Back Clinic Hip Pain & Disorders Team. These types of disorders are common complaints that can be caused by a variety of problems. The precise location of your hip pain can give more information about the underlying cause. The hip joint on its own tends to result in pain on the inside of your hip or groin area. Pain on the outside, upper thigh, or outer buttock is usually caused by ailments/problems with the muscles, ligaments, tendons, and soft tissues surrounding the hip joint. Hip pain can also be caused by diseases and conditions in other areas of your body, i.e. the lower back. The first thing is to identify where the pain is coming from.
The most important distinguishing factor is to find out if the hip is the cause of the pain. When hip pain comes from muscles, tendons, or ligament injuries, it typically comes from overuse or Repetitive Strain Injury (RSI). This comes from overusing the hip muscles in the body i.e. iliopsoas tendinitis. This can come from tendon and ligament irritations, which typically are involved in snapping hip syndrome. It can come from inside the joint that is more characteristic of hip osteoarthritis. Each of these types of pain presents itself in slightly different ways, which is then the most important part in diagnosing what the cause is.
Back discomfort and pain could be caused by hip issues and could be resolved with hip replacement. According to a recent study, a total hip replacement solved back pain in four out of five individuals dealing with spinal discomfort and pain. When the hip/s are stiff or cannot move normally, this places added pressure on the spine. Studies show that low back pain was resolved in 82% of individuals after a total hip replacement known as total hip arthroplasty or THA. The body is designed as a fluid chain with fluid motion connecting the neck all the way down to the toes.
When a region like the hip tightens/stiffens, it generates added stress/pressure on the other areas of the body, which in this case happens to be the lower spine. Individuals with mild arthritis of the spine are able to experience increased pain reduction than individuals with severe arthritis. An insight into the relationship between the hips and low back that can lead to accurate diagnoses and optimal treatment plans.
Hip Issues
The hip/s move with the lower back during activities like walking, sitting, bending, etc. Tight muscles, normal wear-and-tear, and osteoarthritis can reduce hip movement, forcing the lower back to make awkward and poor posture causing adjustments. Individuals usually relieve the painful position by increasing the curve of their lower back.
If an individual has severe arthritis of the hip, they put a lot of stress and pressure on the low back that often results in low back pain. Advanced hip osteoarthritis is the breakdown of joint cartilage and the most common type of arthritis. Individuals with this type experience low back pain 50% of the time, and even higher depending on the individual’s condition. 80% to 90% of individuals with hip or knee arthritis, unfortunately, develop low back arthritis.
There is not yet a clear reason as to why this occurs. It is theorized that some osteoarthritis risk factors like obesity and high-impact/force activities can be modified with lifestyle adjustments. Other risk factors that include injury, trauma, age, and congenital conditions like hip dysplasia, cannot be avoided. Hip osteoarthritis isn�t the only hip issue that can also cause lower back pain. Other hip issues.
Sacroiliac joint dysfunction
The sacroiliac joint connects the sacrum to the pelvis. It is a shock absorber between the upper body, the pelvis and can stiffen with time. Sacroiliac joint pain affects around 15% to 25% of individuals with low back pain. It worsens when climbing stairs, getting up from a seated position or running. Symptoms include:
Low back pain
Pain in buttock/s
Groin pain
Stiffness
Instability
Piriformis syndrome
About 200,000 individuals each year are affected with piriformis syndrome and is often misdiagnosed as symptoms resemble sciatica. What happens is the piriformis muscle, which connects the sacrum to the top of the femur, tightens/irritates the sciatic nerve. Symptoms are often mistaken for sciatica with pain in the buttocks, numbness, and tingling that travels down the back of the leg and into the feet.
Diagnosis
A doctor or chiropractor will use a combination of diagnostic tools. This typically includes a physical exam, X-rays with other specific tests to help identify the source of pain. What typically happens is a patient will undergo a hip and lumbar spine X-ray, but the thoracic spine, pelvis, and hip areas are missed. Getting the middle segment is critical to see how the spine and hips are working together. It is critical to understand the hip-spine connection. All spine patients should have X-rays of the hips to make sure any problems don’t go undetected. The overlap of symptoms with these two areas could be overlooked.
