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OCS Prep > Hip > Flashcards

Hip Flashcards

1
Q

hip disorders 0-2 yo

A
  • developmental dysplasia of the hip
  • septic arthritis
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2
Q

hip disorders 2-12 yo

A
  • acute transient synovitis
  • leg- calve-perthes
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3
Q

hip disorders 8-17 yo

A

SCFE

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4
Q

hip disorders 5-30 yo

A

osteoid osteoma (femoral neck)

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5
Q

normal torsion

A
  • 8-15
  • 40 degrees at birth
  • normal at 16 years old
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6
Q

anteversion

A

torsion >15
in-toeing, excessive IR

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7
Q

retroversion

A

torsion <8
toe out, excessive ER

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8
Q

craigs test

A
  • tests verison of hip
  • prone, knee in 90 flex
  • rotation hip IR and ER, find greater troch at parallel to table, measure ankle of leg
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9
Q

developmental dysplasia

A
  • 1/100 births
  • 6:1 girls:boys
  • 80% unilateral, 20% bilateral
  • mechanical: position in the womb
  • physiological: estrogen and relaxin in utero
  • environmental: cultural positioning of infants
  • limited and asymmetric abduction
  • asymmetric thigh folds
  • positive galeazzi sign (unequal knee height in supine hips to 90)
  • positive ortolani sign(relocating dislocated hip)
  • telescoping
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10
Q

developmental dysplasia treatment

A

birth to 9 months
- abduction diapers
- pavlik harness

9 months or older
- abduction orthosis (double diaper)
- surgical intervention

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11
Q

septic arthritis

A
  • acute, rapidly progressing infection
  • <2 years old
  • pyogenic bacteria
  • irritability
  • hip held in open packed position
  • fever, sweating, chills, tachycardia
  • loss of appetite

treatment
- aspiration, IV antibiotics

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12
Q

acute transient synovitis

A
  • inflammation of synovial lining
  • self limiting
  • often preceded by upper respiratory infection
  • up to 5% later develop AVN
  • unknown cause

Features:
- hip pain, limp, refuse to walk
- decreased hip ROM >IR
- fever possible (<101)
- radiographs will be normal

Management
- relative rest
- PWB crutches
- radiographs

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13
Q

Legg-calve Perthes

A
  • AVN of femoral head
  • 3-12 most common (9-12)
  • males >females
  • whites > blacks
  • 95% unilateral
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14
Q

legg-calve perthes presention

A
  • hip and knee pain at night
  • ROM decreased abduction and ER; flexion contracture common
  • abnormal growth patterns: forearm and hands short, feet short
  • psoatic limp: worse late in day
  • often very active
  • correlated with ADD
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15
Q

legg- calve perthes treatment

A
  • reduce hip irritability
  • restore and maintain hip mobility
  • regain a spherical femoral head
  • prevent ball from extruding or collapsing
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16
Q

SCFE

A
  • posterior and inferior displacement of femoral head
  • 2:1 boys:girls
  • 10-16 yo most common
  • 50% are bilateral
  • obese
  • black > white
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17
Q

SCFE presentation

A
  • gradual hip pain and limp
  • medial sided knee pain
  • hip extension and IR limited
  • passive flexion presents with abd/ER
  • 3-12 months before diagnosis

treatment is ORIF

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18
Q

OA subjectively

A
  • older patient >60
  • groin pain, postero/lateral hip, anterior thigh pain
  • commonly refers pain to the knee
  • high frequency associated with Lspine DJD
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19
Q

two clusters of OA
(SN of 8%, SP 75%)

A
  • hip pain
  • IR <15
  • pain with IR
  • morning stiffness >60 min
  • age over 50
  • IR<15
  • flexion <115
  • stiffness >60 min
  • pain in hip
20
Q

labral tears

A
  • complaint of pain, clicking, locking, catching, instability, or giving away
  • anterior groin pain in 96-100%
  • MOI: hip external rotation +extension

EXAM
- FABER SN .88
- femroal acetabular impingement test
- imaging gold standard is arthroscopy

21
Q

AVN

A
  • 4th decade of life
  • nonspecific leg pain
  • steroid usage, renal disease, alcoholism, sickle cell disease, gout, previous trauma

EXAM
- hip AROM WNL
- radiographs findings do not occur until 3 months
- MRI highly specific/sensitive

22
Q

iliopsoas bursitis

A

Subjective
- anterior hip pain
- worse with hip extension
- overuse
- may complain of snapping

Exam
- present in hip flexion and ER for relief
- pain with passive hip extension
- pain with resisted hip flexion
- bursa tender to palpation
- (+) snapping hip maneuver
- (+) supine heel raise

23
Q

femoral neck stress fracture

A

Subjective
- stress fx: 10% of all injuries seen in sports
- femur is 4th most common site of fracture
- overuse vs insufficiency
- females > males
- groin, thigh, or knee pain
- often occurs after change in activity
- risk factors: female, amenorrhea >6months, family history of OP, smoker, eating disorder

