Lecture Notes: X-ray Pathologies and Hip Injuries

Introduction

• Discussion on obscure x-ray pathologies relevant to Board of Certification (BOC) questions.
• Focus on femoral head anomalies.

Slipped Capital Femoral Epiphysis (SCFE)

• Also known as Skiffy.
• Common in children due to open growth plates.
• Growth plates generally close in females earlier (high school) than males (college).
• Important to consider in high school athletes when assessing growth plate injuries.

Legg-Calvé-Perthes Disease

• Avascular necrosis of the femoral head.
• Caused by the interruption of blood flow.
• Presents as a flattened femoral head.
• Relevant for BOC questions about hip pain in children.

Anatomy Quiz and Review

• Identification of hip structures: iliac spines, greater and lesser trochanters, acetabulum.
• Muscles and tendons: gluteus medius, minimus, piriformis, adductor magnus, iliacus, tensor fascia lata.
• Importance of understanding anatomical landmarks for assessments.

Mechanisms of Injury (MOI) Analysis

• Acute MOIs discussed, such as hip pointers, fractures, contusions.
• Chronic conditions like gluteal tendinopathy, stress fractures from overuse.

Hamstring Strains

• Common MOI is excessive eccentric contraction during activities like running and kicking.
• Diagnostic indicators: pain with contraction and stretch.
• Risk factors: history of strain, age, hamstring weakness.
• Prevention: focus on eccentric strengthening, e.g., Nordic hamstring exercises.

Diagnostic Testing

• Use of Goniometer for range of motion assessments.
• Use of handheld dynamometer for objective strength measures.

Snapping Hip Syndrome

• Types:
  • External: IT band over greater trochanter.
  • Internal: Psoas tendon over pelvic brim.
  • Intra-articular: Labral tears within the joint.
• Symptoms: Clicking, snapping, pain in motion.
• Special tests: Faber, Fadir, Scour, Twist tests.

Special Tests for Hip Pathologies

• Importance of combining multiple tests for accurate diagnosis.
• Discussion on specific tests like the Thomas test for hip flexor tightness.

Conclusion

• Emphasis on practical application of knowledge for diagnosing and managing hip and thigh injuries.
• Ongoing practice and review of special tests and diagnostic techniques.

Next Steps

• Next week's focus: intra-articular pathologies, labral tears, and hip impingement.
• Assignments: Clinical journal and quiz preparation.

These notes summarize the key aspects of the lecture, highlighting important pathologies and diagnostic approaches related to the hip and thigh region. They serve as a study aid for understanding the clinical relevance of hip injuries and their management.