CLINICAL CASE HIP PAIN

DR SHRENIK SHAH

SHREY HOSPITAL

www.eswtindia.in

CLINICAL PICTURE

M/ 40 radiographer had persistent

hip pain since 1 year

Unable to sit cross legged

ADL not much affected

No rest pain or sleepless nights

No fever or constitutional signs

All lab investigations were normal

XRAY

FEMOROACETABULAR

IMPINGEMENT

The impingement causes

repeated minor damage to the

labrum & edge of the

acetabulum. This results in labral

tears (which can be painful) &

damage to the cartilage lining

the hip joint

DIFFERENTIAL DIAGNOSIS OF FAI

• Low back pain

• Trochanteric bursitis

• Piriformis syndrome

• Sports hernia (abdominal muscle strain)

• Groin or thigh strains

• Iliopsoas tendinosis

PROVOCATIVE TESTS

impingement test for

problems in the front of

the hip.

reverse impingement

test for problems in the

back of the hip.

MRI

TREATMENT OF FAI

Non operative

A less active lifestyle, possibly

with cortisone injections,

physiotherapy advice or rest.

(Although a good physiotherapy

program focusing on hip

strengthening may be beneficial,

the stretching associated with

yoga may make the symptoms

worse).

Surgery

Arthroscopic hip debridement

Open surgery

ESWT- EXTRACORPOREAL SHOCK WAVE

THERAPY- ORTHOTRIPSY

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FINAL RESULT 9 MONTHS FOLLOW UP

No pain

Nearly full range of

movements

Does swimming daily

Fit to to do all duties

CASE 2 M/62 Dr having Diabetes,

hypertension, obesity and Asthama

chronic LBP and left trochanteric pain radiating to thigh and knee

Inability to sit cross legged and squatt

Spine Xrays and MRI were normal

Pain progressive with limp

ADL affected due to limitation of flexion of left hip

X ray

Case 2 MRI MR arthrography

ESWT

FINAL RESULT AT 1 YEAR

THANK YOU

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