FAQ - Hip Dislocation, Congenital
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partial hip dislocation?


Can a partial hip dislocation result from stretching forward to the ground with your legs crossed and reaching for your back foot or does it only occur with blunt trama? And also can a partial hip dislocation reduce itself?
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Is it possible to trap a Testicle in a Hip Joint?


I heard a story that a sports player once experienced a hip dislocation during a game. The physio decided to put the hip back in place on the side line and managed to trap the testicle in the joint. Is this possible? Is this true?
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Wow.
I'm trying to think how.
That'd have to be one saggy nut sack...  (+ info)

Hip Dislocation?? PLEASE HELP!!!?


i was playing soccer and i took a huge swing at the ball and missed, immideatly i felt a huge pop in my right hip area. I immiedietly fell to the ground swearing. Right after i got up and walked to the sideline with a huge limp and my leg/hip really hurt and it was shaking. i just laid on the sideline for the rest of the game, when i stood up, it hurt just as much as it did before, and my limp was still as bad. Is this hip dislocation? What should i do about my problem.

I am a 14 year old male

(sorry about the spelling, im really rushed.)

it is a dull pain when i sit down that never stops, and a sharp pain every time i move my right leg.
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No one can tell you for sure. You need to see a Dr.  (+ info)

Hip replacement dislocation?


Can anyone tell about this procedure...I had my hip replaced 4 yrs ago...it has dislocated 3 times in the last 13 months. My doctor is bringing me in to sort it out...I would like to know what is the procedure for this fix...I didn't get to ask him everything because I was in shock when I heard I had to have surgery again...he mentioned ..something like a cap that would stop it from popping out again. Can any of you kind people fill me in on all of this...many thanks in advance.
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Your surgeon may be talking about a "constrained cup". Below is a link to a web page that goes into detail about dislocation and how repeated dislocations may be surgically treated.

http://totaljoints.info/DISLOCARION_totalhip.htm

This web site was developed by an ortho surgeon as a service to patients. It appears in [slightly fractured] English translation and is free of commercial content. You can scroll past the grim details about what a dislocation is since you have already learned that all too well! Go to the sections on Treatment and Revision Operations where he discusses the possible surgical fixes for repeated dislocation. If nothing else, reading this information will help you develop a list of questions to ask your surgeon as you plan your treatment.  (+ info)

I think I may have hip dysplasia or dislocation?


I asked this question last night but didn't get much feedback. I'm very worried - I'm a 16 year old female with muscular dystrophy (in a wheelchair) and I've had a full spinal fusion. I have very limited range of motionin my hips and legs (contractures). Recently, within the past two weeks, I have had mild pain in my right hip mostly when I lie on it or when I am turning over in bed. The effected hip (right) is warm, swollen and very sensitive to touch. It feels as though I've been hit and there is a bruise. I'm very worried because I've read about hip displacements and dislocations and now I'm convinced that's what is wrong with me. Sitting in my whelchair is painless, as is transferring - a parent will pick me up under my knees and arms to move me. I can move my thigh and lower leg with no discomfort. However, I have a dull pain from my hip to my knee. I have read that in most cases an invasive technique is used to correct this, if indeed I do have a dislocation. I am extremely frightened of hospitals, surgery and pain, so I am putting those options off until I absolutely have to.

Summary: 16 year old female
musculary dystrophy
spinal fusion
right hip pain
swollen, warm, sensitive to touch - pain when lying on right side inbed

Please help me! I want to know what I have. Aren't dislocations extremely painful? If I do have a dislocation, what are my options? If it doesn't sound like dislocation, what could it be?
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Could this be hip dislocation?


I have muscular dystrophy (in a wheelchair) and aside from contractions, I have had no issues with my hips ever. Never had any pain or anything, but now all of a sudden I'm having pain on my right side around my hip. Now, I also have sciatica so I don't know if the pain is being caused by that or it's effects.
I have not fallen or bumped my hip in any way that would cause dislocation. It's not necessarily painful, I don't think, but definitely uncomfortable. My leg is not turned a weird way and the pain isn't severe at all. I can move my knee and foot without pain, as well as my hip. I'm having a throbbing feeling when I lay on my right side for a period of time in bed. When I turn onto my back, my hip feels like it's being pulled. I'm having no other unusual symptoms to accompany this pain, though.

