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A 58-year-old male self-referred to an outpatient physical therapy clinic with a primary complaint of right anterolateral hip pain. The pain intensity and progression of his functional limitations prompted him to seek medical attention. Diagnostic imaging was performed that revealed signs of hip osteoarthritis (Fig. 20-1). His primary care physician referred him to an orthopaedic surgeon to discuss surgical options. However, the patient chose a conservative route to treat his symptoms and scheduled a consultation with a physical therapist. He describes experiencing intermittent hip pain that is aggravated by squatting, ascending stairs, and hip rotation during weightbearing activities. He has not been able to engage in his usual cardiovascular conditioning program or any strength training due to pain. His goal is to return to his previous level of function during his activities of daily living and resume his cardiovascular and strength training program at his local fitness club.

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Based on the patient's diagnosis, what are the contributing factors to his condition?

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What examination signs and priorities are associated with hip osteoarthritis?

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What are the functional limitations and assets of the patient?

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Figure 20-1.

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What are the most appropriate physical therapy interventions for a patient with hip osteoarthritis?

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Figure 20-1.
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Anteroposterior (AP) radiograph of the right hip showing sclerotic changes, decreased joint space, and an osteophyte on the superior joint margin.

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IMPAIRMENT-BASED PHYSICAL THERAPY: Physical therapy interventions addressing modifiable musculoskeletal impairments that are associated with decreased function and/or increased activity-related pain; the decision to utilize specific interventions is based on continual assessment of the patient's impairments and how they are affected by each intervention; as the status of the patient changes, the plan of care is modified

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JOINT HYPOMOBILITY: Decrease in normal movement of a joint due to articular surface dysfunction or disease or injury that affects bone, muscle, ligament, or the joint itself; often leads to limited active and passive range of motion

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JOINT MOBILIZATION: Passive movement directed at joint structures with the aim of achieving a therapeutic effect (increase in joint motion and/or decrease in pain); a high-velocity, low-amplitude thrust maneuver is a type of mobilization technique also known as a joint manipulation

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OSTEOARTHRITIS: Defective integrity of articular cartilage associated with changes in the underlying bone and at joint margins; these changes often lead to pain, loss of mobility and muscle strength, impaired function, and decreased quality of life

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REGIONAL INTERDEPENDENCE: Theory that dysfunction either proximally and/or distally may contribute to pain in the involved joint

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  1. Utilize evidence and clinical practice guidelines for the examination and treatment of an individual with hip osteoarthritis.

  2. Prescribe appropriate manual therapy and joint range of motion activities ...

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