Symptoms include painful catching, popping, and clicking of the hip, worsening of symptoms over time, and possible groin pain which is worsened with running in athletic patients. Physical examination should include lumbo-pelvic mobility and mechanics, and most often reveals pain with combined hip flexion, internal rotation, and adduction, often without range of motion restrictions. Suggested imaging for confirmation of this diagnosis include arthrography, magnetic resonance imaging (MRI), and computerized tomography (CT) arthrography. Physical therapy is recommended as the first line of conservative treatment prior to surgery for labral tear and FAI. Physical therapy management should involve activity modification including rest if the patient is highly aggravated, and education to avoid end ranges of hip flexion and adduction. Manual therapy to the hip to improve hip glide in flexion as well as strengthening of the hip is indicated as well (Loudon & Reiman, 2014). Specifically, patients with FAI have been identified as exhibiting weakness in the tensor fascia latae (TFL), hip external rotators, hip abductors, and adductors (Casartelli, 2011). If physical therapy has not assisted in reducing pain and symptoms after 6 weeks of earnest treatment, surgical management may be considered. Arthroscopic procedures are commonly performed, though physical therapy treatment may be warranted post-operatively to aid in return to sport conditioning. Surgical intervention is required for Stage II and beyond. Core decompression is often performed on Stage II hips with the goal of reducing intramedullary pressure and halting ischemic damage. Patients with Stage III impairments may be treated with osteotomy or surface hemiarthroplasty. Stage IV patients most often undergo total hip arthroplasty (Orrin & Crues, 2004). Physical therapy treatment in early stages consists of educating the patient in range of motion exercises, while treatment for later stages is dependent on the type of surgery performed to reconcile the hip lesion. Acute SA in children is most often associated with blood-borne infection. The slower blood flow in the metaphyseal capillaries makes growing bones in children more susceptible to infection from SA after any trauma or infection. SA is more common in males than females with a ratio of 2:1. The incidence in developed countries is 4-5 cases per 100,000 children per year (Pääkkönen, 2017). Symptoms of SA include patient report of a few days of redness, warmth, pain, and swelling with decreased range of motion of the involved joint, and sometimes fever. Medical management includes antibiotic treatment, arthroscopic lavage, and possible surgical drainage to preserve the articular cartilage. In progressive cases, total hip arthroplasty may be required (Nair, 2017). Physical therapy treatment includes gentle mobilization of the hip after 5 days of medical treatment, and once the physical signs of joint synovitis have completely resolved. After the patient has been cleared medically, aggressive physical therapy to regain range of motion and strength of the hip is advised (Orrin & Crues, 2004).
present, bony spurs develop around the femoral head or in the acetabulum and over time, this friction causes tearing and degeneration of the articular cartilage in the anterior aspect of the joint and can result in osteoarthritis (Powers, 2016). Patients with FAI will report pain or a dull ache in the groin or deep within the hip itself, popping, clicking, and a sense of the hip giving way (Thornborg, 2018). Pain is often aggravated with physical activity, including running, and may present with an audible click during flexion or extension of the hip (Loudon & Reiman, 2014). Examination should include an FAI-specific test. With the patient supine on a table, therapists should use a combined movement of 90° passive hip flexion on the symptomatic side followed by forced adduction and internal rotation, also referred to as FADIR (Laborie et al., 2013). The test is positive if pain is reproduced. Some evidence suggests that healthy individuals without FAI may exhibit a positive response in this particular test; a radiograph may be required for definitive diagnosis (Laborie et al., 2013). Tears of the acetabular labrum may also result from significant trauma or dislocation. Martin et al. (2006) noted in a study that a labral tear was arthroscopically identified in 90% of individuals with mechanical hip symptoms. Non- traumatic disruption is often associated with the presence of a capsular laxity, femoral acetabular impingement, dysplasia of the acetabulum, cyst formation, and chondral lesions. Patient history is important in the differential diagnosis of acetabular labral lesions, and often the patient will report a twist of the hip or a fall (Martin et al., 2006). Ischemic necrosis of the femoral head Ischemic necrosis of the femoral head presents as degeneration of the femoral head due to poor blood supply. Impingement to blood supply and alcoholism have been cited as causes for this disease. Progression of ischemic necrosis of the femoral head is classified into four categories with Stage IV being the most significantly impaired. Medical management of this impairment when identified prior to complete collapse of the femoral head includes education in alcohol consumption, careful use of corticosteroids, and resting the joint including non-weightbearing and range of motion exercises (Orrin & Crues, 2004). Septic arthritis The incidence rates of septic arthritis (SA) in developed countries range from about 2 to 7 cases per 100,000 people and the incidence appears to be increasing (Nair, 2017). Possible factors to account for this include: an aging population, more orthopedic and invasive procedures, and more frequent use of immunosuppressive therapies. Septic arthritis of the hip is uncommon in patients who have a competent immune system. Patients with septic arthritis of the hip often have an underlying hip injury that predisposes it to infection after bacteremia. Risk factors include people age 80 years or greater, diabetes, rheumatoid arthritis, hip or knee prostheses, skin infection, and immunosuppression (Nair, 2017). he most common route for the pathogen to enter a joint is via hematogenous spread. Older adults are particularly susceptible to this route of infection because of primary diseases affecting their joints, like rheumatoid arthritis and the presence of comorbid conditions such as diabetes, skin infections, and cancer. Other routes include direct inoculation such as through trauma, or rarely, iatrogenic, such as therapeutic intraarticular corticosteroid injection (Nair, 2017).
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