Common Disorders of the Hip Flashcards
(110 cards)
1
Q
Avascular Necrosis
What is the avascular necrosis?
A
areas of dead trabecular bone and bone marrow
- this goes to the subcondral plate
2
Q
Avascular Necrosis
What are the subjective findings?
A
- pain @ groin (radiate to lateral hip, knee or ass)
- “throbbing and deep”
- pain is intermittent with gradual onset
- antalgic shift
3
Q
Avascular Necrosis
What are common risk factors?
A
- cumulative corticosteroid total dose
- alcohol abuse
- systemic lupus
- sickle cell
- trauma
- cancer
4
Q
Avascular Necrosis
What is the objective findings?
A
- painful ROM (with forced IR)
- pain with SLR
- antalgic gait
5
Q
Avascular Necrosis
What are the special tests?
A
based on:
- subjective
- physical
- imaging
6
Q
Avascular Necrosis
What is indicated in imaging?
A
- AP view of pelvis
- AP frog lateral radiographs
7
Q
Avascular Necrosis
What is the best intervention?
A
Surgery is the best result
8
Q
Avascular Necrosis
What is the prognosis?
A
Success related to the stage when care was started
9
Q
Avascular Necrosis
What are the complications?
A
incomplete fx and superimposed degenertative arthritis
10
Q
What is Legg-Calve-Perthes disease?
A
An idiopathic osteonecrosis of the head aged 4-10
- formed with less blood
- unilateral in 90% of pt
11
Q
Legg-Calve-Perthes Disease
What is the assumed cause?
A
localized manifestation of generalized disorder of the epiphyseal cartilage that happens in the proximal femur
12
Q
Legg-Calve-Perthes Disease
What population is most affected?
A
4x more common in boys
13
Q
Legg-Calve-Perthes Disease
What are the subjective findings?
A
- vague ache in the groin that goes to medial thigh and inner knee
- early stage muscle spasm
14
Q
Legg-Calve-Perthes Disease
What are the objective findings?
A
- limp (slight dragging)
- atrophy of quads
- may be small for their age
- (+) trendelenburg
- out-toeing
- decreased abduction and IR
- hip flexion contracture (0-30 deg)
15
Q
Legg-Calve-Perthes Disease
What is the medical/imaging studies?
A
- AP and frog-lateral radiographs of pelvis
- normal early on
- progress to fragmentation
- irregularity
- eventual collapse of head
16
Q
Legg-Calve-Perthes Disease
What are the interventions?
A
Less than 6 y/o and min capital femoral epiphysis involvement and normal ROM = intermittent physicals and radiographs every 2 months
More severe = operative or non-op
17
Q
What is slipped capital femoral epiphysis?
A
Displacement of head thru the physis
- usually occurs during adolescent growth spurt
18
Q
Slipped Capital Femoral Epiphysis
What is the position of the femoral head?
A
It stays in the acetabulum while the femoral neck is displaced anteriorly from the capital femoral epiphysis
19
Q
What is the most common disorder of the hip in adolescents?
A
Slipped capital femoral epiphysis
20
Q
Slipped Capital Femoral Epiphysis
What is the subjective findings?
A
- pain with activity
- hx of groin pain or medial thigh pain
- around 45% report knee or lower thigh for intial sx
- pain is dull and aching
- may be mild weakness in the leg
- may be no hx of trauma (can be so bad that theres pain turning in bed)
21
Q
Slipped Capital Femoral Epiphysis
What are the objective findings?
A
- antalgic gait with limp (ofteen ER of involved foot)
- decreased ROM hip
- PROM will show ER of hip
- LE is 1-3 cm shorter
affected ROM - IR, abd and flexion
22
Q
Slipped Capital Femoral Epiphysis
What does it cause?
A
The only peds disorder that causes greater loss of IR when the hip is moved into flexion
23
Q
Slipped Capital Femoral Epiphysis
What are the predisposing factors?
A
- obesity
- male gender
- greater involvement with sport activities
24
Q
Slipped Capital Femoral Epiphysis
What are the special tests?
A
IR with hip flexed to 90 deg
25
# Slipped Capital Femoral Epiphysis
What are the medical/imaging studies?