Could this be hip dislocation? As I said, I haven't done anything to physically injure myself. Any help would be appreciated!
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Is a click movement in a toddlers hip a sign of dislocation?


At my one year old daughter's yearly checkup, the doctor said she had a slight click in her hip?and not to worry as most toddlers have this as tendons are forming and will likely go away, but nonetheless, wants to see her again at 15 months. I am worried sick this is a hip dislocation. When you hold her and move her in a certain position, you can sometimes feel a pop in her hip...I liken it to the sound when knuckles crack. She is walking like crazy, bearing weight on both legs, has no abnormal gait, and seems to have full movement of her legs and hips, not too mention, equal length legs......has anyone else heard this in their toddlers??
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born with congenital dislocated hip. Fine as a child?


but not long after my first child, i was left with a loud clunking and pain in hip/pelvic area which has got worse over the past twelve years.Even walking now is discomfort. I was sent for an x ray about ten years ago but nothing showed up. Every time i go the gp they just keep fobbing me off. My mum also has oesteoporosis of the hips,spine. Any advice, any help would be appreciated
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This has been going on for some time now. Your GP should refer you to a specialist (Orthopaedic surgeon).
Good luck  (+ info)

What diagnosis: age 64, no history trauma, pain left hip, left thigh, left lower leg and left foot?


No relief except by oxycontin. Continues 2 weeks, blood studies negative, x rays all negative for fracture, dislocation or herniation.
I have no allergies or history of such problems or any problems to the areas. Came on suddenly, accompanied by constipation which cleared up with medication. ?????
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Could be Osteoarthritis of the HIP, which was not mentioned on the x-ray but where they asked? At 64 you could expect some wear and tear of the hip, which would impinge the nerve and so the pain.  (+ info)

what is the treatment of lateral rotation of leg (at hip) due to congenital spasticity in adults?


Joint Dysfunction
Anatomy:

The pevlic girdle is a closed OSTEOARTICULAR RING

The function of the pelvic girdle is that of Force Attenuation. In other words, its role is the efficient absorption, transmission and distribution of forces that cross the pelvic girdle.

Innominate: the innominate bone is comprised of the ilium, ischium, and pubis. There are two innominate bones. One on the right and one on the left.

Axis of Rotation:

There are transverse axes at the sacrum (superior, middle, inferior transverse axis) which permit flexion/extension movements.

There are also two diagonal axes. The left oblique axis that starts in the upper left, and the right oblique axis which begins at the upper right portion of the sacrum. The oblique axis allow for rotation of the sacrum

PUBIC MOTION: Pubic motion may be either superior or inferior. There is only about 2mm of motion possible at this joint.

Motion: 10-13 degrees of motion is considered normal.

ILIOSACRAL MOTION: this is ilium movement on the sacrum. Movements of the ilium include anterior/posterior rotation, superior/inferior movement and medial/lateral flaring.

SACROILIAL MOTION: this is sacral movement o the ilium. Movements of the sacrum include flexion/extension and rotation.

Common Symptoms:

Pain over the PSIS, ASIS, and posterior iliac crest.

Pain in the posterior thigh, groin, and buttock

Pain with ambulation (walking)

Pain with ascending and descending stairs.

Pain with walking and stairs, is a result of the stuck sacrum that is trying to move but is unable to. Each step will stress this joint and cause pain.

Pain with transitional movements

Pain in the coccyx. This is known as coccydynia and is due to sacral rotation.

Key findings that point to SI problems are pain in the PSIS and pain or popping with a shotgun test.

Mechanisms of Injury:

Rotation with lifting

Forceful movement in a diagonal pattern. Examples include golf swing, baseball swing, shoveling, etc.