EXAM
- pain at extreme ROM
- pain with weight bearing
- positive hop test (70% accurate)
- positive heel tap
- positive FABER, scour, quadrant
- positive fulcrum
- bone scan 100% sensitive

24
Q

osteitis pubis

A
  • gradual onset of pain in pubic region
  • following bladder or prostate surgery
  • long distance runners, weightlifters, fencers, soccer players, football players

EXAM
- tenderness along pubis
- PROM hip adductors limited w pain
- RROM hip adductors weak with pain

25
obturator nerve entrapment
- activity induced entrapment - can be due to pelvic fx, hematoma, retroperitoneal masses, intrapelvic tumors - presents as medial thigh pain with exercise - pain continues with activity, recedes with rest EXAM - paresthesias medial thigh - adductor muscle weakness (no pain) - pain may be reproduced with weightbearing hip ER and adduction - EMG diagnostic
26
ilioinguinal nerve entrapment
- supplies cutaneous innervation to groin, scrotum, or labia - c/o pain in from inguinal region to genitals - risk factors: abdominal muscle hypertrophy, pregnancy, prior iliac crest bone graft harvesting, overtraining athletes - reproduction of symptoms with hip hyperextension
27
signs of buttock
- limited straight leg raise - limited hip flexion to the same extent as SLR - limited trunk flexion to the same extent as hip flexion - painful weakness of hip extension - noncapsular pattern of restriction at the hip - swollen buttock
28
hip outcome measures recommendation
Level A: hip outcome score, copenhagen hip and groin outcome score, interneational hip outcome tool
29
labral debridement protocol
- early PROM - CPM use (6-12 hours/day for 3-4 weeks) - overcoming inhibition of posterior hip musculature is an important key to progression - AD should be continued until gait is normal - aquatic walking or deweighing treadmill - avoid normal treadmill to prevent forced extension - avoid excessive early flexion and abd to prevent inflammation
30
labral repair (anterior/superior) protocol considerations
- limit PROM to 90 flexion for 10 days and 25 degrees abduction, gentle external rotation and extension for 3 weeks - PWB for 10-28 days\ - avoid excessive early flexion and abd to prevent inflammation
31
osteoplasty rehab considerations
- limited impact activities for 8 weeks - flexion limited to 90 for 10 days, - foot flat weightbearing for 4 weeks - slightly slower progression - avoid excessive early flexion and abd to prevent inflammation
32
microfracture rehab considerations
- flexion is limited to 90 deg for 10 days - size and location of lesion affects WB adn tolerance - slower progression, 6-7 weeks of limited weight bearing - avoid excessive early flexion and abd to prevent inflammation
33
sports hernia
- insidious onset - gradually worsening - diffuse - unilateral groin pain that may radiate to perineum and upper medial thigh - mainly males mid 20's
34
main causes of chronic groin pain
- adductor longus dysfunction - osteitis pubis - sport hernia - pathological condition of the hip joint
35
sports hernia rehab
- avoid sharp movements - focus on core and leg inflexibility, weakness, , endurance - jogging at 3-4 weeks - 6-8 weeks for full return
36
sports hernia rehab
- avoid sharp movements - focus on core and leg inflexibility, weakness, , endurance - jogging at 3-4 weeks - 6-8 weeks for full return
37
hamstring reinjury risks
- persistent weakness in injured muscle - reduced extensibility of the musculotendon unit due to residual scar tissue - adaptive changes in the biomechanics and motor patterns of sporting movements
38
rehab for hamstring strains overall
- eccentric strength training - neuromuscular control of lumbopelvic musculature - progressive agility and trunk stabilization has better outcomes versus stretching and strengthening - early mobilization
39
phase 1 hamstring rehab
- protection - ice - NSAIDs - lumbopelvic musculature, SLB, short stride frontal plane stepping (grapevine), avoid isolated resistance training Progression criteria - normal walking stride without pain - very low speed jogging without pain - pain- free isometric contraction against submax resistance during prone knee flexion
40
phase 2 hamstring rehab
- avoid end range HS lengthening if weakness persists - ice - neuromuscular control, agility, trunk stabilization Progression criteria - full strength without pain during 1 rep max - forward and backward jogging at 50% max speed without pain
41
phase 3 hamstring rehab
- ice if needed - sport specific drills - progress hamstring strength to end range motion Return to sport - all strength and mobility be preformed without pain - less than 5% difference
42
cam impingement
- when the femoral head has an abnormally large radius with loss of the normal spherical junction between the femoral head and neck - usually in anterosuperior labral and chondral lesion - young athletic males
43
pincer impingement
- abnormal acetabulum with increased overcoverage - leads to posteroinferior chondrol lesions - more common in middle-aged women in athletics
44
where to labral tears commonly happen and refer
- anterior or anterosuperior - anterior groin
45
tests for intra-articular hip pain
- Faber, scour, patrick, resisted straight leg raise - Faber is sensitive in ruling out labral
46
hip precautions with THA posterior
- avoid hip flexion past 90, adduction past midline - cemented THA is not limited in weightbearing

OCS Prep (11 decks)

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