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Hip Pain

Are you frustrated with your Hip pain that is not getting better? Are you experiencing Hip discomfort after prolong walking, squatting or running? Walking in limping or imbalance? You are in the right place! We certainly able to help with our innovative and non-invasive (non-surgical) form of treatment. Get your hip check today. Call us at (65) 6471 2744 or Email to info@boneclinic.com.sg to schedule for an appointment

HIP PAIN CLINIC

HIP PAIN CLINIC

Hip pain refers to pain in and around the hip area. The pain in this area can be from arthritis, weak muscles or bursitis. The hip is the largest joint in the body and when it is not working well your life can be very limited.

The hip joint attaches the leg to the torso of the body. In the hip joint, the head of the thighbone (femur) swivels in a socket, called the acetabulum, that is made up of pelvic bones. While many causes of hip pain can arise from the joint itself, there are numerous structures surrounding the hip that can also be the source of pain.

Trauma is often the cause of hip pain, but any source of inflammation may cause pain in the hip area. Pain is one of the symptoms of inflammation, along with swelling, warmth, and redness; together these are signals that a problem may exist.

Hip pain is common problem, and it can be confusing because there are many causes. It is important to make an accurate diagnosis of the cause of your symptoms so that appropriate treatment can be directed at the underlying problem. If you have hip pain, some common conditions include:

When do you need to call us about your hip pain?

If you are unsure of the cause of your symptoms, or if you do not know the specific treatment recommendations for your condition, you should seek medical attention. Treatment of hip pain must be directed at the specific cause of your problem. Some signs that you should be seen by a doctor include:

    • Inability to walk comfortably on the affected side
    • Injury that causes deformity around the joint
    • Hip pain that occurs at night or while resting
    • Hip pain that persists beyond a few days
    • Inability to bend the hip
    • Swelling of the hip or the thigh area
    • Signs of an infection, including fever, redness, warmth
    • Any other unusual symptoms

What are the best treatments for hip pain?

Treatment depends entirely on the cause of the problem. Therefore, it is of utmost importance that you understand the cause of your symptoms before embarking on a treatment program. If you are unsure of your diagnosis, or the severity of your condition, you should seek medical advice before beginning any treatment plan.

Read more about Transient Synovitis Hip in Children

Read more about Acetabular Labrum Tear

CURE YOUR HIP PAIN TODAY. GET A HIP SPECIALIST TO RULE OUT THE CAUSES AND CURE OF YOUR HIP PAIN. CALL (65) 6471 2744 – 24 Hours OR EMAIL TO info@boneclinic.com.sg TO GET AN APPOINTMENT

Avascular Necrosis

Diagnosed with AVN (Avascular Necrosis)? You are at the Right Place. Get Professional opinion and treatment about your condition today. Call us +65 64712744 or SMS to +65 92357641 to schedule for an appointment.

Avascular necrosis is the death of bone tissue due to a lack of blood supply. Also called osteonecrosis, avascular necrosis can lead to tiny breaks in the bone and the bone’s eventual collapse.

The blood flow to a section of bone can be interrupted if the bone is fractured or the joint becomes dislocated. Avascular necrosis of bone is also associated with long-term use of high-dose steroid medications and excessive alcohol intake.

The hip is the joint most commonly affected by avascular necrosis. While avascular necrosis of bone can happen to anyone, it usually occurs in men between the ages of 30 and 60.

Avascular Necrosis

Avascular Necrosis

Symptoms:

Many people have no symptoms in the early stages of avascular necrosis of bone. As the disease worsens, your affected joint may hurt only when you put weight on it. Eventually, the joint may hurt even when you’re lying down.

Pain can be mild or severe and usually develops gradually. Joints most likely to be affected are the hip, shoulder, knee, hand and foot. Pain associated with avascular necrosis of the hip may be focused in the groin, thigh or buttock. Some people experience avascular necrosis bilaterally — for example, in both hips or in both knees.

When to see a doctor

See your doctor if you experience persistent pain in any joint. Seek immediate medical attention if you believe you have a broken bone or a dislocated joint.

Your risk of developing avascular necrosis can be increased by certain diseases, medical treatments or excessive drinking.

Excessive drinking

Several alcoholic drinks a day for several years can cause fatty deposits to form in your blood vessels. This can restrict the flow of blood to your bones. The more alcohol you habitually drink every day,  the higher your risk of avascular necrosis.

