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Parents and carers

Snapping ‘clicky’ hip

· Oct 20, 2024 ·

What is it?

People who pop, click, or snap their hips during particular movements have snapping hip syndrome. Some people make an audible click when they bend at the hip.

For other people, they may feel a popping or catching in their hip joint.

There are two types of snapping hip and while they are mostly harmless, these conditions sometimes lead to joint pain.

Types of snapping hip

Illustration of the front of the hip joint with joints, muscles and bones. It has a red-highlighted muscle, showing a tendon sliding over bones at the front of the hip joint, creating tension and then releasing with a “snap.

Internal snapping hip (at the front of the hip)

This type of snapping hip is the most common. It occurs when a tendon slides over bony structures at the front of the hip joint, creating tension and then releasing with a “snap.”

Tightness in the muscles around your bottom or hip is often the cause of the snapping sound.

People with internal snapping hip syndrome may experience:

  • Hip popping is when: running, rising from a seated position or when the hip turns the leg away from the body.
  • Pain that worsens with activity as repeated irritation is associated with inflammation of the structures at the front of the hip joint.

Illustration of a human hip with a highlighted hip flexor muscle and pain indicator.

External snapping hip (at the side of the hip)

This occurs when a muscle or tendon slides over the top of the thigh bone. The resulting tension is followed by a release and snapping sensation at the outside of the hip. This is often due to tightness in the muscles around your bottom.

People with external snapping hip syndrome may experience:

  • The snapping typically occurs during activities such as running and climbing stairs or carrying a heavy load like shopping or a heavy backpack.
  • Hip popping can be accompanied by sharp, sudden pain felt on the outside of the hip.
  • The hip can sometimes feel like it is about to pop out of its socket when snapping but it will not come out of its socket.
  • Pain that worsens with activity, as repeated irritation causes the tendon to become inflamed.

Painful symptoms develop gradually; the pain may begin as a mild annoyance and worsen over weeks or months.

Treatment

  • Rest: People with snapping hip syndrome are advised to avoid the motions or activities that cause the snapping, popping or clicking sensation as much as possible. Resting helps to reduce any irritation around the hip.
  • Stretching: Often muscles surrounding the hip joint are tight and increasing their flexibility it can reduce pain and the amount of ‘snapping’ of the hip.

Daily stretching programme

Exercise 1

  • Put one leg out behind you whilst half kneeling on the other.
  • Keep your back straight and lean forward into your bent leg and feel the stretch over the front of your thigh on the leg behind.
  • Hold for 30 seconds.

Repeat 3 times on both legs, daily.

Exercise 2

  • Lie on your back with your knees bent.
  • Cross the ankle of the leg to be stretched over the other knee.
  • Put your arms around your thigh.
  • Bring your thigh towards your stomach. Feel the stretch in your bottom muscles.
  • Hold for 30 seconds.

Repeat 3 times on both legs, daily.

Exercise 3

  • Lie face down.
  • Bend your knee and hold on to your ankle. Pull your heel towards your bottom. Feel the stretching on the front of your thigh.
  • Hold for 30 seconds.

Repeat 3 times on both legs, daily.

Exercise 4

  • Sit on the floor.
  • Bring one leg in front of you and bend your knee 45 degrees.
  • Straighten your other leg behind you.
  • Turn your body towards the bent leg and lean your body gently forward. Feel the stretch in your bottom muscles.
  • Hold for 30 seconds.

Repeat 3 times on both legs, daily.

Physiotherapy video

Return to activity

Once your pain has improved or the ‘snapping’ sensation has reduced then you can gradually return to your usual activities. Ensure you warm up and cool down properly. Your pain should be used as a guide as to when to increase the length or amount of activity.

Further advice

If your symptoms are not settling, please contact the physiotherapy department on the details below:

Looking after a child with a fractured clavicle

· Oct 20, 2024 ·

Your child has been diagnosed with a fractured clavicle. This is a common injury in children that heals very well.

What is it?

A fractured clavicle is a break in the collarbone. This usually happens after a fall onto the shoulder.

Treatment

Your child will be given a broad arm sling to be worn under their clothing. This will support the arm and shoulder reducing unnecessary movement. This injury can be very painful when the shoulder is moved.

You will be shown how to apply the sling so you can put it on after your child has had a bath or a shower or if it becomes loose.

Keeping your child comfortable at home

Pain relief

Your child may be sore for the first 3 or 4 days. The recommended dose of your child’s usual pain relief e.g. paracetamol (Calpol) and/or ibuprofen can be given following the instructions on the bottle to reduce pain.

Rest

In the first 3 or 4 days it is important to keep your child fairly still (involved in gentle play activities only). This will reduce the movement of the arm and help keep your child comfortable.

Positioning

Pain can be a common problem, especially at bedtime, as it is often difficult for your child to get comfortable. To help with this you can position your child in bed so that they are lying back, but not completely flat, with additional pillows around the shoulder area. Older children may benefit from being supported in an armchair.

Broad arm sling

Please continue to use this under your child’s clothes until they are more comfortable when it can be worn over the clothes.

As the clavicle heals it will be less painful and you may find that your child starts to move their arm more during play.

Other measures

It is important for your child to gently move the elbow, wrist and hand regularly to stop the joints becoming stiff.

Physiotherapy video

Follow up

In young children, the clavicle fracture will be healed in 3-4 weeks. In young people, it can take 6-8 weeks.

During this time you may feel or see a bump over the fractured area. Do not be alarmed by this – this is normal and means healing is taking place. This bump may be present for 6 months or longer after the initial injury. In some cases, it never fully disappears.

Please avoid contact sports and rough play for 6 weeks after the time of injury.

