PREFERRED PRACTICE PATTERN
4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated With Localized Inflammation
Patient is a 17-year-old high school football player. He was tackled from the right side 1 week ago from a direct blow of the helmet onto the iliac crest. He said he had pain going down his right leg to the knee. He presents with a hematoma at the iliac crest and bruising from the iliac crest down the iliotibial band (ITB). He has a positive Ober test and weakness in hip abduction. He is ambulating with a wide gait pattern and does not like to lay on his right side.
Ober test. (From Dutton M. Dutton’s Orthopedic Survival Guide: Managing Common Conditions. http://www.accessphysiotherapy.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)
Origins of hip pain and dysesthesias. (From Cush JJ, Kavanaugh A, Stein CM. Evaluation of musculoskeletal complaints. In: JJ Cush, Kavanaugh A, Stein CM, eds. Rheumatology: Diagnosis and Therapeutics. 2nd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2005:pp. 3–20, with permission.)
(A) Structure of the hip joint. (B) The right hip illustrating the lateral view of the ligaments of the hip joint. (From Morton DA, Foreman KB, Albertine KH. The Big Picture: Gross Anatomy. http://www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)
In younger children, concern must be on a slipped growth plate or avulsion of the iliac apophysis
Wearing of a hip pad in sports, to limit contusion
Can lead to myositis ossificans2
Stress fractures or blood supply disruption to the hip may show up later
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