[
musculoskeletal imaging
]
Journal of Orthopaedic & Sports Physical Therapy® Downloaded from www.jospt.org at Universite de Sherbrooke on May 4, 2015. For personal use only. No other uses without permission. Copyright © 2015 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.
Right
FIGURE 1. Anterior-to-posterior radiograph of the pelvis and hips demonstrating sclerosis in the right femoral head (arrow).
Left
FIGURE 2. Coronal short-tau inversion recovery magnetic resonance image demonstrating subcortical trabecular interruption in the right femoral head, with associated marrow edema extending into the right femoral neck, as well as mild collapse along the superior aspect of the femoral articular surface. There is also subcortical trabecular interruption in the left femoral head.
Avascular Necrosis of the Femoral Head MATT LEE, PT, DPT, Kentucky Orthopedic Rehab Team, Nicholasville, KY. CHARLES HAZLE, PT, PhD, University of Kentucky, Lexington, KY.
T
he patient was a 51-year-old man who was evaluated by a physical therapist for a chief complaint of right hip pain that began insidiously 2 weeks prior. He reported increased pain with weight-bearing activities, as well as morning stiffness of his right hip that lasted approximately 30 minutes. The patient had taken oral corticosteroid medications for asthma and chronic obstructive pulmonary disease intermittently over the past 20 years, but denied constitutional symptoms. Visual observation revealed an antalgic gait for the right lower extremity, characterized by an abbreviated stance phase and the right hip positioned in external rotation. Right hip passive range
of motion was limited to 80° of flexion and 10° of internal rotation, with each of these movements causing an increase in pain. Because the patient’s history and physical examination findings were initially consistent with hip osteoarthritis,1 he was treated with a single bout of nonthrust hip joint mobilizations. Immediate assessment following the hip joint mobilizations showed improved hip range of motion, as well as decreased pain with ambulation. However, the patient’s initial signs and symptoms returned within 5 minutes with increased severity. Given the concern over the atypical response to hip joint mobilizations and long-term use of oral
corticosteroid medications, he was immediately referred to his primary care physician. Radiographs of the pelvis and hips revealed sclerosis in the right femoral head, which raised concern for avascular necrosis (FIGURE 1). Subsequent magnetic resonance imaging revealed findings that were characteristic of avascular necrosis in the right femoral head, as well as findings of mild avascular necrosis in the left femoral head (FIGURE 2).2 Six weeks later, the patient underwent right total hip arthroplasty. His left hip, which is asymptomatic, is being monitored closely. t J Orthop Sports Phys Ther 2015;45(5):425. doi:10.2519/ jospt.2015.0405
References 1. Altman R, Alarcón G, Appelrouth D, et al. The American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the hip. Arthritis Rheum. 1991;34:505-514. 2. American College of Radiology. ACR Appropriateness Criteria: avascular necrosis (osteonecrosis) of the hip. Available at: https://acsearch.acr.org/docs/69420/Narrative/. Accessed March 11, 2015. journal of orthopaedic & sports physical therapy | volume 45 | number 5 | may 2015 |
45-05 Imaging-Lee.indd 425
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4/15/2015 7:10:09 PM
musculoskeletal imaging
]
Journal of Orthopaedic & Sports Physical Therapy® Downloaded from www.jospt.org at Universite de Sherbrooke on May 4, 2015. For personal use only. No other uses without permission. Copyright © 2015 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.
Right
FIGURE 1. Anterior-to-posterior radiograph of the pelvis and hips demonstrating sclerosis in the right femoral head (arrow).
Left
FIGURE 2. Coronal short-tau inversion recovery magnetic resonance image demonstrating subcortical trabecular interruption in the right femoral head, with associated marrow edema extending into the right femoral neck, as well as mild collapse along the superior aspect of the femoral articular surface. There is also subcortical trabecular interruption in the left femoral head.
Avascular Necrosis of the Femoral Head MATT LEE, PT, DPT, Kentucky Orthopedic Rehab Team, Nicholasville, KY. CHARLES HAZLE, PT, PhD, University of Kentucky, Lexington, KY.
T
he patient was a 51-year-old man who was evaluated by a physical therapist for a chief complaint of right hip pain that began insidiously 2 weeks prior. He reported increased pain with weight-bearing activities, as well as morning stiffness of his right hip that lasted approximately 30 minutes. The patient had taken oral corticosteroid medications for asthma and chronic obstructive pulmonary disease intermittently over the past 20 years, but denied constitutional symptoms. Visual observation revealed an antalgic gait for the right lower extremity, characterized by an abbreviated stance phase and the right hip positioned in external rotation. Right hip passive range
of motion was limited to 80° of flexion and 10° of internal rotation, with each of these movements causing an increase in pain. Because the patient’s history and physical examination findings were initially consistent with hip osteoarthritis,1 he was treated with a single bout of nonthrust hip joint mobilizations. Immediate assessment following the hip joint mobilizations showed improved hip range of motion, as well as decreased pain with ambulation. However, the patient’s initial signs and symptoms returned within 5 minutes with increased severity. Given the concern over the atypical response to hip joint mobilizations and long-term use of oral
corticosteroid medications, he was immediately referred to his primary care physician. Radiographs of the pelvis and hips revealed sclerosis in the right femoral head, which raised concern for avascular necrosis (FIGURE 1). Subsequent magnetic resonance imaging revealed findings that were characteristic of avascular necrosis in the right femoral head, as well as findings of mild avascular necrosis in the left femoral head (FIGURE 2).2 Six weeks later, the patient underwent right total hip arthroplasty. His left hip, which is asymptomatic, is being monitored closely. t J Orthop Sports Phys Ther 2015;45(5):425. doi:10.2519/ jospt.2015.0405
References 1. Altman R, Alarcón G, Appelrouth D, et al. The American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the hip. Arthritis Rheum. 1991;34:505-514. 2. American College of Radiology. ACR Appropriateness Criteria: avascular necrosis (osteonecrosis) of the hip. Available at: https://acsearch.acr.org/docs/69420/Narrative/. Accessed March 11, 2015. journal of orthopaedic & sports physical therapy | volume 45 | number 5 | may 2015 |
45-05 Imaging-Lee.indd 425
425
4/15/2015 7:10:09 PM
