOMY 217
MECHANISM OF THE CORE AND THE KINETIC CHAIN 222
ASSESSING THE CORE MUSCULATURE 226
EXERCISE PROGRAMS FOR CORE STRENGTHENING AND ENDURANCE 233
ROLE OF CORE STRENGTHENING AND SPECIFIC MUSCLE GROUPS 237
CONCLUSION 239
References 239
Chapter 11: Manual Medicine of the Hip and Pelvis 241
CLINICAL PEARLS 241
CASE 241
INTRODUCTION 243
FUNCTIONAL ANATOMY OF THE HIP AND PELVIS 244
MANIPULATION BASICS 247
METHODS OF MANIPULATION 247
ACTIVATING FORCES 248
GOALS OF TREATMENT 248
MANUAL MEDICINE TECHNIQUES 249
Counterstrain9,15,21 249
Psoas 249
Piriformis 250
Muscle Energy Techniques15,20,22,23 250
Anteriorly Rotated Inominate, or the Inferior Pubic Shear 250
Posterior Rotated Inominate, or Superior Pubic Shear 251
SI Joint Dysfunction/Pubic Shear 251
Restricted Hip Abduction 251
Restricted Hip Adduction 252
Restricted Hip Extension 253
Restricted Hip Flexion 253
Restriction in Hip External Rotation 253
Restricted in Internal Rotation 254
Sacral Base Anterior 254
Sacral Torsion About the Same Axis 256
High Velocity Low Amplitude Techniques15,20,22,23 256
Unilateral Sacral Shear, Superior Inominate Shear 256
Right Posterior Innominate 258
Sacral Base Posterior 259
Table Assisted Technique 260
Right Posterior Innominate 260
Articulatory Technique for the Lumbar Spine and the SI Joint15 260
Stretching Techniques 262
Hamstrings (Semitendinosus, Biceps Femoris, Semimembranosus) 262
Iliopsoas 262
Quadriceps Femoris Stretch 263
Iliotibial Band Stretch 263
Gluteal Stretch (Figure 4 Stretch) 264
Piriformis Stretch 265
Doctor-Assisted Resisted Piriformis Stretch 267
Groin Stretch 267
SUMMARY 267
References 269
Chapter 12: Taping and Bracing for Pelvic and Hip Injuries 271
CLINICAL PEARLS 271
CASE STUDY 271
INTRODUCTION 271
INDICATIONS FOR TAPING 272
EFFICACY OF TAPING 272
DRAWBACKS 272
TYPES OF TAPE 272
TAPING TECHNIQUES 274
BRACING 274
Compression Shorts 274
CASE CONCLUSION 276
References 278
Chapter 13: Nonsurgical Interventions 279
CLINICAL PEARLS 279
CASE PRESENTAION 279
Physical Examination 280
Differential Diagnosis 280
Imaging 281
INTRODUCTION 281
RATIONALE FOR USE 281
DIAGNOSTIC INJECTIONS 282
THERAPEUTIC INJECTIONS 283
PHARMACOLOGICAL AGENTS 283
Corticosteroids 283
Hyaluronic Acid 284
Anesthetics 284
Lidocaine 284
Bupivacaine 285
Proliferants 285
SAFETY CONSIDERATIONS 285
CONTRAINDICATIONS 286
POTENTIAL COMPLICATIONS 286
ANATOMY 287
PROCEDURES 288
Documentation 288
Injection Technique Fundamentals 288
Image Guidance 288
Positioning 289
Target Selection 289
Sterile Preparation 289
Drapes 289
Universal Precautions 289
Gloves 289
Skin Wheel 289
Negative Aspiration 289
Injectate Volume 290
Steroid Dosing 290
Injection Resistance 290
Microbicide Removal 290
Dressing 290
Sharps 290
SOFT TISSUE INJECTIONS 290
Greater Trochanteric Bursa (Fig. 13.3) 290
Ischial Bursa (Fig. 13.4) 292
Hamstring Origin (Fig. 13.5) 292
Iliopsoas Bursa (Fig. 13.6) 293
Hip Adductor Origin (Fig. 13.7) 294
JOINT INJECTIONS 295
Sacroiliac (Fig. 13.8) 295
Hip (Fig. 13.9) 296
Pubic Symphysis (Fig. 13.10) 297
Sacrococcygeal (Fig. 13.11) 298
NERVE BLOCKS 299
Lateral Femoral Cutaneous Nerve (Fig. 13.12) 299
CASE PRESENTION WRAP-UP 300
References 301
Chapter 14: Treatment Options for Osteoarthritis of the Hip 304
CLINICAL PEARLS 304
CASE VINETTE 304
EPIDEMIOLOGY 305
RISK FACTORS 306
DIAGNOSIS 306
NONOPERATIVE MANAGEMENT 309
Nonpharmacologic Therapy 310
Exercise: General Benefit 310
Exercise: Type 310
Hydrotherapy 311
Exercise: Adherence and Risk 311
Patient Education and Self-Management Programs 312
Assistive Devices 312
Weight Loss 312
Pharmacologic Therapy 313
Acetaminophen 313
NSAIDs 313
COX-2 Inhibitors 314
Opioids 314
Tramadol 315
Intra-Articular Injectable Therapy 315
Corticosteroids 315
Viscosupplementation 316
SUPPLEMENTS/ALTERNATIVE THERAPIES 317
Glucosamine and Chondroitin 317
Other Supplements 318
Acupuncture 318
Diacerein 319
Future Directions 319
INDICATIONS FOR SURGERY 319
CASE CONCLUSION 319
References 320
Chapter 15: Surgical Interventions in Hip and Pelvis Injuries 323
CLINICAL PEARLS 323
CASE PRESENTATION 323
Chief Compliant 323
Patient History 323
Physical Examination 324
Imaging 324
INTRODUCTION 324
MUSCLE STRAIN/AVULSION 324
HIP DISLOCATION 326
HIP FRACTURES 327
STRESS FRACTURES 327
ACETABULAR LABRAL TEARS 329
SPORTS/HOCKEY HERNIA 331
GILMORE’S GROIN/GROIN DISRUPTION 331
OSTEITIS PUBIS 332
SNAPPING HIP SYNDROME 332
NERVE COMPRESSION 333
SCIATIC/PIRIFORMIS/HAMSTRING SYNDROMES 333
ADOLESCENTS 336
Slipped Capital Femoral Epiphysis 336
Apophyseal Avulsions 337
TUMOR 337
CONCLUSION OF CASE PRESENTATION 338
Intervention 338
Follow up 338
Decision-Making 338
References 339
Appendix 1 342
EVIDENCE-BASED MEDICINE 342
STRENGTH OF RECOMMENDATION TAXONOMY 342
LEVEL OF EVIDENCE4,5 343
References 345
PHYSICAL THERAPY MODALITIES 346
Summary 346