AP and frog-lateral radiographs of the pelvis
26
# Slipped Capital Femoral Epiphysis
What are the interventions?
- sx relief
- containment of femoral head
- ROM restoration
- surgical fixation
27
What is the description of stress fx on the femoral neck?
because of the accelerated bone remodeling from repeated stress
28
# Stress fx
What is the population affeected with this?
In military recruits and athletes (runners especially)
29
# Stress fx
In older populations, where is the fracture?
on the superior side of the neck
30
# Stress fx
In younger populations, where is the fracture?
in the inferior side of the neck (compression-side fracture)
31
# Stress fx
What is the subjective findings?
- suddeen hip pain (associated with revent changes in training or surface)
- pain the deep thigh (early sx)
- pain during WB or at extremes of hip motion = radiate to knees
- night pain happens with fx progression
32
# Stress fx
What are the objective findings?
- physical exam is usually (-)
- may be empty end feel
- pain at extremities of hip ER or IR
- pain with resisted hip ER
33
# Stress fx
What are the special tests?
Not one test
- resisted SLR = (+) pain @ thigh or groin
- patellar-pubic percussion tests can be +
- Flucrum test = (+) sharp pain and apprehension
## Footnote
Patellar-pubic
- sensitivity = 0.96
- specificity = 0.76
34
# Stress fx
What are the medical/imaging studies?
- radiographs taken too soon only (+) in 20% of cases
- best dx/d with MRI
35
# Stress fx
For tension side fractures, how are they treated?
treated surgically
36
# Stress fx
If there is no fx line but sclerosis, what is the intervention?
modified best rest to NWB on crutches until no sx
- pain free = progress to wt-bearing
- significant PWB is pain free = cycling and swimming
- weekly radiograph until full w/o pain
37
# Stress fx
If there is a fx but no displacement, what is the intervention?
intial period of best rest or complete NWB then WB as sx permit
38
What is a 2 joint hamstring strain?
the strain/rupture of 1 or more of the 3 hammies
- muscle tears are usually partial
- eccentric phase of the muscle usually are the time for tears
39
# Hamstring Strain
What are the subjective findings?
- distinct MOI w/ pain right away during full stride running or while quick deceleration
- can hear a "pop"
- posterior thigh pain
- gets worse with knee flexion
40
# Hamstring Strain
What is the objective findings?
- tenderness with PROM stretching of hammies
- tender to palpation
- Pain w/ resisted knee flexion (IR/ER to isolate)
41
# Hamstring Strain
What is the medical studies needed?
Radiographs are rarely needed unless there is a question of a fracture or bony avulsion injury
## Footnote
Avulsion - tendon tear with bone
42
# Hamstring Strain
What is grade 1 intervention?
continue with activities as much as possible
43
# Hamstring strain
What is grade 2 intervention?
5-21 days of rehab or 3 weeks
44
# Hamstring Strain
What is grade 3 intervention?
3-12 weeks of rehab
45
# Hamstring Strain
What are the important components of hamstring interventions?
Be sure to emphasize eccentric loading of the hammies
be able to address any biomechanical factors:
- excessive anterior pelvic tilt
- SI or lumbar dysfunction
- leg length issues
- other factors
46
What is hip adductor tendinopathy?
most commonly proximal adductor pathology that comes from repetitive loading
47
# Hip adductor tendinopathy
What are the muscles that are affected?
Gracilis
pectineus
adductor long / brev / magnus
48
# Hip adductor tendinopathy
What is the most common muscle injured?
Adductor longus
49
# Hip adductor tendinopathy
What is the primary movement that is associated with MOI?
Repetitive loading that has to do with twisting and turning
- possible muscle imbalance of the muscles stabilizing the hip joint and pubis
50
# Hip adductor tendinopathy
What are the subjective findings?
- twinging or stabbing pain @ groin that starts and stops quickly
- edema or ecchymosis several days post injury
- sx are bad with running, directional changes, kicking, SL exercises, cutting and lunges
51
# Hip adductor tendinopathy
What are the objective findings?
* pain w/ passive abduction
* manual resistance to hip adduction at different angles of hip flexion:
0 = gracilis
45 = add longus and brevis
90 = pectineus
52
# Hip adductor tendinopathy
What are the interventions?