Repetitive unilateral standing. (Upslip)

Carrying a child on one hip. (Upslip)

Fall on ischial tuberosity. (Upslip or posterior rotation depending on direction of force)

Vertical thrust on extended leg as with triple jumping. (Upslip)

Unexpectedly stepping off a step or curb. (Upslip)

Note: Pregnant women are predisposed to sacroiliac joint dysfunction due to ligamentous laxity via hormonal changes for up to two years post partum. (This is from the hormone relaxin.) Women who take oral contraceptives are similarly predisposed.

Provocation Tests:

Pelvic gapping Test: supine, cross arms and place palms on th4e ASIS. Push outward. This will stress the anterior ligaments.

Pelvic Compression: Side lying. Push down on ilium. This stresses posterior ligaments.

Sacral Thrust: Prone. Anterior pressure on sacrum with palm.

Patrick Fabre Test: Supine. Cross leg over extended leg and apply pressure down on crossed leg.

Evaluation:

Motion Assessment: (+) indicates NO motion. Remember that a certain amount of motion is NORMAL.

Ilial Motion: March Test: Palpate PSIS bilaterally. Perform hip flexion of at least 90 degrees. The PSIS should drop. A (+) test results when the PSIS does not move.

Flare Test: Palpate ASIS bilaterally in a wide stance. Hip IR/ER on heel. Evaluate the quantity of IR/ER motion of leg as well as the quantity of ASIS movement of the innominate bones. A (+) test is the side that has less motion moving in inward or outward rotation.

Sacral Motion: Rotation:

Palpate the sacrum bilaterally. Perform lumbar lateral flexion. You should find that the sacrum rotates away from the direction you move. (Right lateral flexion results in the right aspect of the sacrum moving inward and the left portion coming back to you.) Remember the rules of concave and convex side rotation. The sacral/coccyx region of the spine is convex so the vertebral bodies rotate opposite the direction of lateral flexion/rotation.

Leg Length Discrepancy:

Leg length discrepancy causes pelvic obliquity. With each step,k the pelvis must drop a distance equal to the amount of the asymmetry. The average person takes approximately 5,000 steps per day. 5 mm is clinically significant.

Clinical Assessment:

Differentiating between an upslip and a true leg length discrepancy (LLD).....

An upslip usually occurs as a result of some identifiable trauma.

An upslip is almost always debilitating and extremely painful.

True LLD: In Standing: ALL landmarks (ASIS, PSIS, iliac crest and greater trochanter are superior.

UPSLIP: In Standing: All landmarks are superior, EXCEPT the greater trochanter.

True LLD: March Test is negative, unless other dysfunction co-exists.

Upslip: March Test is positive.

True LLD: In sitting: Iliac crests are equal.

Upslip: In sitting: Iliac crest is superior.

True LLD: Supine: long leg remains long

Upslip: Supine: Long leg is short.

Radiological Assessment:

X-ray can confirm true LLD.

Standing pelvis x-ray for femoral head height is used.

Must stand with weight equally distributed over both extremities, and with both knees fully extended.

Sacroiliac Joint Dysfunction:

The side of pain is irrelevant in identifying the side of the dysfunction. Use movement testing.

Asymetrical landmarks are commonly seen.

Hypomobility: limited motion progressing in severity to absent motion.

Hypermobility: Excessive motion which compromises stability.

Ilial Lesions:

Anterior Innominate rotation:

+ March Test

ASIS inferior

PSIS superior

Posterior innominate rotation:

+ March Test

ASIS Superior

PSIS inferior

Upslip:

+ March Test

Iliac crest may be superior

Unilateral ASIS and PSIS superior

Upslip with posterior rotation:

+ March Test

Iliac crest may be superior

1 ASIS markedly superior and both PSIS equal

Upslip with anterior rotation:

+ March Test

Iliac crest may be superior

1 PSIS markedly superior and both ASIS equal

Inflare:

ASIS anterior

+ Flare Test

Outflare:

ASIS Posterior

+ Flare Test

Pubic Lesions:

Superior Shear: Pubic symphysis is superior unilaterally

Inferior Shear: Pubic symphysis is inferior unilaterally

Treatment:

Address muscular imbalances:

Stretch short muscles

Strengthen weak muscles

Restore symmetry:

Sub maximal isometric contractions

Warn the athlete of probable soreness

May hear or feel a pop

Contractions are done for 3 seconds and consist of 3 sets of 3

Always end with pubic shotgun

Ultrasound:

non-thermal effects:

Ice

Precautions: instruct patient concerning appropriate/inappropriate stress of sitting, standing, sports, etc.

Pelvic stabilization program: upper and lower abdominals, gluts, Swiss ball.

Treatment Scheme:

Day 1: Do corrections and then ice.

Day 2: If ok: you are done. You may want to address muscle imbalances

If not better: Do corrections + add stretching exercises, ice

Correction for Rt Posterior Innominate Rotation & Rt Superior Pubic Shear

Test Results:

Rt. + March Test

Rt. ASIS Superior

Rt. PSIS Inferior

Rt. Pubic symphysis superior

Correction for the Posterior Innominate rotation:

Position: Supine

Both hips flexed

Rt. Hip is extended more than Lt.

Resist:

Rt. Hip flexion (force)

Lt. Hip extension (counterforce)

Correction of Superior Pubic Shear:

Position: supine

Rt. Hip extended

Lt. Hip flexed

Resist:

Rt. Hip adduction (force)

Lt. Hip extension (counterforce)

Pubic Shotgun:

Position:

Supine with knees flexed to 90 and feet flat on table

Resist: hip adduction with hand/arm wedged between the two knees.

Contract as hard as possible within limits of discomfort.

Home Positioning:

Supine with Rt. Hip fully extended (hip extension causes anterior innominate rotation)

Lt. Hip flexed to 90 and supported (use chair/sofa)

Muscle Imbalance Considerations:

Stretch Rt. Hamstrings

Strengthen Rt. Hip flexors

Correction for Rt Anterior Innominate Rotation & Rt Inferior Pubic Shear

Test Results:

Rt. + March Test

Rt. ASIS Inferior

Rt. PSIS Superior

Rt. Pubic symphysis Inferior

Correction for the Anterior Innominate rotation:

Position: Supine

Both hips flexed

Rt. Hip is flexed more than Lt.

Resist:

Rt. Hip extension (force)

Lt. Hip flexion (counterforce)

Correction of Superior Pubic Shear:

Position: supine

Rt. Hip flexed

Lt. Hip extended

Resist:

Rt. Hip extension(force)

Lt. Hip adduction (counterforce)

Pubic Shotgun:

Position:

Supine with knees flexed to 90 and feet flat on table

Resist: hip adduction with hand/arm wedged between the two knees.

Contract as hard as possible within limits of discomfort.

Home Positioning:

Supine with Rt. Hip flexed to 90 and supported (hip flexion causes posterior innominate rotation)

Lt. Hip fully extended

Muscle Imbalance Considerations:

Stretch Rt. Hip flexors

Strengthen Rt. Hip extensors

Upslips:

almost always occur with either an anterior or posterior innominate rotation. Correct the upslip first before addressing the pubic shear. Position patient for upslip correction by remembering the saying "never put the 2 P's together" (ie. Prone and posterior)

Left Upslip with an Anterior Innominate Rotation:

Test Results:

+ Lt. March Test

Lt. Iliac crest most likely superior

Lt. PSIS is markedly (about 1") superior

Both ASIS are equal

Correction Technique:

Position: Prone:

Grasp proximal to the Lt. Ankle with the him in slight external rotation, abduction, and extension

Start with a gentle sustained long axis distraction for 5 seconds for 2-3 repetitions.

Take up the slack and provide a quick low amplitude pull so that the athlete barely slides down the table.