Medications

Certain types of medications can increase your risk of avascular necrosis. Examples include:

  • Steroids. Taken at high doses and for long periods of time, corticosteroids, such as prednisone, increase your risk of avascular necrosis. Like alcohol, these drugs may increase the amount of fat in your blood, leading to blockage of the small vessels feeding your bones. Doctors often prescribe high doses of corticosteroids for diseases such as vasculitis or lupus.
  • Osteoporosis drugs. People who take bisphosphonates — a type of medicine used to help strengthen bones weakened by osteoporosis — sometimes develop osteonecrosis of the jaw. This risk is higher for people who have received large doses of bisphosphonates intravenously to counteract the damage caused by cancer in the bones.

Medical conditions

Some underlying medical conditions increase your risk of developing avascular necrosis. They include:

  • HIV/AIDS
  • Lupus
  • Diabetes
  • Sickle cell anemia

Medical procedures

Several types of medical procedures increase your risk of avascular necrosis. Examples include:

  • Cancer treatments such as radiation
  • Dialysis, a process to clean the blood after kidney failure
  • Kidney and other organ transplants

Complications:

Avascular necrosis that goes untreated will worsen with time. Eventually the bone may become weakened enough that it collapses. When the bone loses its smooth shape, severe arthritis can result.

 Test and Diagnosis:

During the exam, your doctor will press around your joint, checking for tenderness. He or she may also move your joints through a variety of positions to see if your range of motion has been reduced.

Imaging tests

Many disorders can cause joint pain. Imaging tests can help pinpoint the proper diagnosis.

  • X-rays. In the early stages of avascular necrosis, X-rays usually appear normal. But X-rays can often reveal bone changes that occur in later stages of the disease.
  • Bone scan. For a bone scan, a small amount of radioactive material is injected into your vein. This material then travels to the parts of your bones that are injured or healing, and shows up as bright spots on the imaging plate.
  • Magnetic resonance imaging (MRI). MRI scans can show early changes in the bone that may indicate avascular necrosis. MRI uses radio waves and a strong magnetic field to produce detailed images of internal structures.

Treatments:

The treatment goal for avascular necrosis is to prevent further bone loss. What treatment you receive depends on the amount of bone damage you already have.

Medications

In some people, avascular necrosis symptoms may be reduced with medications such as:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs).Medications such as ibuprofen (Advil, Motrin, others) or naproxen (Aleve) may help relieve the pain and inflammation associated with avascular necrosis.
  • Osteoporosis drugs. Some studies indicate that osteoporosis medications, such as alendronate (Fosamax, Binosto), may slow the progression of avascular necrosis.
  • Cholesterol drugs. Reducing the amount of fat (lipids) in your blood may help prevent the vessel blockages that often cause avascular necrosis.
  • Blood thinners. If you have a clotting disorder, blood thinners such as warfarin (Coumadin, Jantoven) may be prescribed to prevent clots in the vessels feeding your bones.

Therapy

In the early stages of avascular necrosis, your doctor might suggest:

  • Rest. Reducing the amount of weight and stress on your affected bone may slow the damage of avascular necrosis. You may need to restrict the amount of physical activity you engage in. In the case of hip or knee avascular necrosis, you may need to use crutches to keep weight off your joint for several months.
  • Exercises. Certain exercises may help you maintain or improve the range of motion in your joint. A physical therapist can choose exercises specifically for your condition and teach you how to do them.
  • Electrical stimulation. Electrical currents may encourage your body to grow new bone to replace the area damaged by avascular necrosis. Electrical stimulation can be used during surgery and applied directly to the damaged area. Or it can be administered through electrodes attached to your skin.

Surgical and other procedures

Because most people don’t start having symptoms until the disease is fairly advanced, you may need to consider surgeries such as:

  • Core decompression. In this operation, your surgeon removes part of the inner layer of your bone. In addition to reducing your pain, the extra space within your bone stimulates the production of healthy bone tissue and new blood vessels.
  • Bone transplant (graft). This procedure can help strengthen the area of bone affected by avascular necrosis The graft is a section of healthy bone taken from another part of your body.
  • Bone reshaping (osteotomy). This procedure removes a wedge of bone above or below a weight-bearing joint to help shift your weight off the damaged bone. Bone reshaping may allow you to postpone joint replacement.
  • Joint replacement. If your diseased bone has already collapsed or other treatment options aren’t helping, you may need surgery to replace the damaged parts of your joint with plastic or metal parts.