If necessary a diagnostic injection into the hip joint can help precisely locate the pain source. This can be done at the clinic or doctor’s office using ultrasound or X-ray to guide the needle. If no pain relief results from the injection, hip replacement is still not considered because the pain could be coming from the spine. A critical part of the diagnosis is not just imaging. One of the most important parts is getting a thorough history of symptoms. X-rays and MRI show what the problem could be, however, the symptoms could coming from another area.
Treatment Options
Before total hip replacement is considered there are nonsurgical approaches to be considered. All diagnoses should start with conservative treatment. Physical therapy, chiropractic, gait training, and core strengthening can optimize the spine to better manage hip issues and arthritis. Conservative therapies could also include:
Weight loss
Activity modification like walking instead of running
Anti-inflammatory medication
Cortisone injections
Total hip replacement is the last option for individuals experiencing pain, difficulty walking, and limited mobility. The procedure removes the damaged cartilage and bone from the hip joint. This includes the head of the thighbone along with the socket where it fits and replaces it with artificial parts.
Conclusion
Get a second opinion. Individuals are encouraged to educate themselves as much as possible on the condition. The hip and spine is a complex relationship. The most important information for patients is that they understand along with their doctor where the pain is coming from, the hip, spine, or both.
Reduce Plantar Fasciitis Foot Pain
Dr. Alex Jimenez�s Blog Post Disclaimer
The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.*
Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*
A doctor, chiropractor, or physical therapist could recommend therapeutic stretches along with exercises as part of a sacroiliitis or sacroiliac joint pain treatment plan. Sacroiliitis refers to inflammation in one or both of the sacroiliac joints. This could be caused by:
Pregnancy
Injury
Infection
Arthritis
Ankylosing spondylitis
Sacroiliac joint pain is a symptom related to sacroiliac joint dysfunction. The symptoms of sacroiliitis and sacroiliac joint pain can be felt in the lower back, buttocks, hips, and legs. These symptoms can be similar to sciatica and can mimic other lower back disorders.
Some of the stretches and exercises included are common for treatment plans for various low back conditions/problems. Talk with a chiropractor or doctor to get their recommendation prior to starting any exercise or stretching program.
Stretches
Piriformis stretch
The piriformis muscle extends over the hip and can aggravate the sacroiliac joint when it becomes tight. To help stretch the muscle:
Lie on back with knees bent
Feet flat on the floor
Slowly raise the right leg
Bring the right knee toward chest
Gently pull the leg in until there is a comfortable stretch in the buttock
Exhale during the stretch movement
Hold the stretch for 30 seconds
Lower leg
Repeat on the left leg
Repeat each side 3 times daily, as needed
The stretch helps the muscle fibers to lengthen/elongate and relax.
Trunk rotation
Trunk rotation increases flexibility in the low back and hips. This can help relieve pressure on the sacroiliac joints. To do this stretch:
Lie on back with knees bent
Feet flat on the floor
With knees together
Slowly rotate to one side
Feet, hips, and back should stay on the floor
Hold 3-5 seconds
Move knees to the opposite side
Repeat 5-10 times on each side
Bridge
This is a stretch that strengthens the muscles in the lower back, buttocks, and hips.
Lie on back with arms at side
Knees should be bent, and feet flat on the floor
Slowly raise hips while squeezing buttocks and hamstrings
Hold raised position for 5 seconds
Repeat 10 times
Water Therapy and Yoga Exercises
Aquatics and yoga are a gentle and natural form of exercise that is recommended for staying active. Talk to a doctor before starting any exercise program. Aquatic therapy, known now as hydrotherapy/water therapy, is one of the gentlest forms of exercise and is highly effective.
Exercising in water creates an almost weightless environment without gravity. Hydrotherapy uses the resistance from the water to improve strength and flexibility without straining the muscles. Regular exercise can cause pain by placing added pressure on the sacroiliac joints. Water therapy conditions the spine and hip muscles without generating muscle stress. Another option for individuals with back pain is yoga. The following poses are recommended and beneficial for the sacroiliac joints:
Child�s pose
This pose stretches the hips and thighs and is a great yoga pose for beginners.
Cobra
Cobra pose can help strengthen and stabilize the sacroiliac joints.
