Buttock pain Flashcards by MA CARMELA CONCEPCION SALES

________typically presents in the obese adolescent

(10–15 years) with knee pain and a slight limp

SCFE

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Every newborn infant should be tested for ______
which can usually be treated successfully when
diagnosed early

DDH,

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The _______ is the most likely cause of pain in the

buttock in adults

spine

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If a woman, especially one with many children,
presents with bilateral buttock or hip pain, consider
_____________ as the
cause

dysfunction of the sacroiliac joints (SIJs)

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If a middle-aged or elderly woman presents with
hip pain, always consider the underdiagnosed
conditions of_______ or _________

trochanteric bursitis or gluteus medius

tendonitis (greater trochanteric pain syndrome).

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___________is prone to develop in the
metaphysis of the upper end of the femur and must
be considered in the child with intense pain, a severe
limp and fever

Osteomyelitis

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Tuberculosis may also present in
children (usually under 10 years) with a presentation
similar to _____

Perthes disease

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________ or _________ is the most

common cause of hip pain and limp in childhood

Transient synovitis or ‘irritable hip’

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Retroperitoneal haematoma can cause referred

pain and ________

femoral nerve palsy.

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Childhood disorders that must not be missed

include:

DDH and acetabular dysplasia
Perthes disease
SCFE
stress fractures of the femoral neck

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‘Red flag’ pointers to potentially serious

hip conditions

Swelling, redness, very limited joint motion
Pain, fever, systemic features (in absence of trauma)
Neurological changes (e.g. loss of power)
Rapid joint swelling after trauma
Constant localised pain unaffected by movement

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__________ commonly causes
shoulder girdle pain in the elderly but pain around
the hip girdle can accompany this important problem

Polymyalgia rheumatica

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Chilblains around the upper thighs occur in cold
climates and are often known as_________ chilblains
because they tend to occur during horse riding in very
cold weather

‘jodhpur’

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___________is a nerve entrapment
causing pain and paraesthesia over the lateral aspect
of the hip

Meralgia paraesthetica

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If a man presents with ‘sciatica’, especially confined to the buttock and upper posterior thigh (without local back pain), consider the possibility of pressure on the sciatic
nerve from a wallet in the hip pocket.

‘hip pocket nerve’ syndrome

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Paget disease can involve the upper end of the______________

femur and the pelvis

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A common finding in psychoneurotic

patients complaining of buttock and thigh pain is _________

90 °

limitation of flexion at the hip joint.

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if after VC, the leg is, shortened and externally rotate, what is the provisional dx?

fractured neck of femur is the provisional diagnosis;

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if after VC, the leg is internally rotated, what is the provisional dx?

posterior dislocation of the hip

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In children it is most important to measure
rotation and abduction/adduction with the knee and
hip flexed to detect __________

early Perthes disease or SCFE.

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How to measure leg length

True leg length __________
Apparent leg length ____________

(ASIS to medial malleolus)

umbilicus to medial malleolus

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Unequal true leg length =_________

* Unequal apparent leg length =________

hip disease on shorter side

tilting of pelvis

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____________—shortened stance phase of
affected leg, as patient doesn’t want to stand on
it, indicates pain with weight-bearing

Antalgic gait

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__________—upper torso shifts towards painful

side due to pain in the hip

Coxalgic gait

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_____________ (the gluteus medius lurch)— | similar to coxalgic but pelvis tilts

Trendelenburg gait

________—tests hip abductors (gluteus medius): the non-weight-bearing hemipelvis drops if abnormal

Trendelenburg test

__________—tests for fixed flexion deformity

Thomas test

Squeeze test for ________

osteitis pubis

plain AP X-ray of pelvis showing _______

both hip joints

_________ is now sensitive in children in detecting fluid in the hip joint, and can diagnose septic arthritis and also localise the site of an osteomyelitic abscess around a swollen joint

Ultrasound diagnosis

In __________ previously known as congenital dislocation of the hip, the underdeveloped femoral head dislocates posteriorly and superiorly

DDH,

RF for DDH

Risk factors include family history, breech delivery, oligohydramnios and caesarean section

Dx of DDH

Diagnosed early by Ortolani and Barlow tests (abnormal thud or clunk on abduction); test usually negative after 2 months

Early Mx of DDH When diagnosed and treated from birth it is possible to produce a normal joint after a few months in an _______

abduction splint

What test________ _________ (IN test: gentle clunk into acetabulum)

Ortolani test

What test________ _________ (OUT test: gentle clunk out of acetabulum

Barlow test

T or F Plain X-ray has little or no place in the diagnosis of DDH in the neonatal period

Recommended test for DDH

Ultrasound imaging is recommended

Tx for DDH * 0–6 months—____________ * 3–18 months—____________ * >18 months—_______

Pavlik harness or abduction splint reduction (closed or open) and cast (pelvic spica) open reduction and possible osteotomy

Cx of DDH

Despite early treatment some cases progress to acetabular dysplasia (underdevelopment of the ‘roof’ of the hip joint) and to premature osteoarthritis

________ results in the femoral head becoming | partly or totally avascular (i.e. avascular necrosis

Perthes disease

Xray of Perthes disease

Joint space appears increased and femoral head too lateral: typical changes of sclerosis, deformity and collapse of the femoral capital epiphysis may be delayed

This common condition is also known as ‘irritable hip’ or observation hip and is the consequence of a self-limiting synovial inflammation

Transient synovitis

Outcome of Transient synovitis

It settles to normal within 7 days, without sequelae.