Prevention

It’s hard to tell if reducing your risk factors will help prevent avascular necrosis, but the following tips can also help improve your general health:

  • Limit alcohol. Heavy drinking is one of the top risk factors for developing avascular necrosis.
  • Keep cholesterol levels low. Tiny bits of fat (lipids) are the most common substance blocking blood supply to bones.
  • Monitor steroid use. Make sure your doctor knows about any past or present use of high-dose steroids. Steroid-related bone damage appears to worsen with repeated courses of high-dose steroids.

The treatment goal for avascular necrosis is to prevent further bone loss. What treatment you receive depends on the amount of bone damage you already have.

Get Professional Opinion and Management about Avascular Necrosis (AVN). Call us at +65 64712744 or Email to: info@boneclinic.com.sg for Appointment.

Total Hip Replacement

Definition of Hip Replacement:

Hip replacement is a surgical procedure in which the hip joint is replaced by a prosthetic implant. Hip replacement surgery can be performed as a total replacement or a hemi (half) replacement. Such joint replacement orthopaedic surgery generally is conducted to relieve arthritis pain or fix severe physical joint damage as part of hip fracture treatment. A total hip replacement (total hip arthroplasty) consists of replacing both the acetabulum and the femoral head while hemiarthroplasty generally only replaces the femoral head. Hip replacement is currently the most successful and reliable orthopaedic operationwith 97% of patients reporting improved outcome.

Who is a candidate for Total Hip Replacement?

Total hip replacements are performed most commonly because of progressively worsening severe arthritis in the hip joint. The most common type of arthritis leading to total hip replacement is degenerative arthritis (osteoarthritis) of the hip joint. This type of arthritis is generally seen with aging, congenital abnormality of the hip joint, or prior trauma to the hip joint. Other conditions leading to total hip replacement include bony fractures of the hip joint, rheumatoid arthritis, and death (aseptic necrosis) of the hip bone. Hip bone necrosis can be caused by fracture of the hip, drugs (such as prednisone and prednisolone), alcoholism, and diseases (such as systemic lupus erythematosus).

The progressively intense chronic pain together with impairment of daily function including walking, climbing stairs, and even arising from a sitting position, eventually become reasons to consider a total hip replacement. Because replaced hip joints can fail with time, whether and when to perform total hip replacement are not easy decisions, especially in younger patients. Replacement is generally considered after pain becomes so severe that it impedes normal function despite use of anti-inflammatory and/or pain medications. A total hip joint replacement is an elective procedure, which means that it is an option selected among other alternatives. It is a decision which is made with an understanding of the potential risks and benefits. A thorough understanding of both the procedure and anticipated outcome is an important part of the decision-making process.

What are preparation needed for the Surgery?

Total hip joint replacement can involve blood loss. Patients planning to undergo total hip replacement often will donate their own (autologous) blood to be banked for transfusion during the surgery. Should blood transfusion be required, the patient will have the advantage of having his or her own blood available, thus minimizing the risks related to blood transfusions. The preoperative evaluation generally includes a review of all medications being taken by the patient. Anti-inflammatory medications, including aspirin, are often discontinued one week prior to surgery because of the effect of these medications on platelet function and blood clotting. They may be reinstituted after surgery. Other preoperative evaluations include complete blood counts, electrolytes (potassium, sodium, chloride, bicarbonate), blood tests for kidney and liver functions, urinalysis, chest X-ray, EKG, and a physical examination. Our physician will determine which of these tests are required, based on your age and medical conditions. Any indications of infection, severe heart or lung disease, or active metabolic disturbances such as uncontrolled diabetes may postpone or defer total hip joint surgery.

What is involved in the rehabilitation process after total hip joint replacement?

After total hip joint replacement surgery, patients often start physical therapy immediately. On the first day after surgery, it is common to begin some minor physical therapy while sitting in a chair. Eventually, rehabilitation incorporates stepping, walking, and climbing. Initially, supportive devices such as a walker or crutches are used. Pain is monitored while exercise takes place. Some degree of discomfort is normal. It is often very gratifying for the patient to notice, even early on, substantial relief from the preoperative pain for which the total hip replacement was performed.

Physical therapy is extremely important in the overall outcome of any joint replacement surgery. The goals of physical therapy are to prevent contractures, improve patient education, and strengthen muscles around the hip joint through controlled exercises. Contractures result from scarring of the tissues around the joint. Contractures do not permit full range of motion and therefore impede mobility of the replaced joint. Patients are instructed not to strain the hip joint with heavy lifting or other unusual activities at home. Specific techniques of body posturing, sitting, and using an elevated toilet seat can be extremely helpful. Patients are instructed not to cross the operated lower extremity across the midline of the body (not crossing the leg over the other leg) because of the risk of dislocating the replaced joint. They are discouraged from bending at the waist and are instructed to use a pillow between the legs when lying on the nonoperated side in order to prevent the operated lower extremity from crossing over the midline. Patients are given home exercise programs to strengthen the muscles around the buttock and thigh. Most patients attend outpatient physical therapy for a period of time while incorporating home exercises regularly into their daily living.

