[Physio Explained] Clinical pearls for assessing hip dysplasia with Andrew Wallis
Aug 7, 2024
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In this discussion, Andrew Wallis, an APA Sports and Manipulative Physiotherapist with extensive experience in elite sports, shares critical insights on assessing hip dysplasia. He explains the importance of distinguishing between extension and flexion movements and highlights the role of gait observation and special tests like apprehension testing. Andrew also addresses common misconceptions about hip dysplasia symptoms, emphasizing personalized rehabilitation strategies to enhance patient comfort and recovery. His expert tips are essential for anyone working in physiotherapy.
Hip dysplasia is marked by instability in the hip joint, often leading to pain due to surrounding structures being affected.
A comprehensive assessment of hip dysplasia includes evaluating gait, muscle strength, and specific symptom-provoking movements for accurate diagnosis.
Deep dives
Understanding Hip Dysplasia
Hip dysplasia is characterized by a shallow acetabulum, which affects the stability of the hip joint. Normal hip function can be likened to a tennis ball resting snugly in a bowl, while a dysplastic hip resembles a ball on a saucer, leading to increased movement and instability. This instability can cause the ball to impact surrounding structures, resulting in pain from inflammation of the labrum, synovium, and nearby tendons. Understanding these dynamics is crucial for early identification and effective treatment of hip dysplasia.
Subjective Presentation of Symptoms
Patients with hip dysplasia often experience insidious, dull aching pain that varies based on hip position and movement patterns. This pain is typically felt in the anterior and lateral areas of the hip, particularly during activities that involve flexion, such as squatting or lunging. A common clinical challenge is distinguishing dysplasia pain from that caused by femoroacetabular impingement (FAI), as both conditions may present overlapping symptoms. Clinicians should be particularly attentive to the directionality of symptoms and ask detailed questions about specific movements that exacerbate the pain.
Assessment Techniques for Dysplasia
Effective assessment of hip dysplasia involves a thorough examination of gait, posture, and isolated strength testing of hip muscles. Observations such as a Trendelenburg gait or sway back posture can indicate underlying instability. Objective measures include strength testing with handheld dynamometers for abductors and rotators while ensuring appropriate testing positions to avoid misleading results. Incorporating both subjective assessments and the presence of mechanical symptoms provides a comprehensive understanding of the condition and helps in developing an effective treatment plan.
In this episode, we explore the assessment of hip dysplasia, focusing on the condition's definition, the differences between extension and flexion-based movements, and both subjective and objective assessment techniques. We discuss the importance of observing gait, head of femur translation, single leg stance, and various special tests, including apprehension testing, to diagnose and understand hip dysplasia.
Andrew is an APA Sports and Manipulative Physiotherapist who is currently employed at St. Kilda Football Club (since 2007) and works privately at Melbourne Orthopaedic Group Sports Medicine. Over the last 20 years, Andrew has worked in both a clinical setting and within the elite sporting environment at Melbourne Victory, Adelaide Thunderbirds, SACA Redbacks, V8 Supercars, triathlon and athletics.
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Our host is @sarah.yule from Physio Network
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