- RICE @ acute stage
- hip add isometrics and gentle stretching @ subacute
- Graded resistive with concentric/eccentric and PNF
53
# Hip adductor tendinopathy
What is the typical prognosis?
Most recover fully or have min pain with high intensity activity only
54
# OA
What are the subjective findings?
- insidious pain @ ass, groin, thigh or knee
- pain is dull ache to sharp
- gets worse with activity
- limping happens
- activity will increase pain that last hours
- hard time with stairs, putting on socks
55
# OA
What are the objective findings?
- early signs: IR and abd or flexion
- pain @ end range
- pain with resisted hip flexion and adduction
56
# OA
What are the special tests?
Scour (Rel = 0.87)
Faber (Sn = .41-.99 / Sp = .71-1.00)
57
# OA
What are some interventions?
| It's a goddamn lot just be careful
- relieve sx
- decrease disability
- reduce progression
- education (modifications)
- modalities
- decreased WB activities (swimming or cycling)
- BW reduction
- walking stick (?)
- manual techniques
- passive stretches
- strengthening of hip and trunk stabilizers
58
# OA
How is the hip unloaded with a walking stick?
Possibly reduce the hip load by 20-30%
59
What is a snapping hip?
snapping or popping sensation that happens when the tendons around the hip move over bony prominences
60
# Snapping Hip
What is the internal etiology?
the iliopsoas is snapping over structures just deep to it
= stenosing tenosynovitis of the muscle insertion
## Footnote
What's deep: femoral head, proximal lesser trochanter
61
# Snapping hip
What is the external etiology?
snapping of the ITB or glute max over the greater trochanter
62
# Snapping hip
What is the external etiology most common in?
in females with wide pelvis and prominent trochanters
63
# Snapping hip
What is the intra-articular etiology?
- synovial chondromatosis
- loose bodies
- fracture fragments
- labral tears
64
# Snapping hip
What are the subjective findings?
- feeling that snapping or poppping @ greater trochanter areea and happens when walking
- snapping from sublux of iliopsoas tendon = pain @ groin when hip extended from a flexed position (sit to stand)
- pain with snapping if trochanteric bursa is inflamed
65
# Snapping hip
What are the objective findings?
- IT band sublux can be felt during standing with hip rotation while holding an adducted position
- snapping of iliopsoas tendon while hip extension from flexed position
66
# Snapping hip
What are the special tests?
Ober and thomas
67
# Snapping hip
If there is an imbalance of the TFL or iliopsoas is causing sx, what is the intervention focused on?
reconditioning and prevention thru:
- muscle length improvement
- correcting imbalances
68
# Snapping hip
What is the typical prognosis?
If responding well to conservative management = no surgery (rarity)
69
What is the most common cause of lateral hip pain?
Trochanteric bursitis while OA is most common
70
# Trochanteric bursitis
What are the subjective findings?
pain @ thigh, groin and glute
- especially when lying on the involved side
- pain could radiate down
- pain is bad when rising from a seat or recumbent position
- gets better after a few steps
- reoccurs after walking for an hour or so
71
# Trochanteric bursitis
What are the objective findings?
- pain with palpation or with stretching of ITB
- resisted abd, extension or ER of hip = pain
- hip adductor tightness
72
# Trochanteric bursitis
What are the special tests?
obers in general (both modified or normal)
| Modified - knee straight
73
# Trochanteric bursitis
What is the overall prognosis?
responds well to conservative measures
- possibly injection of a local anesthetic and corticosteroid prep into the greater trochanter
73
# Trochanteric bursitis
What are the interventions?
- stretching the soft tissues of lateral thigh
- flexibility of ER, quads and hip flexors
- stronger hip abduction
- establishing muscular balance between hip adductors and abductors
- possibly orthotics if because of biomechanical fault
74
What is the etiology of labral tears?
- trauma
- FAI
- capsular laxity/hip hypermobility
- dysplasia
- degeneration
## Footnote
often goes undiagnosed during an extended time period
75
# Labral tears
What are the subjective findings?
