This document provides an overview of common hip and pelvis conditions, including trauma, fractures, infections, and causes of spontaneous hip pain. It describes clinical exams and imaging used to diagnose conditions like slipped femoral epiphysis, Legg-Calve-Perthes disease, septic arthritis, psoas abscess, tuberculosis, and hip impingement. Physical exam findings and characteristic features of various hip injuries and diseases are outlined.

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Pelvis and hip
for beginners
Duane Anderson, MD
February 2020

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What will be the topics?
 Trauma
 Spontaneous hip pain

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Historical Perspective: Pennal & Tile
 AP, Inlet, and Outlet Pelvic Radiographs

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Historical Perspective: Pennal & Tile
 AP, Inlet, and Outlet Pelvic Radiographs
 Best for: posterior displacement & internal/external rotation deformity

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Pelvis injuries
 Severe trauma
 Vascular injury
 Urethral injury
 Neurologic injury
 Rectal injury

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Young Burgess
and Tile

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Acetabular fractures

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Acetabular fracture x-ray views

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Hip fracture types

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Xray views,
AP pelvis and lateral hip

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After minor trauma of the hip
 Persistent groin pain in the elderly with nl xrays
 Consider a CT

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Spontaneous hip pain in children
 Slipped Femoral Epiphysis
 Calve-Legg-Perthes disease
 Psoas abscess
 Septic arthritis of the hip
 TB of the hip

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Infection of the hip
 Onset slow or rapid, TB vs bacteria
 CBC, ESR, Temp, CRP quantitative
 Plain x-rays likely nl depending on length of time
 US essential in diagnosis
 Physical exam

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Physical exam
psoas abscess
 Able to ambulate
 Walks hunched over
 Doesn’t like hip extension
 Rotation of the hip is not bothersome
 US of the hip AND pelvis gets you the diagnosis

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PSOAS ABCESS

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Physical exam
TB of the hip
 Able to ambulate
 Doesn’t like hip extension
 Hip rotation is painful at extremes
 US is positive for fluid in the hip
 X-RAY NL EARLY ON

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Physical exam of the hip
septic arthritis
 Unable to ambulate
 Painful motion in any direction
 Fluid in the hip joint

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Calve-Legg-Perthes of the hip
 Spontaneous pain in a 5-10
year old
 Painful limp, usually unilateral
 Lacks rotation

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Slipped Femoral Ephiphysis
 Spontaneous pain usually
unilateral
 Age 10-13

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Spontaneous pain in an adult
 Back related
 Sacroiliac
 Trochanteric bursitis
 Avascular necrosis
 Osteoarthritis
 TB of the hip
 Hip impingement

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Hip pain related to the spine
 Felt in the buttock
 Tender in the spine, SI joint,
buttock
 Spine x-rays may or may not
be positive
 Piriformis syndrome= buttock
pain as well but rare

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Sacroiliac pain
 Tender in the SI joint area
 Ankylosing Spondylitis
 FABER test is positive

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FABER OR PATRICK’S TEST
 FLEXION
 ABDUCTION
 EXTERNAL ROTATION
 F AB ER

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Trochanteric Bursitis
 Lateral hip pain
 Painful to lay on that side
 Nl hip x-rays
 Tender to direct palpation over
the hip
 Nl hip exam except painful
 Responds to cortisone shot
 Inject with the hip passively
abducted to create more space

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AVN
 Spontaneous pain in the groin
 HIV
 Steroids
 Idiopathic
 Can have nl x-rays
 Early diagnosis by MRI
 Trendelenburg gait or antalgic
gait

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AVN

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Osteoarthritis of the hip
 Spontaneous groin pain
 May have nl x-rays early on
 Loss of rotation of the hip
 Trendelenburg gait
 Causes include acetabular
abnormal development,
impingement, old age
 Loss of motion in all directions as
disease progresses
 Painful rotation early on

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TB of the hip
 Spontaneous groin pain
 Able to ambulate
 NL x-rays
 Elevated ESR most of the time
 Limited motion
 HIGH index of suspicion
 US of the HIP, aspiration, biopsy
 Drug treatment!
 Erosions on both sides of the joint is
characteristic of late TB

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Hip impingement
 Cause of much of osteoarthritis of
the hip
 Pain in 20-30 year old, especially
athletes
 Both femoral and acetabular
abnormalities alone or combined
 Early on painful flexion and
internal rotation
 X-rays are abnormal to the trained
eye

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PincerCam

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Hip impingement sign
 Pain with prolonged sitting in
the groin
 Worse with more hip flexion
 Pain with flexion and IR

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Rotation prone

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FEMORAL STRETCH OR ELY TEST
 SHORTENED RECTUS
FEMORUS
 IF NO LIFT OFF BUT
PAINFUL= FEMORAL
NERVE IRRITATION OR
PROXIMAL LUMBAR
HERNIATED DISC

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HIP FLEXION CONTRACTURE
STAHELI TEST THOMAS TEST