Acquired torticollis

· Oct 20, 2024 ·

Acquired torticollis most commonly occurs due to muscle spasms.

The muscle spasm tends to come on suddenly without any history of injury or any other symptoms such as sore throat or temperature.

There will be pain on the side of the tight muscles and the head might feel stuck or too painful to move.

If your child has suffered an injury before the muscle spasm, they should be seen in the Emergency Department.

Management

Give good amounts of pain relief regularly for the first 24-48 hours and then as required.

  • Paracetamol and Ibuprofen – dose as per the recommendation on the bottle/packet.
  • Paracetamol and Ibuprofen are even better at treating pain if you give them at the same time.
  • Give every 6 hours in the first few days.

It can be useful to put a hot or cold pack over the painful area to reduce pain and spasms.

Encourage gentle exercises frequently:

  1. Look up, look down
  2. Look side to side
  3. Stretch the ear towards the shoulder
  4. Bring the chin to the chest, and stick the chin out.

The gentle movement of the neck is important to stop the muscles stiffening up.

Things should be much improved within a couple of days. If things are not improving or there is an ongoing concern, you should speak firstly to your GP.

Things to look out for when your child has a sore neck:

  • Any fever
  • Pain or swelling on touching the neck
  • Drooling or difficulty swallowing
  • Change in voice.

Looking after a child with an elbow effusion

· Oct 20, 2024 ·

Your child has attended the Emergency Department with an injury to the elbow. The x-ray shows no obvious fracture (break in the bone) however, there is a sign telling us that there is fluid (usually blood) within the joint. This is called an effusion.

What is it?

The elbow is a complex joint in children. It has many growth areas that can be damaged and cause an effusion.

When we see an effusion, we suspect there could be a fracture, however, this is not always the case.

Treatment

We treat an elbow effusion by supporting the arm in a collar and cuff under their clothes. We usually ask your child to wear the collar and cuff for 14 days.

Keeping your child comfortable at home

Pain relief

Your child may be sore for the first few days. The recommended dose of your child’s usual pain relief e.g. paracetamol (calpol) or ibuprofen can be given to keep them comfortable.

If your child complains of pain, give pain relief and encourage them to rest.

Activities

It is important to encourage your child in gentle play or activities for the first 2 weeks. This will help reduce the swelling and pain in the elbow. Please do not allow your child to do sports or gym or be involved in rough play.

Gentle movements

Please encourage your child to gently move their hand, wrist and shoulders several times a day to stop them becoming stiff.

Hygiene

We recommend that you check the skin under the arm twice daily to ensure your child is not developing a heat rash. A gentle wash twice daily with soap and water and thorough drying will prevent this.

Follow up

Please remove the collar and cuff in 14 days. Your child’s elbow will be a bit stiff & sore initially as it has not been moved. You may need to give them some painkillers over the next few days.

We would expect your child’s elbow to be better and be able to fully straighten their arm out in 3 weeks.

If this is not the case, please phone 0131 312 0007 or 0131 312 0008 and ask to make a face-to-face review clinic appointment.

Physiotherapy for upper limb fracture

· Oct 18, 2024 ·

What to expect after removing the cast or sling

To help your fracture heal, the decision may be made to immobilise your arm by placing it into a cast or sling for some time. This is typically around 4-6 weeks. This will be decided by your orthopaedic doctor.

After your cast is removed, you will probably have dry flaky skin, altered sensation, joint stiffness, muscle weakness and some swelling.

This leaflet will provide advice and exercises to help with these effects.

Skin Care

After your cast or sling is removed it is helpful to massage non-perfumed moisturiser over your shoulder and arm.

This will help hydrate the dry skin while also providing a positive touch to an area that has not been touched or moved for a period of time.

This will help with dry skin and sensory concerns.

Exercises

The following exercises will help reduce swelling and stiffness and increase your joint movement. Carry out these exercises regularly and gradually work through them.

The exercises get harder as you work through the leaflet so it may be a few weeks before you can manage them all.

Exercises may feel difficult at first but should not be painful. If an exercise is painful, you should stop and try again later.

 

© The Peter Pan Club & H.M.L

Arm circles

  • Start with your hands by your side with your palms facing forward.
  • Bring your arms all the way up and over your head.
  • Return to the starting position.

 

© Physiotools

 

Prayer stretch

  • Place your palms together just above your head and gently press them together.
  • Keeping your palms in contact slowly bring them down in front of your body and hold at the bottom for 20 seconds.
  • Repeat 5 times.

 

© Physiotools

Quadruped Arm Raise

  • Begin on your hands and knees.
  • Raise one arm out in front of you. Try to keep your arm as straight as it will go.
  • Repeat with your other arm.
  • Repeat 10 times.

 

© Physiotools

Child’s pose

  • Sit back on your heels.
  • Slide your hands forward to feel a stretch in your upper body and shoulders.
  • Take a deep breath and walk your fingers forward to increase the stretch.
  • Hold for 20 seconds.
  • Repeat 3 times.

 

© Physiotools

Knee Push-Up

  • Start on your hands and knees.
  • Keeping your back straight, slowly lower your nose to the floor.
  • Straighten your arms and return to the starting position.
  • Repeat 10 times.

Activity ideas to encourage the use of your arms

  • Popping bubbles
  • Arts and crafts
  • Swimming
  • Bat and ball games
  • Animal walks
  • Wall push-ups
  • Skipping rope
  • Push/pull toys (prams, trolleys)
  • Building block towers on a table.

When to seek further help?

If your child reports the following complaints after 3 – 4 weeks of following the advice in this leaflet please call the physiotherapy team to discuss further assessment:

  • Ongoing pain which stops your child from taking part in normal activities
  • Difficulty returning to normal function
  • Ongoing stiffness.
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