Lie flat on the stomach
Hands beneath the shoulders
Slowly push up as far as the arms extend
Bring upper body off the ground
Keep the pelvis and legs on the floor
When extended, be sure low back and buttocks are relaxed
Hold for 15 to 30 seconds
Gently lower to the floor
Triangle pose
Triangle pose helps to strengthen the sacroiliac joints and makes them less susceptible to pain. However, this pose involves twisting, so make sure to do this pose only when the joints are stable and pain-free.
Before stretching and exercise
Before starting any stretching or exercise program, check with a doctor or chiropractor, if the joints are able then the stretching/exercise could begin right away. However, in most cases, a doctor will refer the patient to a physical therapist or chiropractor to create a customized exercise and stretching plan. The therapist will show exactly what activities will strengthen the joints and how to do them properly and safely. These movements can help condition the spinal and abdominal muscles. This can help prevent future episodes of back pain.
If an individual just had surgery for sacroiliac joint pain, the surgeon more than likely prescribed a customized rehabilitation stretching/exercise program. Follow instructions, and get the surgeon�s approval before engaging in anything outside of the plan.
Staying fit safely
When dealing with sacroiliac joint dysfunction or sacroiliitis, physical activity may need to be redefined after treatment. As regular exercise could mean strenuous activity and could do more damage. Exercises like heavy weightlifting, contact sports, and intense biking could place excessive pressure on the joints. A doctor or chiropractor will offer the best stretching and exercises for every individual.
Physical activity combined with gentle stretching and conditioning exercises can effectively reduce low back and hip pain. Talk to a doctor, chiropractor, or physical therapist about incorporating healthy exercise into a daily regimen. For some, the workout might not feel like there’s anything going on, but the effects on the pain will be.
Chiropractic Hip Pain Treatment
Dr. Alex Jimenez�s Blog Post Disclaimer
The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.*
Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*
Sacroiliac joint dysfunction and its symptoms can also be a cause for low back pain conditions and disorders.
This condition is also known as:
Sacroiliitis
SI joint inflammation
SI joint syndrome
Sacroiliac joint dysfunction
SI joint strain
It can make regular activities like sitting, standing, walking, and sleeping frustrating, difficult and unbearable. It has been found in around 30-35% of individuals.�Many individuals can spend months or even years dealing with symptoms but are never aware that it’s not the correct diagnosis. Sacroiliac joint dysfunction can sometimes be difficult to diagnose. These joints are so close to the hip and low back, that it is common for sacroiliac joint dysfunction to be mistaken for other causes/conditions of low back pain, like a herniated, slipped or bulging disc.
Sacroiliac Joint Dysfunction Symptoms
When low back pain is present, it can be quite difficult for a doctor to figure out the exact source/cause of your pain.
These are a few recognizable symptoms of sacroiliac joint dysfunction.
Low back pain is the most common.
Pain could also present in the hips, buttocks, thighs, and possibly the groin area.
The pain can be so severe that just touching the area is unbearable.
Other activities that can cause symptoms:
Common movements like climbing stairs, sitting down/getting up out of a seat, can cause pain. Pain can also be aggravated from standing or walking for extended periods but improve when relaxed or lying down. Stiffness or a burning sensation in the pelvis can also present.
Causes of Joint Dysfunction
A variety of conditions can cause sacroiliac joint dysfunction. The most common:
Arthritis
Joint pain can be caused by spinal osteoarthritis because as the cartilage around the sacroiliac joint wears down, the bones can start to rub against each other. Ankylosing spondylitis is an inflammatory arthritis that affects the spine that can also cause joint dysfunction.
Pregnancy
Pregnant women can experience low back pain or pelvic pain from sacroiliac dysfunction because the joints get stretched and lose their elasticity during pregnancy. Hormone changes and added weight during pregnancy can place added stress on the sacroiliac joints.
Accident Trauma
High impact from an auto accident, slip and fall injury, or sports injury could damage the sacroiliac joint/s.
Viral Infection
Infections are extremely rare but could be another cause of joint pain.
There are a variety of treatment options that can help reduce and prevent low back pain.
