Hip

Dislocated Hip

• Hip
• Dislocated Hip
  • Diagnosis & Testing
  • Treatment
  • Surgical Management
  • Rehabilitation
• Iliotibial Band Friction syndrome
• Greater Trochanteric Bursitis

Mechanism of Injury

The hip joint is also known as a ball and socket joint. The ball in this case is the head of the femur, or upper leg bone. The femur site in the socket which is the acetabulum, made of the pelvic bones. When a dislocation occurs, which is rare although very severe, the head of the femur comes out of the acetabulum due to a strong force being applied to the hip joint. This type of injury is usually seen with falls from heights, car accidents and sometimes even sporting events.
Anterior hip dislocations occur when the head of the femur comes away from the joint and moves toward the front of the pelvis. Posterior dislocations, which are more common, occur when the force being applied to the hip moves the femoral head out of the acetabulum and toward the back of the pelvis.

Athletes with Osteochondral Injuries May Experience

• Severe pain in the hip
• Obvious deformity of the hip joint
• Inability to move the leg
• Possible numbness or tingling due to a disruption of the nerves

Complications

This is such a severe injury because of the anatomy of the joint. There is a possibility that the blood supply to the bone may become disrupted and lead to bone death of the femoral head also known as avascular necrosis.
Another complication that arises with this injury even with a successful reduction is the possibility of arthritis. This is caused by damage to the cartilage surrounding the joint which occurs when the femoral head is forced out of the acetabulum.

Diagnosis and Testing

An injury of this severity is usually easy to diagnose, however the use of X-ray and CT scan may be used to determine if any other structures were damaged in the process of dislocation. X-ray will be used to see if the pelvic bones were broken and Ct scan to determine if the soft tissue has been compromised.

Treatment

This is an injury requiring immediate medical attention. Lendermon Sports Medicine  will determine if a closed or open reduction is necessary. With a closed reduction Dr.Lendermon will reduce the joint, where they will manipulate the femoral head back in to the acetabulum. Anesthesia or muscle relaxants may be used to help the muscles from guarding so that the joint is easily reduced. If a closed reduction can not be done an open reduction will have to be done to surgically replace the femoral head. An open reduction is also usually done when the pelvic bones have been broken so that they may be repaired as well. After the reduction is complete another set of X-ray or CT scans may be done to make sure the joint is in the correct position.

Don’t let an injury keep you on the bench. Schedule your Lendermon Sports Medicine appointment today.

Rehabilitation

Rehab for an injury of this extent takes time depending on if other structures were damaged during the dislocation. The first portion of the process will include rest and non weight bearing of the joint. Anti-inflammatory medications and ice will help with the pain and swelling the patient will be experiencing. Only when they are pain free can weight bearing be started with crutches. Exercises will be administered aiming at strengthening the muscles surrounding the joint. Lendermon Sports Medicine  will develop a program specifically for that patient so that they are able to get back to their life as quickly and safely as possible.

Illiotibial Band Syndrome

1. An irritation to the illiotibial band (commonly called IT band), which runs along the outside of the thigh, beginning at the hip and extending to the shin just below the knee.
2. The IT band acts as a stabilizer during running and can become irritated and inflamed with overuse.
3. Most common is runners.

Cause

1. Overuse
2. Poor training habits: running on uneven or banked surface, inadequate warm-up and cool-down, increased distance too quickly, running up and down stairs.
3. Anatomical abnormalities: high or low arches, foot pronation, uneven leg length, bowed legs.

Symptoms

1. Pain on the outside of knee or lower thigh.
2. Pain may be worse with descending stairs, getting up from seated position, and after activity.

Mechanism of injury

Trochanteric bursitis is inflammation of the bursa at the point of the hip/knee known as the greater trochanter.  Trochanteric bursitis can result from play or work activities that cause overuse or injury to the joint areas, injury to the hip/knee, stress on the soft tissues as a result of an abnormal or poorly positioned joint or bone, incorrect posture, other diseases or conditions and previous surgery. 

Injury to the greater trochanteric bursitis is most commonly found among women, middle-aged/elderly people, and in athletes who participate in running-oriented activities.

Common symptoms of greater trochanteric bursitis include:

• Tenderness and swelling over the hip
• Pain
• Redness/Warmth

Diagnosis
Diagnosis can be made most reliably by a physical examination.  X-rays are often obtained to ensure that there are no bone spurs or calcifications that could be contributing to the problem.  An MRI may occasionally be obtained if the diagnosis is unclear or if the problem does not resolve with treatment. 

Treatment
Reducing pain and inflammation, preserving mobility, and preventing disability and recurrence are the goals of treatment.

Initial treatment of greater trochanteric bursitis

• Rest
• Ice
• Compression
• Elevation

Heat may be tried after a few days to decrease pain and stiffness.  Medications such as an anti-inflammatory or steroids may be used to decrease pain and swelling.  Physical therapy and splinting are also found to be very helpful.  

Surgical Management
Surgery is almost never required for this condition.  Most cases can be treated, however, surgery may be necessary in order to drain or remove the bursa or when other treatments are not effective. 

Rehabilitation
Most cases of bursitis subside after a few weeks.  Seek medical advice if you continue to have pain that interferes with your normal day-to-day activities, have soreness that doesn’t improve, have recurrence, or have a fever and the hip/knee appears red or inflamed.