Correction of Inferior Pubic Shear:

Position: supine

Lt. Hip extended

Rt. Hip flexed

Resist:

Lt. Hip adduction (force)

Rt. Hip extension (counterforce)

Perform a Pubic Shotgun

Lt. Upslip with a Posterior Innominate Rotation:

Test Results:

+ Lt. March Test

Lt. Iliac Crest most likely superior

Lt. ASIS markedly superior

Both PSIS equal

Correction Technique:

Position Supine

Grasp proximal to the Lt. Ankle with the hip in slight external rotation, abduction, and flexion.

Start with a gentle sustained long axis distraction for 5 seconds for 2-3 repetitions.

Take up the slack and provide a quick low amplitude pull so that the athlete barely slides down the table.

Note: With an upslip with a posterior innominate rotation, you must also correct the superior pubic shear on that side.

Correction of Superior Pubic Shear:

Position: supine

Rt. Hip extended

Lt. Hip flexed

Resist:

Rt. Hip adduction (force)

Lt. Hip extension (counterforce)

Perform a Pubic Shotgun

A self mobilization can be done by hip hiking the opposite leg as a home program exercise.

Stretching the quadratus lumborum is done by leaning away while maintaining an erect posture (no trunk flexion or extension).

Correction for a Right Inflare:

Test Results:

+ Rt. Flare test

a positive test exhibits limited ROM of the foot and/or painful ROM in one direction (in this case, it will be an inability to rotate outward as far as the unaffected leg). The motion limitation may not be readily observable.

Rt. ASIS anterior

The ATC should be able to see the difference in height for it to be considered clinically significant.

Rt. Inflare Correction Technique:

Position: Supine with Rt. Hip flexed to 45 degrees and the foot flat on the table.

Resist: Rt. Hip abduction.

Note: do not perform a shotgun with this condition as the adductors will pull the flare back in.

Correction for a Right Outflare:

Test Results:

+ Rt. Flare test

a positive test exhibits limited ROM of the foot and/or painful ROM in one direction (in this case, it will be an inability to rotate inward as far as the unaffected leg). The motion limitation may not be readily observable.

Rt. ASIS posterior

The ATC should be able to see the difference in height for it to be considered clinically significant.

Rt. Outflare Correction Technique:

Position: Supine with the Rt. Hip and knee flexed to 90 degrees and the leg supported by the athletic trainers arm.

Resist: Hip adduction and apply a lateral distraction to the Rt. PSIS simultaneously.

Notes of caution:

For outflares - no ER of hip during correction as a home program

reminder. Use elastic belt (3" preferable) to help with maintaining

inflare tendency. No sleeping with leg in ER. ie as when you sleep

prone and flex,er leg.

for inflare problems, sleep with pillows between legs to keep thigh out

of inflare tendency. keep thigh in at least a neutral adduction posture.

Sofa Exercise for Outflare home program: While lying on your back with your right calf resting on the sofa, position your leg so that your knee is bent to a right angle. Push your right knee into the arm of the sofa. Hold for 2 seconds. Repeat 6 times.

Precautions for patients with sacroiliac joint problems

It is important to protect your sacroiliac joints while we are working to restore their normal function. The sacroiliac joints are the junction between your lower back and your pelvis. The position of your legs can affect the position of your SI joints. The following precautions will help to protect your SI joints.

Don't sit with your legs crossed.
Don't sit on one leg.
Don't stand with your weight on one leg.
Stairs: One step at a time. When going up lead with the non painful side first. When going gown, lead with the painful leg.
Your leg position should be symmetrical. If one leg is elevated, then the other leg should also be elevated.
If you sleep on your stomach, don't bend at the hips.
If you sleep on your side, put two pillows between your knees.
If you sleep on your back, but both legs up or both legs down.
You will probably develp increased soreness and discomfort following the evaluation and treatment. This is to be expected. You can decrease the inflammation and soreness by applying ice to the area for 15 minutes. Do not use heat because the heat will increase the inflammation.  (+ info)

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Last update: September 2014
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