Exercise/Physical Therapy
Exercise and physical therapy are therapies that doctors highly recommend before other treatments like pain medications or surgery. Exercise, chiropractic and physical therapy can help manage pain and other symptoms. Consult your doctor before starting any physical therapy or exercise program. Your doctor can recommend a chiropractor or therapist that can help get you started with the proper exercise treatment plan.
Physical Therapy
Physical therapy can help reduce stress on the joints, that are strained and tight. It also helps maintain joint flexibility. A physical therapist will perform passive and active treatment therapies to help manage joint pain.
Passive treatments – the physical therapist does the majority of the work. An example of passive treatment applying heat or ice along with massaging the area.
Active treatments – the patient participates in the treatment with at-home exercise routines is an example of active treatment.
A combination of passive and active treatment provides the best outcomes and offers the most benefits, as the patient has the know-how of proper posture, exercises that they can do and injury prevention. A chiropractor and physical therapist can build a physical therapy program to help address your symptoms.
Exercise
With sacroiliac joint dysfunction, you do not have to do hard intense exercise. The benefits come from a consistent gentle exercise routine with an emphasis on consistency. Exercising stretches and strengthens muscles of the low back muscles and helps maintain joint flexibility.
An overall exercise plan should incorporate the three main types:
Sacroiliac joint dysfunction is known to cause low back pain, but diagnosing can be hard for some doctors. Especially those that do not have a great deal of experience in sacroiliac joint pain. However,�chiropractors specialize in this area as the SI joint is an important part of the musculoskeletal system.
Piriformis syndrome will cause dull, mild pain in the low back, buttocks and can radiate down the leg.
Hip pain attributed to avascular necrosis will be severe and constant.
Sacroiliac joint pain could be attributed to the hip and the low back because the sacroiliac joints connect the sacrum in the spine to the hip bones.
Symptoms that the Spine Is the Root
Where groin pain is a sign that the pain is linked to the hip when the pain is above the waistline and travels down the body usually indicates a low back issue.
Among the most common degenerative conditions that affect the lumbar spine are:
Herniated discs
Spinal stenosis
Spondylolisthesis
Pain is caused by irritating the low back nerves, which result in pain shooting down the leg/s and:
Weakness
Numbness
Reduced range of motion
Arthritis of the spine brings on pain usually when first getting out of bed or rising up after sitting.
It usually improves after beginning to move.
Spinal stenosis or nerve pressure compression pain worsens with prolonged standing or walking, while relief comes with sitting.
Getting to the Root
When there is pain in the lower body and are not sure whether it’s the back or hip, the first course of action is to visit your doctor or a chiropractor.
They will review your medical history and perform a series of physical exams, such as various movements to get an idea of what is going on.
Your primary doctor may refer you to a doctor/chiropractor who specializes in hip or spinal conditions to make an accurate diagnosis.
The doctor will ask you to describe the:
Pain
Location
When it worsens
When it’s relieved
What the pain feels like (e.g., sharp, dull).
The doctor may have you perform various movements to observe your biomechanics.
The goal is to determine what movements trigger the pain.
For both spine and hip pain, surgery is rarely necessary and only utilized as the last-resort option.
Labrum Tear Hip Treatment El Paso, TX Chiropractor
Andrew Hutchinson turned into chiropractic care and Crossfit rehab after suffering a high ankle sprain and a hip labrum tear for which he moved through with surgery to repair it. After being bedridden for weeks so as to correctly recuperate, Andrew Hutchinson transitioned to chiropractic care and Crossfit rehab to regain his strength, freedom, and flexibility before returning to perform. Although he has suffered other sports accidents, Andrew Hutchinson continues to trust in chiropractic care and Crossfit rehab to keep his spine properly aligned and maintain overall health and wellbeing.
Labrum tears in athletes may occur from a single event or recurring trauma. Running may lead to labrum tears as a result of labrum being used more for weight-bearing and taking excessive forces while at the end-range motion of the leg. Sporting activities are likely causes, especially the ones that require frequent hip rotation or pivoting to some wealthy femur as in ballet or hockey. Continuous hip rotation places increased pressure on the capsular tissue and injury to the iliofemoral ligament. This then causes hip instability placing increased stress on the labrum and resulting in a cool labrum tear.
What’s Afoot
Muscle imbalances in the hip, such as tight hip flexors, can cause low back pain � or at least contribute to it. When the hip flexor muscles are too tight, it causes what is known as an anterior pelvic tilt. In other words, the muscles cause an anterior pull on the pelvis. This affect posture and throws the entire lower body out of alignment. It can also affect the knees and feet if left untreated.
NCBI Resources
Hip flexors can become too tight if the person sits for extended periods of time or engages in activities like cycling and jogging. A chiropractor can guide you through exercises that will help release the tight muscles and stop the micro spams that occur as a result. They will also assess your knees, feet, and ankles to ensure that the issue has not through them out of alignment as well. Correcting the cause of the problem will often correct the associated issues and resolve the pain allowing you to return to your normal activities.
Although hip pain is most often associated with older individuals, in reality, it can affect people from all age groups. The hips are complex joints, which means there are many things that can go wrong in the hips�complications that can lead to pain and discomfort in the hip area. Whatever your age, when hip pain strikes you naturally want to know if there is a way to make it better or eliminate it altogether. Fortunately, chiropractic offers effective methods for addressing hip pain.
Causes of Hip Pain?
There are a surprising number of ways that hip pain can develop. It may show up at one or both sides of your hips, or on the front of your hip. It can also show up on the back of one or both hips. Where the pain develops can serve as an indicator of what is actually causing the pain. Your chiropractor will look closely at your condition to determine the cause, which may be attributed to the following:
Osteoarthritis
The cartilage that surrounds your joints can begin to wear down over time. The degeneration of cartilage around joints is known as osteoarthritis. Many times, osteoarthritis can develop due to normal wear and tear, which is why the condition is so often associated with aging. However, it is possible for younger individuals to develop osteoarthritis as well.
Transient Osteoarthritis
Both middle-aged men and pregnant women can suffer from transient osteoarthritis. It is a painful condition, but fortunately, it is reversible with proper treatment.
Bursitis
Bursa are sacs filled with fluid found in your joints, including the hips. The bursa are supposed to provide cushioning to your joints and lessen the friction created as your joints move. However, the bursa can become inflamed, which can lead to pain each time the joint is used.
Muscle Strain
There are a multitude of muscles that support the hips and make it possible for them to function. If one or more of those muscles is strained, it can lead to pain. Muscle strain is common in active individuals.
Overuse
Any joint and the soft tissues that support it can be overused. Overuse is common in individuals who perform repetitive motions, such as having to do the same motion hundreds of times a day for particular job activity.
Chiropractic Can Help
Studies have shown that chiropractic can increase mobility and lessen the pain when patients are experiencing hip pain. Treatment can be quite effective for many hip conditions, including all of those listed above. Since chiropractic steers clear of unnecessary medications and surgery, it is non-invasive and can be used regularly with minimal risk of side effects. Even if the condition you suffer from is not completely eliminated by treatment, it can make your symptoms much more tolerable by reducing pain and improving mobility.
Some common treatments for hip pain in chiropractic include:
Adjustments
By realigning your spine, adjustments can reduce or eliminate strain that may be placed on your hips. Regular adjustments can help ensure that your body maintains alignment and minimizes the amount of unnecessary strain might be impacting your hip area.
Exercises
Sometimes the best long-term solution to hip pain is to strengthen the muscles surrounding the hips. Your chiropractor can give you personalized exercises based on your body�s needs to help you get stronger so that your body supports your hips day in and day out.
Stretches
Hip pain can lead to loss of mobility. Appropriate stretches can help you regain some of that mobility.
Contact Us & Schedule An Appointment for Hip Pain Relief
Labrum Tear Hip Treatment El Paso, TX Chiropractor
Andrew Hutchinson turned into chiropractic care and Crossfit rehab after suffering a high ankle sprain and a hip labrum tear for which he moved through with surgery to repair it. After being bedridden for weeks so as to correctly recuperate, Andrew Hutchinson transitioned to chiropractic care and Crossfit rehab to regain his strength, freedom, and flexibility before returning to perform. Although he has suffered other sports accidents, Andrew Hutchinson continues to trust in chiropractic care and Crossfit rehab to keep his spine properly aligned and maintain overall health and wellbeing.
Labrum rips in athletes may occur from a single event or recurring trauma. Running may lead to labrum tears as a result of labrum being used more for weight-bearing and taking excessive forces while at the end-range motion of the leg. Sporting activities are likely causes, especially the ones that require frequent hip rotation or pivoting to some wealthy femur as in ballet or hockey. Continuous hip rotation places increased pressure on the capsular tissue and injury to the iliofemoral ligament. This then causes hip instability placing increased stress on the labrum and resulting in a cool labrum tear.
Hip Weakness
Muscle imbalances in the hip, such as tight hip flexors, can cause low back pain � or at least contribute to it. When the hip flexor muscles are too tight, it causes what is known as an anterior pelvic tilt.�Hip flexors�can become too tight if the person sits for extended periods of time or engages in activities like cycling and jogging. A chiropractor can guide you through exercises that will help release the tight muscles and stop the micro spams that occur as a result.
NCBI Resources
Treating your hip is successful when the focus is on restoring the balance and function of the entire body. This starts from the ground up with the feet along with a chiropractic examination that determines the root cause, which in turn helps in making an informed decision on a treatment plan. This instead of merely reducing the pain and inflammation in the irritated areas.
X-radiography pitfalls: some undisplaced Garden 1 & 2 Fxs may be missed d/t pre-existing DJD and osteophytes along the femoral head-neck junction that may overly the Fx line
Fx line is incomplete and too small/subtle especially if the study is read by non-radiologists
Incomplete Fxs if left untreated will not heal and likely to progress to complete Fxs
AP hip spot view: note valgus deformity of the head (above yellow arrow) with a small/subtle line of sclerosis in the sub-capital region representing Garden 1 Fx. MRI may help with Dx of subtle radiographic Fxs. If MRI contraindicated, Tc 99 radionuclide bone scan may help demonstrate high uptake of the radiopharmaceutical in Fx (below image)
Above – Tc99 Radionuclide Bone Scan Reveals Left Subcapital Femoral Neck Fx
Garden 2 complete undisplaced (above green arrows) Fx
AP hip: Garden 3 complete partially displaced Fx (above the first image)
AP pelvis: complete displaced Garden 4 Fx (above the second image)
Clinical pearls: in some cases of Garden 4 Fx, DDx may be difficult to differentiate from OSP vs. pathologic fx d/t to bone Mets of Multiple myeloma (MM)
Management: depends on patients age and activity level
Garden 3 & 4� require total hip arthroplasty in patients <85-y.o.
Garden 1 & 2 may be treated with closed reduction of fx and open capsule and 3-cannulated fixating screws
Pre-existing DJD may require total arthroplasty
Occasionally observation may be performed on patients who are not active and significant risks of surgery and depends on surgical centers
m/c Rx of Garden 1 & 2 undisplaced Fx with 3-screws. Screws proximity depends on the bone quality and Fx type
THA aka hip replacement: cemented THA with bone cement (above the first image) vs. non-cemented (biologic) that is used mostly in younger patients
2-types: metal on metal vs. metal on polyethylene
The femoral angle of the prosthesis should have slight valgus but never >140 degrees
The non-cemented component uses porous metal allowing the bone to integrate sometimes coating in bone cement from osteoconduction
THA has good outcome and prognosis
Occasionally cement failure, fractures, and infections may complicate this procedure
Unstable Fx: a result of high energy trauma with >50% d/t MVA
20% closed Fx and 50% of open Fx result in mortality
Mortality is associated with vascular and internal organs injuries
Vascular injury: 20% arterial 80% venous
Chronic morbidity/disability and prolonged pain
Unstable Fx are rarely seen in the outpatient setting and typically and present to the ED
Stable pelvic Fx are usually caused by muscles/tendons avulsions and more often seen in pediatric cases
Understanding Pelvic Anatomy Is The Key To Successful Imaging Dx
The bony pelvis is a continuous ring of bone held by strong ligaments
During significant impact, pelvic fractures may occur in more than one location because forces applied to one region of the ring will also correspond to injury on the other, usually the opposite side of the ring (above image)
