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MC > Buttock pain > Flashcards

Buttock pain Flashcards

1
Q

________typically presents in the obese adolescent

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

A

SCFE

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2
Q

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

A

DDH,

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3
Q

The _______ is the most likely cause of pain in the

buttock in adults

A

spine

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4
Q

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

A

dysfunction of the sacroiliac joints (SIJs)

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5
Q

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

A

trochanteric bursitis or gluteus medius

tendonitis (greater trochanteric pain syndrome).

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6
Q

___________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

A

Osteomyelitis

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7
Q

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

A

Perthes disease

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8
Q

________ or _________ is the most

common cause of hip pain and limp in childhood

A

Transient synovitis or ‘irritable hip’

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9
Q

Retroperitoneal haematoma can cause referred

pain and ________

A

femoral nerve palsy.

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10
Q

Childhood disorders that must not be missed

include:

A
  • DDH and acetabular dysplasia
  • Perthes disease
  • SCFE
  • stress fractures of the femoral neck
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11
Q

‘Red flag’ pointers to potentially serious

hip conditions

A
  • 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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12
Q

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

A

Polymyalgia rheumatica

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13
Q

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

A

‘jodhpur’

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14
Q

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

A

Meralgia paraesthetica

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15
Q

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.

A

‘hip pocket nerve’ syndrome

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16
Q

Paget disease can involve the upper end of the______________

A

femur and the pelvis

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17
Q

A common finding in psychoneurotic

patients complaining of buttock and thigh pain is _________

A

90 °

limitation of flexion at the hip joint.

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18
Q

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

A

fractured neck of femur is the provisional diagnosis;

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19
Q

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

A

posterior dislocation of the hip

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20
Q

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

A

early Perthes disease or SCFE.

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21
Q

How to measure leg length

True leg length __________
Apparent leg length ____________

A

(ASIS to medial malleolus)

umbilicus to medial malleolus

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22
Q
  • Unequal true leg length =_________

* Unequal apparent leg length =________

A

hip disease on shorter side

tilting of pelvis

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23
Q

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

A

Antalgic gait

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24
Q

__________—upper torso shifts towards painful

side due to pain in the hip

A

Coxalgic gait

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25
Q

_____________ (the gluteus medius lurch)—

similar to coxalgic but pelvis tilts

A

Trendelenburg gait

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26
Q

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

A

Trendelenburg test

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27
Q

__________—tests for fixed flexion deformity

A

Thomas test

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28
Q

Squeeze test for ________

A

osteitis pubis

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29
Q

plain AP X-ray of pelvis showing _______

A

both hip joints

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30
Q

_________ 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

A

Ultrasound diagnosis

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31
Q

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

A

DDH,

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32
Q

RF for DDH

A

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

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33
Q

Dx of DDH

A

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

34
Q

Early Mx of DDH

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

A

abduction splint

35
Q

What test________

_________ (IN test: gentle clunk into acetabulum)

A

Ortolani test

36
Q

What test________

_________ (OUT test: gentle clunk
out of acetabulum

A

Barlow test

37
Q

T or F

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

A

T

38
Q

Recommended test for DDH

A

Ultrasound imaging is recommended

39
Q

Tx for DDH

  • 0–6 months—____________
  • 3–18 months—____________
  • > 18 months—_______
A

Pavlik harness or abduction splint

reduction (closed or open) and cast (pelvic spica)

open reduction and possible osteotomy

40
Q

Cx of DDH

A

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

41
Q

________ results in the femoral head becoming

partly or totally avascular (i.e. avascular necrosis

A

Perthes disease

42
Q

Xray of Perthes disease

A

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

43
Q

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

A

Transient synovitis

44
Q

Outcome of Transient synovitis

A

It settles to normal within 7 days, without sequelae.

45
Q

Why do Xray in transient synovitis after 5-6 mos

A

Follow-up X-ray is

needed in 4 to 6 months to exclude Perthes disease

46
Q

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

A

avascular necrosis

47
Q

________ 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.

A

Septic arthritis

48
Q

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

A

T

49
Q

If sepsis is suspected it is better to proceed

to an _________ if clinically indicated.

A

arthrotomy

50
Q

Forceful contraction of muscles originating around

the pelvis can lead to _______

A

avulsion at their origin in those with skeletal immaturity

51
Q

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 _________

A

traction apophysitis or with acute avulsion

fractures

52
Q

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.

A

Subcapital fractures

53
Q

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

A

avascular necrosis

54
Q

RF for AVN

A

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

55
Q

_______ of the hip is the most common

form of hip disorder.

A

Osteoarthritis

56
Q

Pain pattern of hip OA

A

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

57
Q

Pain radiation pattern of hip OA

A

Pain usually in groin—may be referred to medial

aspect of thigh, buttock or knee

58
Q

Order of movement loss in hip OA is ___

A

IR, extension,

abduction, adduction, flexion, ER

59
Q

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.

A

hip resurfacing

60
Q

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

A

Acetabular labral tears

61
Q

What test to dx Acetabular labral tears

A

The impingement test should be

performed

62
Q

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

A

examination after hip joint anaesthetic injection

63
Q

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.

A

SIJ

64
Q

When is SIJ pain worse?

A

It is worse in loading situations e.g. walking, running,

getting in and out of cars.

65
Q

How to test SIJ problem by direct pressure?

A

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

66
Q

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

A

Winged compression test

67
Q

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

A

Lateral compression test.

68
Q

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).

A

Patrick or FABERE test

69
Q

_________ 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).

A

Hypomobile SIJ

70
Q

Pain pattern of SIJ disorders

A

Pain tends to follow rotational stresses of the SIJ

71
Q

________ 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

A

Hypermobile SIJ

72
Q

Pain pattern of Hypermobile SIJ

A

The patient presents typically with severe aching

pain in the lower back, buttocks or upper thigh.

73
Q

T or F

In hypermobile SIJ,

It is difficult to treat and manual therapy usually exacerbates the symptoms.

A

T

74
Q

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

A

Greater trochanteric pain

syndrome

75
Q

Pain pattern of Greater trochanteric pain

syndrome

A

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

76
Q

Advise for pts with Greater trochanteric pain

syndrome

A

Advise the patients to walk with

the feet turned out—‘the Charlie Chaplin gait’

77
Q

Surgical Tx of Greater trochanteric pain

syndrome

A

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

78
Q

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

A

Fascia lata syndrome

79
Q

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

A

Snapping or clicking hip (coxa

saltans)

80
Q

Causes of Snapping or clicking hip (coxa

saltans)

A

• 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

MC (90 decks)

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