Musculo Lecture FInal Study Guide

Musculo Lecture FInal Study Guide - HIP SURGERIES 1 Hip...

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HIP SURGERIES: 1. Hip Arthroscopy 2. Hip Fractures a. ORIF Procedures OA surgical Options : 3. Total Hip Arthroplasty 4. Resurfacing a. Joint Preserving Techniques HIP ARTHROSCOPY Anterior Femoroacetabular Impingement (FAI) Repetitive abutement of femoral neck & acetabular rim Leads to reduced joint clearance o Excessive over coverage of femoral head by acetabulum ( PINCER ) o Reduced femoral head & neck offset ( CAM) o Combination: offset & over coverage ( MIXED ) Impingement (contact or shear) labral and/or chondral lesions FAI can lead to OA Patients with anterior FAI often have pain with flexion/internal rotation because it is the anterior/superior portion of the acetabular cup that is affected Normal Hip Neck – Head offset Acetabular rim Normal clearance FAI: “PINCER” Head = normal “Abutment” o acetabular abnormality o local anterior over coverage Labral tears o “1 st to Fail” Chondral lesions o More benign Common in middle age women: o Athletic – hip movements Ie: dancers or cross-fitters If you don’t have the ROM to do full squat, cannot be expected to do a deep squat. That would result in having impingement or severe compensation Center edge angle = increased (so roof hangs over more) Acetabular anteversion angle = decreased (closing the door) FAI: “CAM” C ontrolled A ction M otion Impingement Jamming: “Flexion” Shear – outside-in abrasion of acetabular cartilage and/or avulsion from labrum & subchondral bone Anterosuperior rim – where the jamming is most common to occur Common in young/athletic people o College age athletes o Hockey players o Baseball players b/c of twisting motion o Dancers & gymnasts Alpha angle = increased (b/c now the head is not spherical and more oval, so bigger radius) Mis-shapen femoral head; excessive bony growth on the femoral neck Bony surfaces rub together because of mis-alignment FAI: MIXED PINCER: Excessive acetabular over coverage of femoral head (develops after repetitive excessive rotational movement)
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CAM: Reduced femoral head & neck offset (born with the Cam lesion) Most patients who do get a hip arthroscopy have a combination of CAM and Pincer impingement FAI: Clinical Presentation o Pain location: o C-sign anterior-lateral hip; groin pain o Aggrevating Activities: o Hip flexion – sitting (especially in a low car), squatting, weight-bearing o Diagnostic Hip Exam o Passive tests of flexion & IR o Pain and limited motion o Special tests: o + impingement test: FADIR o + for FAI and/or labrum closing down the hip joint space, pinching the structures synonymous with the Hawkins-Kennedy test in the shoulder where we take a structure and shut it down o Diagnosis: o Radiograph: A/P & frog lateral o MR arthrogram – best for labrum!
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