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March 15 ch 17 hip.doc

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Physical Education and Sport
Brad Kern

March 15 – Ch 17 Hip Hip Problems in Adolescent Athletes Legg Calve’ – Perthes Disease (Coxa Plana) Cause of Condition • Avascular necrosis of the femoral head in child aged 4-10 • Articular cartilage becomes necrotic and flattens Signs of Coxa Plana • Pain in groin that can be referred to the abdomen or knee • Limping is also typical • Varying onsets and may exhibit limited ROM • In most cases it takes a few months for pain to onset Legg- Calve’- Perthes Disease (continued) Care • Bed rest to reduce chance of chronic condition • Brace to avoid direct weight bearing • Early treatment and head of femur may reossify and revascularize and hip may become normal again Complication of Legg – Calve’-Perthes Disease • If not treated early, will result in ill-shaping and osteoarthritis in later life Slipped Capital Femoral Epiphysis Cause of Condition • May be growth hormone or growth plate related • 25% of cases are seen in both hips • Epiphysis slips from femoral head in backwards direction due to weakness in growth plate • May occur during periods of elevated growth and is seen in most boys 10-17 who are tall and obese who have a big growth spurt Signs of a slipped capital femoral epiphysis • Pain in groin that comes on over weeks or months • Hip and knee pain during passive and active motion; limitations of abduction, flexion, medial rotation and a limp Management of a Slipped Capital Femoral Epiphysis • With minor slippage, rest and non-weight bearing may prevent further slippage • Major displacement requires surgery • If undetected or surgery fails severe problems will result Illiac Crest Contusion (hip pointer) Cause of Injury • Contusion of iliac crest or abdominal musculature • Result of direct blow to inadequately protected illac crest Signs of a Illiac Crest Contusion (hip pointer) • Pain, spasm, and transitory paralysis of soft tissue structures. Its hard to walk with a hip pointer, let alone run. • Decreased rotation of trunk or thigh/hip flexion due to pain Caring for a Illiac Crest Contusion (hip pointer) • RICE for at least 48 hours, NSAID’s • Bed rest for 1-2 days in severe cases • Referral must be made, X-ray • Padding should be used upon return to minimize chance of added injury Osteitis Pubis Cause of Osteitis Pubis •
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