1/8. Hip arthroscopy in the adolescent and pediatric athlete.The current literature offers only sparse reports of the use of hip arthroscopy in the pediatric patient injured during athletics. In contrast, the role of this technique in the diagnosis and treatment of multiple childhood hip conditions including pyarthrosis, legg-calve-perthes disease, slipped capital femoral epiphysis, coxa vara, juvenile chronic arthritis, chondrolysis, and avascular necrosis is well described. The application of this relatively uncommon technique to the young athlete has only recently become more attractive. The ability to examine and treat traumatic intra-articular pathology with minimal morbidity and prompt recovery is mandated by the young age of these patients and their demanding activity levels. Hip arthroscopists are now beginning to correlate preoperative physical exam findings and history with diagnosis and expectations for outcome. As our combined experience with this technique grows, the specific indications for its use in the young athlete become increasingly better defined. In pediatric and adolescent patients, the new onset of hip pain should warrant a high level of suspicion for the more common causes of pain such as infection, legg-calve-perthes disease, slipped capital femoral epiphysis, or developmental dysplasia. When these have been evaluated, further differential diagnosis should include labral tears, loose bodies, synovitis, and chondral lesions. As this review begins to elucidate, these conditions are amenable to arthroscopic evaluation and treatment. At this time, the presence of reproducible mechanical symptoms after a twisting or axial loading injury during athletics should prompt the orthopaedic surgeon to consider arthroscopic examination of the hip if conservative therapy fails. Satisfying and reproducible results have been achieved when using hip arthroscopy within these parameters.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/8. Lateral impact injury. A source of occult hip pathology.arthroscopy has helped greatly in understanding the nature of many intra-articular disorders of the hip. It also has provided a better understanding of the pathomechanics and natural progression. This knowledge has aided in improving interpretative clinical skills and investigative techniques. Isolated traumatic chondral injury can occur as a result of impact loading over the greater trochanter. There seems to be a particular propensity for this injury in young physically fit adult males apt to incur this type of blow as a consequence of sport or activity. Initially, this injury may appear innocuous with variable dysfunction. When present, arthroscopy can reliably discern the pathology and often result in significant symptomatic improvement. The long-term consequences of these lesions are still concerning. Although symptomatic improvement from arthroscopic intervention is encouraging, for some cases the long-term influence may only be the knowledge provided for counseling the patient. Nonetheless, arthroscopy can be valuable in both the assessment and management of chondral injuries.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/8. Occult acetabular fracture in an elderly runner.STUDY DESIGN: Resident's case problem. BACKGROUND: A 79-year-old African American male runner sustained a left hip injury while jogging on a running track. Initial radiographs did not show any bony injuries and the patient was diagnosed with hip tendonitis. The patient was initially treated conservatively with medications and referred to a local physical therapy clinic for thermal modalities and therapeutic exercises. The patient failed to show any improvement despite a period of conservative treatment. The author examined the patient 6 months postinjury at a university physical therapy department. diagnosis: The author suspected the presence of a possible fracture and the patient was referred to an orthopaedic surgeon. Subsequent radiographic imaging studies including a CT scan revealed a supra-acetabular fracture. The patient underwent a total hip arthroplasty approximately 1 year after the initial injury and has since recovered well. DISCUSSION: It is not uncommon for runners or joggers to develop hip or pelvic pain, but there has been no prior report in the literature of the occurrence of an acetabular hip fracture while jogging. This resident's case problem illustrates the challenges of arriving at an accurate diagnosis in the presence of a rare fracture and the need for careful follow-up, especially among elderly individuals with cognitive deficits.- - - - - - - - - - ranking = 2keywords = physical (Clic here for more details about this article) |
4/8. The triggering role of physical injury in the onset of peripheral arthritis in seronegative spondyloarthropathy.Three more cases of B27-positive patients who developed peripheral arthritis immediately after trauma are reported. The first had an exacerbation of arthritis in the right hip after falling from her motor-bike. The second had arthritis of the distal interphalangeal (DIP) joint of the right forefinger after shutting his finger in the door of his car. The third had arthritis of the right sternoclavicular joint after a road-accident while fastening her safety belt.- - - - - - - - - - ranking = 4keywords = physical (Clic here for more details about this article) |
5/8. Trauma and seronegative spondyloarthropathy: rapid joint destruction in peripheral arthritis triggered by physical injury.Two B27 positive patients developed peripheral arthritis immediately after a significant musculoskeletal injury. Unlike previously reported peripheral arthritis precipitated by trauma in B27 positive subjects the arthritis was rapidly destructive.- - - - - - - - - - ranking = 4keywords = physical (Clic here for more details about this article) |
6/8. Bone scan utilization in the differential diagnosis of exercise-induced lower extremity pain.In 4 patients with lower extremity pain and either negative or equivocal radiograhic findings, the bone scan was definitely positive for stress fracture in all, accurately localized the lesion, and permitted proper therapy. The condition in all instances proved to be a microfracture at the origin or insertion of a muscle. The pain was always intensified by physical activity.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
7/8. The role of hip arthroscopy in the diagnosis and treatment of hip disease.OBJECTIVE: To report the results of arthroscopy performed on adults with hip disease who did not respond to extended conservative treatment and to evaluate the relationship between clinical findings, radiologic tests and surgical abnormalities. DESIGN: A case study. SETTING: new england Baptist Hospital, boston, Mass. patients: Fifty-nine patients (32 women, 27 men) with refractory hip pain, between the ages of 17 and 69 years, who were seen between January 1989 and January 1992. INTERVENTION: Hip arthroscopy. MAIN OUTCOME MEASURES: Cause of hip pain, results of physical examination and operative findings. RESULTS: In 26 patients the cause of hip pain was traumatic; in 21 the cause was idiopathic. On physical had pain on straight leg examination, 56% of patients reported painful clicking of the hip joint, 37% had pain on straight leg raising, 9% had decreased extension and 34% had had episodes of locking of the joint. Five percent had pain predominantly in the thigh, 41% reported at least one episode of "giving way" of the hip and 7% had snapping of the iliotibial band. At arthroscopy, 69% of patients had synovitis in the hip joint, 59% had a tear of the acetabular labrum, 39% had loose bodies, 32% had degenerative arthritis and 27% had a chondral defect. On statistical analysis, significant (p < 0.05) relationships were found between acetabular labral tears and preoperative complaints of clicking or giving way, between loose bodies and preoperative locking and between degeneration of the hip joint and thigh pain. CONCLUSION: arthroscopy of the hip is a valuable diagnostic and therapeutic procedure for patients with hip pain refractory to conservative therapy.- - - - - - - - - - ranking = 2keywords = physical (Clic here for more details about this article) |
8/8. Luxatio erecta of the hip: a critical retrospective.The term "luxatio erecta" has been borrowed from the shoulder to identify rare traumatic hip dislocations in which there is inferior dislocation of the femoral head and inversion of the femoral shaft. A review of the literature is presented along with an additional illustrative case. The mechanism of injury, and the radiological and physical appearance of the patient, indicate that there are two subtypes of dislocation hitherto lumped together under the single term.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |