Keywords: Hip Dysplasia CaseFile . chiropractic help . hip arthritis . sacroiliac joint treatment
Mr F, a 59-year old man presented at our clinic with sharp stabs of pain in the right groin that began approximately six years previously. The pain radiated down the front of the thigh to just below the knee.
He remarked that he had regular chronic mild lower back pain, but only rarely did it really trouble him.
The pain in the groin began gradually, intermittent but in the last six months the pain became much worse. He had difficulty reaching his shoe, walking caused sharp pain, and even cycling was restricted. Climbing stairs was painful.
Remarkably (as most people have no idea how their mother's pregnancy went) he knew that in the pregnancy his mother told him that he lay in the transverse position.
Physiotherapy had brought a little temporary relief. Otherwise, nothing relieved the pain.
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Hip Dysplasia CaseFile
Mr F stood with a distinct lop-sided posture. A short left leg tilted his pelvis, giving him a mild C-shaped scoliosis.
Range of Motion of the lumbar spine: Lumbar flexion was mildly pain in the low back. Extension (backward bending) and sidebending to the left produced R lower back pain.
Range of Motion of the right hip:
Flexion was severely limited to no more than 90* with a very hard "end-feel". That's typical of bone on bone. On flexing the hip to his chest, noteworthy was that he could only achieve it by simultaneously abducting the hip outwards. Likewise adduction, pulling it towards the opposite shoulder, was extremely restricted and caused sharp stabs of pain in the groin. Rotation, extension and abduction were relatively normal.
Motion palpation: The right sacroiliac joint was severely fixated (what I call a "feel of concrete" in the joint. It appeared "ankylosed".). Likewise there was a fixation of L5, the lowermost lumbar bone.
Sacroiliac tests were negative. (Yeoman's test produced mild L5 pain but nothing in the hip or SI joint) The Patrick Fabere test was normal (surprisingly). Straight leg raise test of Lasegue only produced pain in the groin (ie. negative for a pinched nerve).
Hip Dysplasia CaseFile
The right acetabulum lies more steeply inclined than the left hip. The cephalad portion of the hip joint is reduced in size, having worsened since the examination in 2005.
Bilaterally, there are degenerative changes occuring at the lateral margin of the roof of the acetabulum. This has the appearance of a moderate Cox arthritis of the right hip associated with the mild case of dysplasia of the right acetabulum.
Normal SI joints.
Developmental Hip dysplasia casefile. DDH.
Hip dysplasia casefile
CONSULT 1 : (17 June) HISTORY AND EXAMINATION
Subjective: Right groin pain.
Objective: Moderate to severe loss of flexion and adduction.
Assessemnt: Right hip dysplasia casefile.
Plan: Hip and pelvic exercises.
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CONSULT 2 : (26 June)
S: R groin pain.
O: No change
A: DDH, X-rays have arrived.
P: Report of Findings.
First Chiropractic treatment of the sacroiliac joints, lumbar spine and hip joint.
CONSULT 3 : 1 July
S: Hip definitely feels looser. No "after pain" from the treatment.
O: No change in the objective findings of this hip dysplasia casefile.
P: Add Mulligan belt mobilisation of the hip.
CONSULT 4 : 6 July
S: Increased pain in the low back.
O: Extension and increased flexion low back pain.
A: Low back in unstable phase after first few treatments: aggravations.
P: Change in treatment of L5. Right-side-down chiropractic adjustment of L5. Supine Thompson drop treatment of the right SIJ. Mulligan mobilisation of the right hip.
CONSULT 5 : 10 July
S: Much less back pain since last treatment. Groin pain still severe when walking. Range of motion of the hip increasing.
O: No lumbar flexion pain. Hip flexion still restricted to 90 degrees. Adduction improving.
A: First range of motion increases, then pain should decrease.
P: Nutrition. Discussed the need for nutritional support for the cartilage in the hip joint. Recommendations:
One big plus: Mr F's weight is perfect.
CONSULT 6 : 13 July
S: Improving. Minimal back pain, Walking improving.
O: Pelvis still obviously low on the left.
A: Time for a heel lift. 5mm lift in the left shoe immediately reduces extension pain in the low back.
P: As before.
CONSULT 7 : 20 July HIP DYSPLASIA CaseFile
S: Magic. 80% less pain in the groin. Can now walk without pain, first time in six years.
O: Hip flexion still limited to 90*. "Concrete feel" in right sacroiliac joint is gone. Normal movment of SIJ on motion palpation.
A: Hard end-feel in the hip is much improved.
P: Mr F can flex his hip another 20* after the treatment. Must continue with the exercises to maintain the increased range of motion. Next consult two weeks. Begin rehab phase, and begin treatment on the left hip FAIS.
CONSULT 8 : August 8.
S: Mr F is a different man. Walking is almost normal, certainly painfree, though he does have a slight limp on careful scruteny.
O: For the first time hip flexion BEFORE the treatment now exceeds 90*. Adduction remains very limited. No abnormal sacroiliac findings.
A: He's doing better than expected. The interesting question is to what extent the Chiropractic adjustment of the sacro-iliac joint subluxation is what has restored his walking, and how much to do with the actual treatment of the hip itself.
P: Add further pelvic stabilisation exercises. Treatment as before. Next treatment in four weeks.
Note: I personally have gone into semi-retirement, and have left the care of Mr F to my colleague. No further updates to this casefile.
DISCUSSION of this Hip Dysplasia casefile
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Interesting challenges of the day
1. Mr B came initially for a painful and stiff neck and then asked whether chiropractic could help the cold numb feeling running down the side of his thigh for six months. Meralgia paresthetica is a double crush syndrome with the nerve affected in the back and groin. He's 80% improved after five treatments.
2. Mrs C has a long history of severe, disabling migraine headaches since having her wisdom teeth removed. She clenches her teeth at night. After six treatments she has no migraines but some jaw joint discomfort remains; a bite plate is in the offing.
3. Mrs U has the trophy for the worst back this year. After major surgery with plates and screws two years later she still had paresis in the lower leg and severe disabling back pain. She's doing far better than expected, in no little part due to a lift in her shoe for a very short leg.
4. Mr V is 86 years old and hurt his back helping his wife into the car. Just one treatment of the sacroiliac joint and he's eighty percent better. It's not always like that.
5. Mr W lay on his back knocking down a pillar. Turning his head causes severe vertigo. He needs the Epley exercises, not pills, research shows. Update, he's fine.
6. Mrs X, a young mother has severe lower back pain, with numbness down the posterior thigh, calf and side of her foot. It started after a long drive in the car. After six treatments she is 60 percent better, but it's slow and is going to take the full 6 weeks to heal.
And now a setback, after lifting her child she now has leg pain. It's going to the be difficult.
7. This lady is a 70 year old woman, is on maintenance care for a nasty lumbar stenosis despite having to do everything at home. Her husband has a hospital acquired infection after a total shoulder replacement. After four operations he is incapacitated.
8. She is an 78 year old woman, is doing remarkably well with a bad sciatica. But over 200 pounds she is not losing weight; in fact, gaining despite my suggestions. She's high risk for a stroke. I have referred her to a dietician to crack the whip.
9. This man is a 73 year old engineer, still working, is doing fine after a long episode of lower back pain. Some pain on the side of the hip remains after five treatments. I reassured him it's not hip arthritis.
10. A 64 year old woman has had scheuermanns disease; it's left her with a spinal kyphosis and chronic middorsal pain. She responds well to chiropractic treatment provides she come every six weeks or so for maintenance treatment.
11. Mr C has been having severe headaches, and taking a lot of analgesics. It's a non complicated upper cervical facet syndrome, and she's doing well.
12. Mrs D, a middle aged woman with hip pain of one year duration, despite other treatment. Xrays reveal an impingement syndrome and early hip arthritis. There's much to be done.
13. Both Mrs E and I can't believe how much better her lower back and leg pain are. Surgery for a scoliosis and spondylolysthesis three years ago helped greatly for one year. But then her leg went lame and weak. He was responded extremely well despite all expectations.
And so the day goes; chiropractors shouldn't be treating the elderly most medical sites state but that's so much bunkum.
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