- anterior hip or groin pain
- feeling clicking, locking and giving away
76
# Labral tears
What are the objective findings/special tests?
hip impingement test
77
# Labral tears
What are the interventions?
Be able to trial conservative management and PT
- we want to limit pivoting motions
- strengthen inhibited muscles
- assess foot motion
Arthroscopic debridgement of tear
## Footnote
PT around 10-12 weeks
78
# Labral tears
Why is it important to limit pivoting motions?
increase forces across the labrum
79
With manual treatments, what can we do?
- restore mobility and function
- decrease pain
- avoid surgery
80
What is FAI a precursor of?
For OA changes in the hip
- strongly associated with labral tears
81
# FAI
What is the % growth rate of hip arthroscopy?
15% per year
82
# FAI
What population is FAI prevelant in?
- more common in 20-40 y.o
- athletes make up 15%
83
# FAI
What is the common MOI?
Repetitive end-range hyperextension or hyperflexion w/ abduction
Idiopathic tears from slipping and twisting injury
## Footnote
The sport will place the athlete at an increased risk for tears
84
What is FAI?
- the contact between femoral head-neck junction and the acetabular rim
- happens with combined movements
85
# FAI
What is the combined movements that causes impingement?
Flexion and extension with adduction and either ER or IR
86
# FAI
What does prolonged impingement lead to?
damage to the labrum and subchondral bone
87
# FAI
What is it often misdiagnosed?
Snapping hip or psoas strain
88
What are the 2 primary causes of labral tears?
hip dysplasia and FAI
89
# FAI
What is a clinical pearl?
if pt doesn't complain of clicking, locking or catching is the best
- helps rule OUT labral tears compared to other hip pathology
90
# FAI
What are the two type of impingements?
CAM and pincer
91
# FAI
What is causes of CAM?
- aspherical femoral head
- bony prominence at anterolateral head-neck junction
- impinges @ rim of labrum
- leads to superior OA
92
# FAI CAM
What are the provocative tests?
FADDIR
93
# FAI
What are the causes of pincer impingement?
- over coverage of fem head by the acetabulum
- acetabulum impinges neck of femur
- leads to posterior-inferior or central OA
94
# FAI CAM
Most prevalent population for CAM?
Young athletic males
95
# FAI Pincer
Most prevalent population for pincer?
Middle aged women
96
# FAI Pincer
What is the provocative test?
hip extension and ER
97
86% of FAI has what kind of impingement?
both CAM and Pincer
Limited in:
- IR and ER rotation
- flexion and adduction
Gradual and progressively become more limited
98
# FAI
What are the common sx?
- C sign
- dull and achy pain
- pain is worse with long term sitting
- sometimes sharp catching pain with activity
- increased sx with hip flex, add and IR
- can limp
99
# FAI
When the sx start, what does indicate?
damage to the cartilage or labrum
= disease progression with pain @ anterior groin area
100
# FAI
What is the Warwick Agreement?
| Answer is a picture
101
# FAI
What is the most common complaint regarding activity?
1. Heavy work (push/pull, climbing, carrying)
2. Twisting
3. squatting
4. heavy-duty housework
5. walking 15 min or more
.....
least common complaint: walking down steep hills
102
# FAI
What are activities that should be avoided?
- end ranges
- treadmill running or narrow straight trail
- upright cycling
- sitting with hips flexed and neutral spine for long periods of time
103
# FAI
What is the end range stretching position?
Flexion
adduction
internal rotation
OR FADDIR
104
# FAI
What does running a straight line "encourage"?
internal rotation of LE
105
# FAI
Why avoid upright cycling?
involves flexion and combination with hip IR
106
# FAI
What are the non-surgical treatments?
- activity changes
- non-steroidal anti-inflammatory meds
- PT
107
# FAI
What are the medications used for non-surgical treatment?
ibuprofen to help reduce pain and inflammation
108
# FAI
What are the PT treatments?
exercises to improve ROM in the hip and strengthen the muscles around the joint
= stress relief on injured labrum or cartilage
109
# FAI
What are the surgical treatments?
- will repair or clean out any damage to labrum and articular cartilage
- FAI = trimming of bony rim of acetabulum and shaving down the bump on the head
- severe cases = need open operation with bigger incisions