Occupational therapists are also part of the rehabilitation process. These therapists review precautions with the patients related to everyday activities. They also educate the patients about the adaptive equipment that is available and the proper ways to do their “ADLs” or activities of daily living.

CURE YOUR HIP PAIN TODAY, CALL (65) 6471 2744 OR SMS TO (65) 92357641 – 24 HOURS

Transient Synovitis of Hip in Children

What is transient synovitis of the hip?
Transient synovitis of the hip joint is a condition that occurs in childhood causing hip pain. The cause of transient synovitis is not well understood, but it may be related to a viral illness of the child. Transient synovitis tends to occur in young children, between the ages of 2 and 9 years old.
Hip Synovitis in Children

Hip Synovitis in Children

What are the symptoms of transient synovitis of the hip?
Transient synovitis causes inflammation and pain around the hip joint. The symptoms tend to begin quickly over 1 to 3 days, and usually resolve over the next several days. The following symptoms are common in children with transient synovitis of the hip:
  • Pain with movement of the hip
  • Hip and knee pain
  • Difficulty walking or a limp
  • Holding the hip flexed and rotated
  • Fever
The concerning aspect is that these symptoms are very similar to a septic, or infected, hip joint. Bacterial infections of the hip joint are more serious, and may require surgery to treat the infection. Therefore, any child with hip pain or a limp must be carefully assessed by a doctor to determine the cause of their symptoms.
How is the diagnosis of hip synovitis made?
Again, the most important part of the diagnosis is to ensure this is not a bacterial infection within the hip joint. Blood work can be done to assess for markers of infection and inflammation. Unfortunately, the results of these studies can be similar in both synovitis and infection. In some patients, a needle will be inserted into the hip joint to assess the fluid within the joint. Patients with bacterial infection in the hip joint will have pus in the joint. These children will have surgery to clean out the infection.In many children who are suspected to have transient synovitis, a period of observation in the hospital or emergency room is sufficient to make the diagnosis. Children who have a bacterial infection tend to rapidly worsen, while children with synovitis steadily improve. Therefore, just watching the child closely for a period of time is often sufficient to make the diagnosis of synovitis.
What is the treatment for hip synovitis?
If the diagnosis is transient synovitis, the most important aspect of treatment is time. Some mild anti-inflammatory medication can help to alleviate pain, and rest for a few days will help as well. The child should be watched by a parent or responsible caregiver to ensure their condition does not worsen. In addition, regular temperature checks are important. Fevers should be reported to your doctor.

Children who have transient synovitis of the hip usually recover completely. Children with transient synovitis of the hip should follow-up with their doctor to ensure all of the symptoms have resolved.

Get your Hip check today! Call +65 6471 2744 (24 Hours) / info@boneclinic.com.sg

Acetabular Labrum Tears

Acetabular labrum tears are a common cause of time away from sport in athletes. First described in 1957, it is only in the last 15 years, with advances in imaging and hip arthroscopy, that such lesions have been recognised as a common cause of groin pain in athletes. Other causes of groin pain include adductor strains, inguinal and femoral hernias, nerve entrapment, stress fractures of the femoral neck, avulsion fractures of the pelvis, osteitis pubis, intraabdominal disorders and referred back pain.

Acetabular labrum lesions that may have gone unrecognised in the past can now be seen using magnetic resonance arthrography and inspected directly using hip arthroscopy, followed by either arthroscopic resection (cutting back) or repair.

Function of the acetabular labrum

The acetabular labrum is a ring of fibrocartilage that attaches to the circular outer edge of the acetabulum (hip socket). It is made of alternating layers of Type I collagen fibres and hyaline cartilage matrix orientated in the direction of functional stress. A spur of bone extends from the acetabulum into the labrum to increase stability. The labrum has a highly variable shape and three surfaces:

* a basal surface which connects the labrum to the acetabular bony rim

* an internal articular surface which is in continuation with the articular surface of the acetabulum

* an external surface where the hip joint capsule attaches.

