Hip main focus Flashcards
Snapping Hip Syndrome
A palpable or audible snapping sensation that is heard during the movement of the hip joint.
Most commonly a result of overuse
-External snapping hip syndrome most commonly is caused by the iliotibial band snapping over the greater trochanter of the femoral head during movements such as flexion, extension, and external or internal rotation.
-Internal snapping hip is most commonly caused by the iliopsoas tendon snapping over underlying bony prominences, such as the iliopectinal eminence or the anterior aspect of the femoral head.
Slightly more common in women than men
Heavy labour jobs, ballet dancers, weight lifters
liotibial band tightness, shorter muscle or tendon lengths, muscle tightness
-External SHS may also have coxa vara, fibrotic scar tissue, a prominent greater trochanter, smaller lateral pelvic width, or a past surgery for anterolateral knee instability.
-Internal SHS Ps describe a painful sensation coming from deep within the anterior groin as they move their hip from flexion into extension or external rotation. The snapping movement can produce an auditory clunk or click.
Pain
Inflammation
Feeling like hip is dislocation
Leg muscle weakness
Swelling
Difficulty standing up from a chair
Acquired dislocation of the hip
Hip dislocation is the displacement of the femur head from the acetabulum
majority from motor vehicle collisions - posterior dislocations
More common in elderly/females
Within 3 months of a hip replacement surgery
The hip will be shortenend, in external rotation, slight flexion and adduction in the more common posterior dislocations.
Coxa vara
Normal femoral neck-shaft is 160deg in adults – angle less than 120deg is called coxa vara. Can be either congenital (CCV) or acquired (ACV).
CCV due to defect of endochondral ossification in medial part of femoral neck
When child starts to crawl or stand the femoral neck bends or develops a stress fracture
Infancy and early childhood (CCV)
ACV can develop at any age if the femoral neck gives way
Limb length discrepancy, Leg is short, thigh may be bowed
Prominent greater trochanter
Limitation of abduction and internal rotation of the hip
Femoral anteversion (in-toe gait)
The femur turns inwards causing the whole leg to turn in
Excessive anteversion of the femoral neck, so that the internal rotation of the hip is increased and external rotation is diminished.
Most evident in children 2-4
Twice as common in girls than boys
When a child walks or runs, the feet turn inward instead of pointing straight ahead
Usually sit on floor with knees facing each other – should be advised to sit with knees facing outwards
Pyogenic arthritis
Bacterial, viral or fungal infections - spreads through the bloodstream to a joint.
lining of your joints has little ability to protect itself from infection. Your body’s reaction to the infection — including inflammation that can increase pressure and reduce blood flow within the joint — contributes to the damage.
Children under 2
Complication of joint surgery
Diabetes mellitus
Immunodeficiency
Pre-existing joint disease, Rheumatoid arthritis
Child is in pain and ill
Hip movements resisted to total lack of ROM
Aspiring pus from joint
Severe joint pain, usually in just 1 joint, that started suddenly
Swelling around a joint
Skin around a joint has changed colour
P feels generally unwell and have a high temperature or feel hot and shivery
Rheumatoid arthritis
Autoimmune disease.
This means your immune system attacks the cells that line your joints by mistake, making the joints swollen, stiff and painful.
Women more likely to get it than men
Develops mainly 30-60
16-40 diagnosed as early onset RA
Usually, P has RA in many other joints
Groin pain comes on subtly
Limp common, may be as a result of knee or ankle RA too
Wasting of buttock or thigh muscles, limb usually held in external rotation and fixed flexion
Painful and restricted in all ROM
Osteoarthritis
Most common non-traumatic disorder of the hip in the middle and late age
Usually no specific cause
<50
In younger Ps (under 40) may appear as a sequel to childhood and adolescent disorders, such as coxa vera, perthes’ disease and Femoroacetabular impingement
Typically occurs after periods of activity
Later becomes more constant and sometimes disturbs sleep
Stiffness most notable after waking up
Limp
Limited ROM
Femoroacetabular impingement
Femoral head (ball of the hip) pinches up against the acetabulum (cup of the hip). When this happens, damage to the labrum (cartilage that surrounds the acetabulum) can occur, causing hip stiffness and pain, and can lead to arthritis.
CAM/Pincer types of Femoroacetabular impingement
- Cam – deformity at femoral head/neck junction, an unusual degree of bony thickening causes jamming of femoral neck against front of acetabulum and abrasion of articular cartilage
- Pincer – over-coverage of femoral head by anterior edge of acetabulum due to depth or retroversion of acetabular socket at a localised site. Hard acetabular margin abuts against the femoral head during movement causing degeneration of the acetabular labarum and adjacent articular cartilage
Iliopectineal Bursitis
Largest bursa in the region of the hip joint
trauma, osteoarthritis, rheumatoid arthritis, septic arthritis
Pt may have radicular pain and edema from groin to anterior thigh as enlargement of the bursa can irritate or entrap the femoral nerve and vein.
Trochanteric Bursitis
Inflammation of the bursa at the outside (lateral) point of the hip known as the greater trochanter
Meralgia Parasthetica
Disorder characterised by tingling, numbness, and burning pain in the outer side of the thigh - may intensify after walking.
Tight clothes, trauma
- Compression of the lateral femoral cutaneous nerve, a sensory nerve to the skin, as it exits the pelvis.
- Often under the inguinal ligament, which runs along your groin from your abdomen to your upper thigh.
- Obesity or weight gain
- Pregnancy
- Local trauma
- Diseases like diabetes
Protrusio acetabuli
Condition of the hip where there is medial displacement of the femoral head into the pelvis and the medial aspect of the femoral head lies medial to the ilioischial line.
Perthes’ disease
Too little blood is supplied to the femoral head. Without enough blood, this bone becomes weak/dies off and fractures easily.
Childhood condition.
- Complains of pain, starts to limp
- pain in the groin, the thigh or the knee - particularly after physical activity.
- They limp and have a restricted range of movement (stiffness) of the hip joint.
Slipped upper femoral epiphysis
Femoral head moves with respect to the rest of the femur. The head of the femur stays in the cup of the hip joint while the rest of the femur is shifted.
* If one side slips, 30% chance of other side slipping as well
* Trauma with an underlying abnormality
* Unusually tall/rapid growth
* obesity
