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Systemic approach of to Dx & role of interventional pain management of chronic hip pain_full version скачать в хорошем качестве

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Systemic approach of to Dx & role of interventional pain management of chronic hip pain_full version

The first is anterior hip pain. The hip joint pathology is the most common cause of anterior hip and anterior thigh pain. Sometimes I encounter muscle and tendon pathology. But it is not frequent compared to hip joint pathology. The patient's age is crucial to assessing the hip joint pathology. The young and athletic group has more muscle and tendon pathology. But the older generation has more joint pathology. A passive ROM test of the hip joint can provide clear differentiation between the Capsular pattern ( hip joint pathology) and Extracapsular pattern (extra-articular pathology). The muscle and tendon pathologies are noted in the proximal aspect of the tendon of tensor fascia lata, the proximal part of the rectus femoris around ASIS. It could be tendinosis, tears, or calcification. Sometimes I have young patients with an adductor injury in the insertional area or muscle tears. But the most frequent cause of anterior hip pain is osteoarthritis or acetabular impingement. The ultrasound is a special tool for studying joint pathology. But if you find a hip joint effusion, you have to think twice before the interventional procedure, which could be the tip of the iceberg. There are diverse severe pathologies in the adult hip. You must consider these diseases if you find an effusion in a normal x-ray or subtle radiographic signs with severe hip pain. Stress fracture, insufficiency fracture, septic hip, transient osteoporosis, Avascular necrosis, arthropathy, osteoarthritis, rheumatoid arthritis, and even tumorous condition. X-rays and ultrasound are not enough in adult joint pathology. We need a further evaluation with the MRI. Degenerative osteoarthritis is the most common pathology of hip pain. Luckily many patients have limited joint motion, but it is not severe to get an operation. The treatment goal is to relieve pain and pass the tough time to return to normal. If I exclude the diagnosis of septic arthritis and aseptic necrosis, I can undergo intra-articular injection with variable drugs according to the pathologies. The ultrasound-guided intraarticular injection has become a standard technique because of its high accuracy. The most common intra-articular injection target is the joint capsule's inferior recess. The synovial joint extends to the femoral neck region, which consists of the anterior, posterior capsule, and interposing synovial joint space. So, you will notice the echogenic joint capsule on the surface of the bony cortex in the oblique scan. I will talk more about osteoarthritis. Traditionally our people lived on the floor. Look at the lady who sits crossed-legged on the floor. It is only possible when the hip joint allows for full external rotation. Most patients do not look for pain doctors for their advanced osteoarthritis, and there are varying ranges of osteoarthritis. Instead, some of them come in the early stages of illness. Painful external rotation or cross-leg sitting position is one of the common complaints. Some patients complain about the limitation of external rotation without pain. Most physiotherapists recommend hip stretching exercises. It is a great exercise when the joint is healthy. But I experienced many cases where these stretching exercises inhibit pain relief or worse pain. So, we need a smart trade-off strategy between functional restoration and pain relief. It is a time to give up functional movement transiently. These interventional strategies may only be possible when functional restoration yields pain relief. Then, after the stabilization of the disease process, we can start to restore the function later. Next, I am going to talk about lateral hip pain. The leading cause of somatic pain with referred pain is the greater trochanteric pain syndrome, and the meralgia paresthetica is the common cause of neuropathic pain in the lateral hip. Greater trochanteric pain syndrome is characterized by chronic intermittent pain over the buttock and lateral aspect of the thigh. It may radiate down the leg to the level of the iliotibial tract. The patients opt to feel pain when rising from a seated position, waking up for pain while lying on the affected side. A focal tenderness over the greater trochanter and iliotibial tract reproduces the patient's pain. But I believe it is a category of pain less than grade VAS 5. So, most patients do not need the interventional procedure. So, it is not a famous case in my pain clinic. Let's review more details about the greater trochanteric pain syndrome. There are very similarities between the shoulder and hip anatomy. #chronichippain #hiparthritis#anteriorhippain #lateralhippain #glutealpain#deepgluteal#spinalintervention #imageguided #learning #imagetrain #GE #Ziehm #MSK #chronicpain #case #lecture #cervical #lumbar #knee #elbow #noninvasive #painfree #ISURA #paindiploma #montpellier #madi #precise #decisionmaking #limethasone #dexamethasone #palmitate #이미지트레이닝 #만성통증 #통증 #초음파시술 #초음파 #시술 #안전한시술

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