CASE STUDY PART 1

PATIENT HISTORY
• 17 y/o female
• Competitive dancer
• Started physical therapy on 6/17/13-12/27/13 for
anterior hip pain and trochanteric bursitis (confirmed
by plain radiographs)
• Treatment:





Soft tissue mobilization with the precussor
Stretching
Fit vibe dance routine
Hip strengthening
Iontophoresis
Cold/Hot pack as needed

PATIENT HISTORY
• Patient reported no change in pain or functional
abilities from therapy.
• Referred to Dr. Cascio in Lake Charles for further
testing
• MRI revealed a Gelnoid labrum tear and a
CAM/Pincer lesion

DIAGNOSIS/AFFECTED STRUCTURES
• Diagnosis: Femoral acetabular impingement & labral tear
• Pincer lesion: extra bone extends out over the normal rim of the
acetabulum. The labrum can be stuck under the rim of the acetabulum.
(1)

• CAM lesion: when the femoral head is not round and cannot rotate
smoothly inside the acetabulum. A A bump forms on the femoral head,
which leads to grinding of the cartilage inside of the acetabulum. (1)

http://orthoinfo.aaos.org/topic.cfm?topic=A00571

PROCEDURE
• Arthroscopic surgery






Labral repair
Acatabuloplasty
Femoroplasty
Psoas tendon release
Synovectomy
Capsular repair
Ligamentum teres debridement

• No additional comorbidities

COMMON CAUSES
• Certain ballet moves create significant stress in the hip
joint anteriorly and superiorly.(2)



développé à la seconde
grand écart facial
grand écart latéral
grand plié

• Most of these position are with hip flexion and external
rotation, which contributes to cartilage wearing. (2)
• Impingements and subluxations are frequently observed
in these four movements, which can cause cartilage
hypercompression (2)
• This hypercompression can lead to early osteoarthritis (2)

EXPLANATION OF INJURY
• The anterior aspect of the labrum is mechanically
weaker because of the presence of areolar tissue,
which is irregularly arranged connective tissue
that is generally weaker than the labrum itself (3)
• The anterior aspect of the hip is also subject to
greater stress, especially through ballet
movements(2)

PRACTICE PATTERNS
• 4A: Primary Prevention/Risk Reduction for Skeletal
Demineralization
• 4C: Impaired Muscle Performance
• 4D: Impaired Joint Mobility, Motor Function, Muscle Performance,
and Range of Motion Associated With Connective Tissue
Dysfunction
• 4E: Impaired Joint Mobility, Motor Function, Muscle Performance,
and Range of Motion Associated With Localized Inflammation
• Pattern 4H: Impaired Joint Mobility, Motor Function, Muscle
Performance, and Range of Motion Associated With Joint
Arthroplasty
• Pattern 4H: Impaired Joint Mobility, Motor Function, Muscle
Performance, and Range of Motion Associated With Joint
Arthroplasty
http://guidetoptpractice.apta.org/content/current

PHARMACEUTICALS & MEDICAL
MANAGEMENT
• Ibuprofen and anti-inflammatories as needed for
pain.
• Visit with Dr. Cascio every 3 weeks.

CURRENT PATIENT PRESENTATION
• Patient is in little to no pain
• No equipment needed
• Anxious to get back to dancing

UNIQUE CHARACTERISTICS
• Patient was a high level, competitive dancer
• Extremely flexible
• Young patient for this type of procedure and
diagnosis
• Qualifies for scholarships from Juilliard and other
major arts programs around the country

IMPACT OF CONDITION & PSYCHOSOCIAL
ISSUES
• Family had to pay $200 to meet deductible
• Patient planned on majoring in dance in college,
but will not be able to dance anymore
• Patient may need another hip surgery or a hip
replacement in her 20s if she continues dance
• Patient was placed on homebound for a month so
that other students would not bump into her
while she was healing

EQUIPMENT NEEDS
• Crutches
• Bledsoe philippon post-arthroscopy hip brace
• Bledsoe philippon post-arthroscopy pillow and
boots

ARCHITECTURAL
BARRIERS/MODIFICATIONS
• Avoid crowded areas
• Maintaining hip guidelines during gait and stairs

INSURANCE/FUNDING




Blue Cross Blue Shield
Parents paid the co-pays
2014 $200 deductible met with surgery
No therapy co-pays
No restrictions, limitations, caps, or authorizations
required.

PLAN OF CARE
• Doctor’s instructions






Foot flat weight bearing (20 lbs) for 2 weeks
Bledsoe brace- 3 weeks then only when ambulating
Rotational boots- 2 weeks at night
Lay prone 1-2 hours a night
Start scar mobilizations on therapy day 1
ART
E-stim as needed at post-op week 3

DOCTOR’S PROTOCOL: PHASE 1

DOCTOR’S PROTOCOL: PHASE 2

DOCTOR’S PROTOCOL PHASE 3

DOCTOR’S PROTOCOL PHASE 4

PRECAUTIONS

EVALUATION ORDER

EVALUATION MEASURES