Thus the majority of unstable pelvic Fx will typically demonstrate more than one break
Pelvic is seen as a ring of� bone connected by some of the strongest ligaments in the body
The pelvic ring comprises 2-semirings: anterior to the acetabulum and posterior to the acetabulum
The bony pelvis is in close proximity to major vessels carrying a greater chance of vascular injury
Anatomical Differences of The Female and Male Pelvis
Post-Traumatic Pelvic Views May Vary and Include:
Standard AP Pelvis (above images)
Judet views evaluating the acetabulo-pelvic region
Inlet/Outlet views helping with the symphysis and SIJ regions
Rad survey of the pelvis should include evaluation of the continuity of pelvic rings:
Inlet/outlet, obturator rings (above the first image)
Symphysis pubis and SIJ for diastasis and post-trauma separation (above the second image)
Lumbosacral spine and hips should also be carefully examined
Pelvic inlet (above top left) and Outlet (above bottom left)
Judet views: left and right posterior oblique views
Additional Survey:
Iliopectineal, ilioischial, Shenton and Sacral arcuate lines will help detection of sacral, acetabular and hip fracture/dislocations
Stable Pelvic Fractures aka Avulsion Injury
Appreciating anatomical sites of pelvic origin/insertion of different muscles will help Dx of pelvic avulsion Fx
Avulsion Fx of the AllS (origin of the direct head of Rectus femoris M)
Pelvic avulsions occur by sudden eccentric contraction especially during kicking or jumping
Imaging: x-radiography will suffice
Clinically: sudden snap or pop followed by local pain. Pt can weight bear
Care: non-operative with rest for 4-weeks. Non-union is rare. No major complications
DDx: key rad DDx feature is not to mistake an avulsion from an aggressive pediatric bone tumor-like osteosarcoma that may show some exuberant new bone formation d/t healing and bone callus
Commonly Encountered Unstable Pelvic Fractures
Malgaigne Fx: d/t vertical shear injury to the ipsilateral pelvis
Rad Dx: ipsilateral superior and inferior pubic rami Fx (anterior ring) with ipsilateral SIJ separation/Fx of the sacrum and adjacent ilium (posterior ring). Symphysis pubis diastasis can be seen. An additional clue is an avulsion of L4 and/or L5 TP that often signifies serious pelvic injury
Clinically: marked leg shortening, shock, inability to weight bear.
Damage to Superior Gluteal Artery can occur
Imaging: x-radiography followed by CT scanning w/o and with IV contrast esp. if visceral injury present
Care: surgical in most cases d/t significant instability. ORIF. Hemostasis, Pelvic stabilization
Prognosis: depends on the complexity, rate of visceral complications and stability. 10% Superior glut artery bleed requiring rapid hemostasis
Open Book Pelvis (major instability)
Mechanism: AP compression of different force magnitude (picture depiction)
Rad Dx: diastasis of symphysis pubis with diastasis of SIJ with and w/o adjacent Fx of the ala
Imaging steps: x-radiographic, CT scanning with and w/o contrast for vascular injury, cystography for acute urinary bladder rupture
Immediate and delayed complications may occur: vascular injury, urethral/bladder injury
Straddle Injury: Unstable Fx
Mechanism: direct impact/collision
High risk of urinary bladder/urethral injury
Imaging: bilateral superior and inferior pubic rami Fx with or w/o diastasis and Fx of SIJ
CT with and w/o contrast for vascular injury
Cystourethrogram additionally evaluates a urogenital injury
2) Osteoporotic patients with low impact, trivial or no trauma (i.e., insufficiency Fx)
X-radiography is crucial to early Dx and prevention of complications which include:
Dx: intra-capsular vs. extra-capsular Fx
Ischemic osteonecrosis aka avascular necrosis (AVN) of the femoral head and rapid disabling DJD
Epidemiology: USA has some of the highest rates of OSP hip Fx worldwide. Highest healthcare cost Fx to treat overall
Women>men, Caucasians>African-Americans
25-30% mortality within the 1st year. Mortality depends on co-morbidities and stat of activity prior Fx
Pathophys: the femoral neck is intra-capsular and transmits arterial flow to the head. The neck is uncovered by the periosteum and unable to develop a good callus. The neck transmits maximum tensile forces through the proximal femur and prone to Fx and non-union
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