Hip dysplasia key signs and symptoms
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- čas přidán 5. 09. 2024
- Hip dysplasia is prevalent in approximately a third of patients with hip pain in primary care (O’Brien et al. 2022) and yet is often missed by clinicians.
I have a confession to make. I’m one of those clinicians.
I was treating a runner a few years ago with hip pain that didn’t seem to be improving and it later emerged she had hip dysplasia. It does require a more specific approach and some patients may go on to have surgery so it’s important we can identify dysplasia early in the treatment process.
This is an area where I felt I wanted to learn more and, in doing so, share it with you. So below is the first in a series of videos on hip dysplasia. It covers:
Key signs and symptoms of acetabular dysplasia
Typical patient demographics
Some scary stats on how long it takes to be diagnosed!
How dysplasia presentation compares to other conditions
The ‘red herring’ that often gets misdiagnosed in patients with dysplasia
Key references:
Nunley et al. (2011): pubmed.ncbi.nl...
Jacobsen et al. (2019): pubmed.ncbi.nl...
Reiman et al. (2019): www.jospt.org/...
O’Brien et al. (2022): pubmed.ncbi.nl...
For more on running injury including a selection of free videos visit www.clinicaled...
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These videos are not intended to replace medical assessment or advice. If you have pain or an injury we recommend seeing a health professional.
59 yr old female. I’ve had clicking in my right hip my whole life.I was hyper mobile as a child .
The past 4 years the pain has become unbearable. I’ve gone to three different specialists and had so much imaging. They have all thrown hands in air, acted puzzled as to why I’m in pain…. Said X-rays looked fine….Blamed it on needing weight loss and thrown me to physical rehab where it hurt me further. I’ve taken loads of NSAIDs and my life has gotten smaller and smaller.
Last week a physician’s assistant really took time with me as I was in desperate tears to get help. She studied my X-ray and said it showed textbook dysplasia that was confirmed with my doctor. MRI w contrast this week to see what shape labrum is in, and plan for surgery after that. I’m so hopeful I can get my life back. Thank you for this video. I want to be as educated as possible .
Omg I’m so sorry. How are you feeling?
I'm curious to know how you're doing now. I thought once the hip was 0:41 in alignment, all of the pain would go away. I've read comments mentioning that the pre op pain remains post op. I'm more than concerned. How are you doing now?
I think I have a partially dislocated hip, but my doctors won't even check it, they always want to check my colon. But they never find what the problem is. My hip has been hurting for 15 years, and it's getting worse. My joints are bad about popping out in knees and sholder and I figure that is what has happened with my hip. My entire hip is in pain all the way down into my left side of my butt cheek. I'm in my late 50's.
Hi, im currently seeing a chiropractor. Had lots of sessions, but the more everything else seems to get neutral, the larger my gait deviations and instability seem to become. I will be having imaging done soonish.
I seem to have no way of gaining stability regardless of what i do and i seem to switch between various different gait patterns. The main things that really screw me over and cause pain, general misery, and an increase in shitty mechanics are: Walking (the main thing), other movement activities specicifically those with twisting or sideways movement and walking on different levels of elevation, including stairs. I hate going up or downstairs, not because of any pain really, although i do get pops and cracks in many areas and it does seem like its far more effort than it should be.
Here are the various notes ive taken on things i believe may correlate to hip dysplasia:
Hospitalised with fluid on the groin (left hip) which i now suspect to have been a torn labrum caused by left hip dysplasia.
Reluctance to have parallel legs, most comfortable with feet splayed apart and femjrs externally rotated.
When seated and trying to keep hips neutral, all i can feel if my left butt bone but as i type this im realising it might not even be that, that im feeling especially since it is quite prominent and i have a quite prominent swayback posture so the IT's should be more tucked under with me sitting on the back side more than the point.
Leg length discrepancy with multiple compensations
When i walk or stand i corkscrew the boxer shorts im wearing between my left groin and left leg and the center line/ buttons ends up shifted left and also facing left
Toe walking to mitigate downward pressure into the floor.
Multiple diff compensatory walking patterns, most prevalent (chiro oppinion) antalgic gait.
Left leg despite feeling smushed up and in and being the lower hip has almost no internal rotation at the femur. 5 degrees at an absolute maximum most likely about 2°. Right side is slso poor but its at least 20° or so despite the fact my hips are twisted to the right (my left) meaning that side is already biased into internal rotation. The left leg is biased into external rotation and despite that appears to only get to fully parallel, so if we factor in the hip twist 5-8° max and thats being generous.
Physical exam on myself. It is very easy to locate the greater trochanter on the left side and hard to lose track of it. Right hand side, hard to even locate without a lot of external leg rotation and easily lost track of under muscle.
Left GT i can feel it raise and turn in a bit then it just stops entirely. If i really push for more internal rotation it starts to actually push out becoming more prevalent and will continue to raise up to max 5mm. The leg will not gain any extra internal rotaion regardless.
If i force myself to shift out of my right leg i can feel the leg raise and twist and there is a sense of security and a subtle locking similar to the ankle joint. The movement is smooth and the rotation doesnt jump or feel restricted. The left leg however drives to a point being stiff the whole way and at the end of ROM theres a very ridgid bone on bone jamming feeling. Whilst in this internally rotated femor 'loaded' position both legs can only move across via hip and back twisting but the left leg moves outwards in a very ridgid arc similar to the curvature of a rainbow whereas the right leg still has a pretty good degree of range of motion anywhere from neutral outwards.
Right foot twists out. This helps with the leg length discrepancy and might be my bodys way of looking for a way to drive internal rotation. However after going over things a lot i think it may actually be a mechanism to stop me shifting out of my right side. I cannot fully shift out of my right side and therefore the twisting propulsion would only load extra weight onto the displaced hip and since it can only push partway out of right stance, it doesnt fully activate the right aic muscles or fully let go of the left aic contractions. This therefore only causes varying foot to floor landing positions and leads to balance issues and joints on the right side colapsing in. I therefore believe i developed the outward foot position to actually inhibit the leg twist motion and stop me from attempting to shift weight onto the left leg.
If you end up seeing this comment, please let me know if this sounds like it is hip dysplasia or if it sounds like any other issue to you. Thanks
What treatment can solve this?
Is it possible in some cases to manage hip dysplasia and continue running?
I was diagnosed as a kid and ended up serving on active duty in the army. It all depends on how it’s impacting you.
Mine was VERY bad as a kid and got slightly better