Why do Xray in transient synovitis after 5-6 mos

Follow-up X-ray is | needed in 4 to 6 months to exclude Perthes disease

One problem of the displaced capital epiphysis of the femoral head (SCFE) is when some patients develop __________despite expert treatment

avascular necrosis

________ of the hip should be suspected in all children with acutely painful or irritable hip problems. These patients may not be obviously sick on presentation, particularly in infants <2 years.

Septic arthritis

T or F, A negative needle aspiration does not exclude septic arthritis

If sepsis is suspected it is better to proceed | to an _________ if clinically indicated.

arthrotomy

Forceful contraction of muscles originating around | the pelvis can lead to _______

avulsion at their origin in those with skeletal immaturity

The most common problem in the little athlete is pain or discomfort in the region of the iliac crest or anterior or superior iliac spines, usually associated with_______ or _________

traction apophysitis or with acute avulsion | fractures

Patients often give a story of two falls—the first very painful, the second with the hip just ‘giving way’ as the femoral head fell off.

Subcapital fractures

The displaced subcapital fracture has at least a 40% incidence of ________ and usually requires prosthetic replacement in patients over 70 years

avascular necrosis

RF for AVN

corticosteroid use, SLE, sickle cell disease, past hip fracture or dislocation, pregnancy, alcoholic liver disease.

_______ of the hip is the most common | form of hip disorder.

Osteoarthritis

Pain pattern of hip OA

pain worse with activity, relieved by rest, and then nocturnal pain and pain after resting

Pain radiation pattern of hip OA

Pain usually in groin—may be referred to medial | aspect of thigh, buttock or knee

Order of movement loss in hip OA is ___

IR, extension, | abduction, adduction, flexion, ER

A type of total hip replacement called _________ is becoming more popular in certain situations in patients under 60 years of age; >90% achieve a good result.

hip resurfacing

____________ are becoming better recognised in motor accident victims, dancers and athletes, especially with the use of MRI and hip arthroscopy

Acetabular labral tears

What test to dx Acetabular labral tears

The impingement test should be | performed

According to Paoloni, ____________ is the gold standard for diagnosing hip pathology

examination after hip joint anaesthetic injection

Pain arising from _______disorders is normally experienced as a dull ache in the buttock but can be referred to the groin or posterior aspect of the thigh.

SIJ

When is SIJ pain worse?

It is worse in loading situations e.g. walking, running, | getting in and out of cars.

How to test SIJ problem by direct pressure?

With the patient lying prone a rhythmic springing force is applied directly to the upper and lower sacrum respectively

What test for SIJ? With the patient lying supine and with arms crossed, ‘separate’ the iliac crests with a downwards and outwards pressure. This compresses the SIJs

Winged compression test

What test for SIJ? With hands placed on the iliac crests, thumbs on the ASISs and heels of hand on the rim of the pelvis, compress the pelvis. This distracts the SIJs

Lateral compression test.

The patient lies supine on the table and the foot of the involved side and extremity is placed on the opposite knee (the hip joint is now flexed, externally rotated and abducted).

Patrick or FABERE test

_________ disorders are usually encountered in young people after some traumatic event, especially women following childbirth (notably multiple or difficult childbirth), or after a heavy fall onto the buttocks, as well as in those with structural problems (e.g. shortened leg).

Hypomobile SIJ

Pain pattern of SIJ disorders

Pain tends to follow rotational stresses of the SIJ

________ disorders are sometimes seen in athletes with instability of the symphysis pubis, in women after childbirth and in those with a history of severe trauma to the pelvis

Hypermobile SIJ

Pain pattern of Hypermobile SIJ

The patient presents typically with severe aching | pain in the lower back, buttocks or upper thigh.

T or F In hypermobile SIJ, It is difficult to treat and manual therapy usually exacerbates the symptoms.

The cause is tendonopathy of the gluteus medius tendon (considered to be the main pathology), where it inserts into the lateral surface of the greater trochanter of the femur and/or gluteus minimus tendon with or without inflammation of the trochanteric bursa

Greater trochanteric pain | syndrome

Pain pattern of Greater trochanteric pain | syndrome

The pain of this condition tends to occur at night, especially after activity such as long walks and gardening.

Advise for pts with Greater trochanteric pain | syndrome

Advise the patients to walk with | the feet turned out—‘the Charlie Chaplin gait’

Surgical Tx of Greater trochanteric pain | syndrome

Surgical intervention such as iliotibial band release ± bursectomy may be necessary.

Pain in the lateral thigh can be caused by inflammation of the fascia lata. It is often due to overuse or weak musculature around the hip. Treatment is relative rest and physiotherapy

Fascia lata syndrome

Some patients complain of a clunking, clicking or snapping hip, either palpable and/or audible. This represents an annoying problem that may cause pain in the groin or thigh. It is more common in females with a wide pelvis

Snapping or clicking hip (coxa | saltans)

Causes of Snapping or clicking hip (coxa | saltans)

• A taut iliotibial band • The iliopsoas tendon snapping across the iliopectineal eminence at the anterior brim of the pelvis • The gluteus maximus sliding across the greater trochanter • Joint laxity

Buttock pain Flashcards

(80 cards)