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Clinical conditions for MSK > Session 3 - Disorders of the hip > Flashcards

Session 3 - Disorders of the hip Flashcards

1
Q

Superior gluteal nerve injury

How can the nerve become damaged?

A
  • a complication of hip surgery
  • injections to the buttock
  • fractures of the greater trochanter (site of insertion of gluteus medius)
  • dislocation of the hip joint
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2
Q

Superior gluteal nerve injury

Name the 2 muscles that are damaged hence the action of the lower limb that is weakened

A
  • Gluteus medius
  • Gluteus minimus

Weakness in abducting the thigh at the hip

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3
Q

Superior gluteal nerve injury

What is the Trendelenburg sign?

A

Sound side sags

  • when asked to stand on the injured limb, the pelvis drops on the undamaged, unsupported side
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4
Q

Osteoarthritis

What is the difference between primary and secondary osteoarthritis?

A

Primary - the cause is unknown

Secondary - there is a known precipitating cause

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5
Q

Osteoarthritis

Give examples of the risk factors for primary OA

A
  • Age
  • Sex (Female>Male)
  • Ethnicity (Coloured > Caucs)
  • Genetics (OA runs in families)
  • Nutrition
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6
Q

Osteoarthritis

Gives some examples of specific causes of secondary OA

A
  • Obesity
  • Trauma
  • Infection
  • Metabolic disorders
  • Haematological disorders
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7
Q

Osteoarthritis

What are the symptoms of OA in any joints?

A
  • deep aching joint pain, exacerbated by use
  • reduced range of motion and grinding (crepitus)
  • stiffness during rest (morning stiffness <1 hour)
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8
Q

Osteoarthritis

Explain the pathology of Osteoarthritis

A
  • Risk factors leads to excessive or uneven loading of the joint and damage to articular hyaline cartilage
  • Increased proteoglycan synthesis by chondrocytes in an attempt to repair damaged cartilage
  • flaking and fibrillation of cartilage leading to an erosion down to the subchondral bone (reduced joint space)
  • Surface changes alter joint biomechanics
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9
Q

Osteoarthritis

Name the 3 effects that altered joint biomechanics leads to due to the surface changes in the cartilage

A
  • Subchondral Sclerosis
    (subchondral bone responds with vascular invasion and increased cellularity, becoming thickened and denser at areas of pressure)
  • Subchondral bone cysts
    (cystic degeneration of bone)
  • Osteophytes
    (osseous metaplasia of connective tissue occurs, leading to the irregular outgrowth of new bone)
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10
Q

Osteoarthritis

What are the four cardinal signs of OA on an X-ray?

A
  • Reduced joint space
  • Subchondral sclerosis
  • Subchondral bone cysts
  • Osteophytes
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11
Q

Osteoarthritis of the hip

What are the symptoms of this?

A
  • Joint stiffness that occurs getting out of bed and when standing up after sitting down for a long time
  • Pain, tenderness or swelling in the hip, gluteal and groin regions radiating to the knee (via the obturator nerve)
  • Mechanical pain (pain accentuated by mobilisation or weight-bearing)
  • Crepitus (a grating sound or crunching/crackling sensation of bone rubbing on bone)
  • Reduced mobility e.g. difficulty walking, difficulty putting on socks and shoes
    getting in and out of a car / the bath etc
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12
Q

Osteoarthritis of the hip

How is this diagnosed?

A
  • clinical presentation (signs and symptoms)

- supported by X-ray changes (cardinal signs)

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13
Q

Osteoarthritis of the hip

What are the initial non-operative/pharmacological treatments used to manage this condition?

A
  • Activity Modification (avoiding activities that worsen symptoms)
  • Weight reduction ( if overweight)
  • Stick/Walker
  • Physiotherapy
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14
Q

Osteoarthritis of the hip

What are the pharmacological treatments used to manage this condition?

A
  • Paracetamol, NSAIDs
  • Nutritional supplements
  • Corticosteroid injections ( reduce swelling)
  • Viscosupplementation ( Hyaluronic acid injections)
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15
Q

Osteoarthritis of the hip

What are the operative treatments used to manage this condition?

A

Total Hip replacement

replaces the damaged surfaces with implants and helps to relieve pain and restore mobility

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16
Q

Fracture of the femur neck

Name the 2 classifications of fractures that occur at the proximal head of the femur

A
  • Intracapsular (around the neck)

- Extracapsular (intertrochanteric and subtrochanteric)

17
Q

Fracture of the femur neck

Why is there a high risk of avascular necrosis to head of femur due to an intracapsular fracture compared to extracapsular?

A
  • likely to disrupt the retinacular branches of the medial femoral circumflex artery
  • the Artery of the Ligamentum Teres in fovea unable to sustain the metabolic demand of the femoral head
  • risk increases if the fracture is displaced
18
Q

Fracture of the femur neck

In which demographic are intracapsular fractures more common and why does it occur?

A
  • elderly, postmenopausal women with osteoporotic bone

- occur after a minor fall

19
Q

Fracture of the femur neck

In which demographic are extracapsular fractures more common and why does it occur?

A
  • the young and middle-aged population

- occur as a result of significant traumatic force (road traffic collision)

20
Q

Fracture of the femur neck

What is the treatment of an intracapsular fracture in an older person?

A

Surgical replacement of the femoral head

  • either hemiarthroplasty [femoral head only]
  • or total hip replacement [head and acetabular cup]
21
Q

Fracture of the femur neck

What are the symptoms of this condition?

A
  • Reduced mobility / sudden inability to bear weight on the limb
  • Pain which may be felt in the hip, groin and/or knee
22
Q

Fracture of the femur neck

What are the signs of this condition during a clinical examination?

A
  • if the fracture is displaced, the affected leg is usually shortened, abducted, and externally rotated.
  • the pain worsened on palpation of the greater trochanter
  • the pain made worse by rotation of the hip
23
Q

Hip dislocation

State the 3 ways in which the hip joint can dislocate

A
  • Anterior dislocation
  • Posterior dislocation
  • Central dislocation
24
Q

Hip dislocation

What is the most common type of dislocation out of the three and why?

A
  • Posterior dislocation

Ischiofemoral ligament present posteriorly and is the weakest of the three ligaments that hold the hip joint

25
Q

Hip dislocation

What are the features of the injured limb in a posterior dislocation?

A
  • shortened ( head of the femur is pulled upwards by the strong extensors (gluteus maximus and hamstrings) and adductors of the hip)
  • flexed
  • adducted
  • medial rotation (anterior fibres of the gluteus medius and minimus pull on the posteriorly displaced greater trochanter)
  • sciatic nerve palsy sometimes present
26
Q

Hip dislocation

What are the features of the injured limb in an anterior dislocation?

A
  • external rotation
  • abduction
  • slight flexion
  • rarely cause damage to femoral nerve
27
Q

Hip dislocation

What are the features of a central dislocation?

A

The head of the femur is driven into the pelvis through the acetabulum.

It is always a fracture-dislocation.

28
Q

Hip dislocation

What is palpable during a rectal examination and why is there a high risk of intrapelvic haemorrhage?

A

The femoral head is palpable on rectal examination and there is a high risk of intrapelvic haemorrhage due to disruption of the pelvic venous plexuses

Clinical conditions for MSK (6 decks)

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