A network of blood vessels enter the outer third of the labrum on the external surface only. The lack of blood supply to the inner two-thirds is thought to impede healing after injury. Free nerve endings are found throughout the acetabular labrum but are most densely packed in the anterior and superior quadrants.

The main function of the acetabular labrum is to improve hip joint stability in two ways. Firstly it deepens the hip socket, providing it with extra structural support. Secondly it partially seals the joint to create a negative intra-articular pressure which counteracts any distractive (pulling-apart) forces.

A second important function of the acetabular labrum is to increase joint congruity. After removal of the labrum the frictional force between the femoral and acetabular articular surfaces is increased by up to 92%, showing that the labrum plays an important role in the even distribution of forces across the articular surface.

How injuries occur

The five most common causes of acetabular labrum tears are:

* trauma

* hip dysplasia (congenital abnormality)

* degeneration

* capsular laxity

* femoro-acetabular impingement.

In athletes, the main cause of tears is trauma, usually from a twisting or pivoting motion whilst weight-bearing. Such movements are common in football and hence the acetabular labral tear is often referred to as ‘footballer’s hip’. Athletes with hip dysplasia are at greater risk of developing a labral tear compared with those with a normal hip joint. Dysplastic hips are more common in hyper-mobile individuals such as dancers and track and field athletes

Symptoms and diagnosis

The presentation of acetabular labral tears is very inconsistent but the most common complaint is a sharp groin pain after trauma. Other possible sites of pain are the anterior thigh, greater trochanter and buttock region. Other symptoms include clicking, locking and ‘giving way’ of the hip. The pain may be reproduced in sport by weight-bearing activities that require twisting, such as kicking a football.

Examination of the hip is often entirely normal with a full range of movement. There are specific tests for a labral tear. The impingement test (flexion, adduction and internal rotation of the hip joint) commonly produces pain or a clicking sensation when an antero-superior tear is present. The McCarthy test involves flexing both hips and then extending the affected hip patients with a labral tear will feel a catch. Passive hyperextension, abduction and external rotation elicit pain with a posterior tear.

Plain radiographs, computed tomography (CT), magnetic resonance imaging (MRI) and arthrograms are all poor at identifying intraarticular disease. However, magnetic resonance arthrography (MRa) is proving to be more promising. MRa involves the injection of dye into the hip capsule followed by MR imaging in several planes.

Since a single radiological technique does not exist at present that can accurately diagnose labrum tears, diagnosis is usually based on a combination of clinical judgement, MRa and hip arthroscopy.

Hip arthroscopy has become increasingly popular over the last 15 years with the development of minimally invasive instruments and techniques. It is usually performed as a day-case procedure under general anaesthetic and takes approximately 30 to 40 minutes.

Arthroscopy can be used both to diagnose and to treat acetabular labrum tears. Diagnostic arthroscopic evaluation is considered when joint symptoms, examination and radiographic studies have failed to provide a diagnosis. Arthroscopy is reported to facilitate a diagnosis in 40% of these cases.

Acetabular Labrum Tears Treatment

Treatment can be conservative or surgical. Conservative management involves rest followed by a graded increase in weightbearing. Traction can also be used. But as yet there is no evidence as to whether the inner two-thirds of the labrum, which lack any blood supply, are able to heal with rest alone. Surgical treatment is either arthroscopic debridement (tidying up) or repair.

Debridement involves removal of damaged tissue back to a stable base while preserving as much of the labrum as possible. Techniques are evolving for repair such as suture anchor. The aim of arthroscopic treatment is to eliminate any unstable flap of labral cartilage, which is thought to relieve groin pain. This in turn should maintain normal function of the hip joint. While it may hypothetically also decrease the development of premature arthrosis, there is no evidence as yet that a labral tear leads to further degenerative changes in the hip.

Post-operatively there is usually four to five days of relative rest prior to starting a rehabilitation programme with gentle mobilisation of the hip joint. Exercises in a hydrotherapy pool are particularly effective, as they allow mobilisation without compression through the joint. Progressive muscle strengthening is undertaken and once the hip has a normal range of motion and strength, functional exercises can be started.

A return to sport is usually possible two to three months after the operation. Arthroscopic debridement is reported to improve symptoms in 67% to 90% of patients. Overall, younger patients and those with no arthritis have a better outcome.

Conclusion

Up to 20% of groin pain in athletes is now thought to be the result of acetabular labrum tears. All health care professionals who work with athletes should have a high index of suspicion for such lesions. Diagnostic tools include MRa and arthroscopy. Treatment is hip arthroscopy with debridement or repair and preliminary studies suggest a positive outcome.