Hip pain
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hip pain Laurie Robichaud PGY4 EM McGill University @laurieMcGillEM
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Transcript of Hip pain
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 sceneright leg pain +++
posterior hip dislocation
presentation
high-energy insult (young)low-energy mechanism (artificial hip)
leg shortening, flexion, internal rotation & adduction
xray
xray
acetabular fracturefemur in internal rotation & adduction
affected femoral head appears smallerfemoral head lateral & superior to acetabulum
complications
peroneal nerve motor examgreat toe extension (most sensitive)
foot dorsiflexionfoot eversion
complications
avascular necrosis acetabular & femur fractures
sciatic nerve injury (peroneal most common)
management
management
analgesiatimely reduction
orthopedic consultation
Mrs. C.
72F HTN, remote left hip arthroplastyright hip pain x 2 weeks
trochanteric bursitis
presentation
localized unilateral hip painmost common in women
often related to increased activity/trauma
ultrasound
ultrasound
well circumscribed anechoic collection (>2mm)lateral aspect of the greater trochanter
deep to gluteus maximus
management
recipe
1ml methylprednisolone (40 mg/ml)5ml lidocaine (1%)
managementNSAIDS
diagnostic injectioncorticosteroid injection
physiotherapy
Mr. D.
72M HTN, DM, OAright hip pain x 1 day
brought in by wife in a wheelchair
evaluation
ultrasound
ultrasound
effusion >5mmeffusion >2mm difference from asymptomatic
contralateral side
septic hip
presentation
hematogenous spreadstaph aureus most common pathogen
knee, hip & shoulder most common joints
management
management
http://highlandultrasound.com/ultrasound-guided-hip-arthocentesis-and-injection/
management
antibioticsarthrocentesis (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
