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Crossover Sign

Crossover Sign of the Hip/Acetabulum The crossover sign is a radiographic finding that is often associated or discussed in the setting of hip impingement, namely femoracetabular impingement (FAI). The crossover sign is indicative of acetabular retroversion, which causes pincer-type FAI. The crossover sign is associated with focal cranial retroversion, and on AP pelvic radiographs is characterized by the anterior rim of the…

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Radiographic Evaluation of the Impinging Hip

Radiographic Evaluation of the Hip You can get a lot of information from the plain radiographs fractures djd (degenerative joint disease) sclerosis congruency scanogram (limb length and alignment) loose bodies osteochondroma osteoid osteoma bony prominence @ head neck junction (Cam impingement) coxa profunda protrusion  crossover sign posterior wall sign acetabular dysplasia AP Pelvis coccyx should centered 1-3 cm over pubic symphysis…

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Iliopsoas Tendonitis & Snapping Hip

Tendinitis probably because something is rubbing on it or tendon is overloaded because of undercoverage/dysplasia and it is stabilizing the head or maybe there is bone spur or calcified labrum rubbing it Internal Snapping Hip Syndrome probably most common cause/indication  this has to be painful to indicate surgery Associated with FAI probably secondary to spur from flexion (>90) to exntesion…

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Proximal Hamstring Repair – Surgical Tips

Tips from Dr. Busconi Nonoperative reserved for 1-2 tendon tears…look at handouts Gluteal crease incisions remember that it is more lateral than you think vertical incisions only for chronic repairs locate the sciatic and posterior lateral cutaneous n. before doing your repair final repair in 30-40 degrees of flexion, make sure knee gets out to 10 degrees of flexion hinged…

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Sciatic Nerve and Deep Gluteal Syndrome

Sciatic Nerve and Deep Gluteal Syndrome - as taught by Dr. Hal Martin differential diagnostic considerations medial to ischium - consider pudendal nerve lateral to ischium hamstring versus iliofemoral impingement 30 degree versus 90 degree active hamstring test walk them in the hallway (long stride walking) - recreate impingement piriformis active test passive piriformis test Pudendal nerve  serial nerve injections…

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Gluteus Medius Tears

Abductor tears are “rotator cuff of the hip” Clinical presentation rarely a history of a pop or injury, usually it is refractory lateral sided hip pain age > 50 females > males (10:1) failed corticosteroid injections abductor weakness trendelenburg gait/sign refractory troch bursitis vs. glut med or minimus tear - this is what you must figure out Literature shows equal…

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Greater Trochanteric Pain Syndrome

Troch bursitis is one of the bane’s of orthopaedics infrequently needs to be treated surgically much recalcitrant bursitis isn’t bursitis at all new term: “greater trochanteric pain syndrome” Signs trendelenberg stance on one leg abductor lurch shift body weight over symptomatic side, reducing forces that abductors need to keep pelvis level MRI is reliable at showing abductor pathology sometimes seen…

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