hip pain
Laurie Robichaud
PGY4 EM McGill University
@laurieMcGillEM
objectives
review common & need-to-know ED hip
conditions discuss the use of ultrasound
for hip pain evaluation
Ms. B.
26F restrained passenger in high speed
MVC
two of her friends died on scene
right leg pain +++
posterior hip
dislocation
presentation
high-energy insult (young)
low-energy mechanism (artificial hip)
leg shortening, flexion, internal rotation &
xray
xray
acetabular fracture
femur in internal rotation & adduction
affected femoral head appears smaller
femoral head lateral...
complications
peroneal nerve motor exam
great toe extension (most sensitive)
foot dorsiflexion
foot eversion
complications
avascular necrosis
acetabular & femur fractures
sciatic nerve injury (peroneal most common)
management
management
https://youtu.be/VYl6M87Uh68
management
analgesia
timely reduction
orthopedic consultation
Mrs. C.
72F HTN, remote left hip arthroplasty
right hip pain x 2 weeks
trochanteric
bursitis
presentation
localized unilateral hip pain
most common in women
often related to increased activity/trauma
ultrasound
ultrasound
well circumscribed anechoic collection
(>2mm)
lateral aspect of the greater trochanter
management
recipe
1ml methylprednisolone (40 mg/ml)
5ml lidocaine (1%)
management
NSAIDS
diagnostic injection
corticosteroid injection
physiotherapy
Mr. D.
72M HTN, DM, OA
right hip pain x 1 day
brought in by wife in a wheelchair
evaluation
ultrasound
ultrasound
effusion >5mm
effusion >2mm difference from asymptomatic
contralateral side
septic hip
presentation
hematogenous spread
staph aureus most common pathogen
knee, hip & shoulder most common joints
management
management
http://highlandultrasound.com/ultrasound
-guided-hip-arthocentesis-and-injection/
management
antibiotics
arthrocentesis (native hips only!)
orthopedic consultation
objectives
review common & need-to-know ED hip
conditions
discuss the use of ultrasound for hip pain
evaluation
questions
thank you
Hip pain
Hip pain
Hip pain
Hip pain
Hip pain
Hip pain
Hip pain
Hip pain
Hip pain
Hip pain
Hip pain
Hip pain
Hip pain
Hip pain
Hip pain
Upcoming SlideShare
Loading in …5
×

Hip pain

688 views

Published on

Review 3 cases of common & need-to-know ED hip conditions

Published in: Health & Medicine
  • Be the first to comment

Hip pain

  1. 1. hip pain Laurie Robichaud PGY4 EM McGill University @laurieMcGillEM
  2. 2. objectives review common & need-to-know ED hip conditions discuss the use of ultrasound for hip pain evaluation
  3. 3. Ms. B. 26F restrained passenger in high speed MVC two of her friends died on scene right leg pain +++
  4. 4. posterior hip dislocation
  5. 5. presentation high-energy insult (young) low-energy mechanism (artificial hip) leg shortening, flexion, internal rotation &
  6. 6. xray
  7. 7. xray acetabular fracture femur in internal rotation & adduction affected femoral head appears smaller femoral head lateral & superior to acetabulum
  8. 8. complications
  9. 9. peroneal nerve motor exam great toe extension (most sensitive) foot dorsiflexion foot eversion
  10. 10. complications avascular necrosis acetabular & femur fractures sciatic nerve injury (peroneal most common)
  11. 11. management
  12. 12. management https://youtu.be/VYl6M87Uh68
  13. 13. management analgesia timely reduction orthopedic consultation
  14. 14. Mrs. C. 72F HTN, remote left hip arthroplasty right hip pain x 2 weeks
  15. 15. trochanteric bursitis
  16. 16. presentation localized unilateral hip pain most common in women often related to increased activity/trauma
  17. 17. ultrasound
  18. 18. ultrasound well circumscribed anechoic collection (>2mm) lateral aspect of the greater trochanter
  19. 19. management
  20. 20. recipe 1ml methylprednisolone (40 mg/ml) 5ml lidocaine (1%)
  21. 21. management NSAIDS diagnostic injection corticosteroid injection physiotherapy
  22. 22. Mr. D. 72M HTN, DM, OA right hip pain x 1 day brought in by wife in a wheelchair
  23. 23. evaluation
  24. 24. ultrasound
  25. 25. ultrasound effusion >5mm effusion >2mm difference from asymptomatic contralateral side
  26. 26. septic hip
  27. 27. presentation hematogenous spread staph aureus most common pathogen knee, hip & shoulder most common joints
  28. 28. management
  29. 29. management http://highlandultrasound.com/ultrasound -guided-hip-arthocentesis-and-injection/
  30. 30. management antibiotics arthrocentesis (native hips only!) orthopedic consultation
  31. 31. objectives review common & need-to-know ED hip conditions discuss the use of ultrasound for hip pain evaluation
  32. 32. questions
  33. 33. thank you

×