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Hip Flashcards

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1
Q

Prevalence in osteoporosis vs osteopenia

A

both W>M over 50. Especially osteoporosis

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2
Q

Osteoporosis recommendations

A

-Screening for rfs >50
-BMD testing for females >65, males >70 (younger post-menopausal women w/ 1 major or 2 minor rfs)

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3
Q

Hip fx stats, progs

A

-Mostly sustained by people >65
-Survivors have shortened life expectancy
+ prog: sx in 48hrs
- prog: males, >86, >2 comorbs, anemia, mini mental test <6/10

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4
Q

Femur fx prognosis and categories

A

Prog: displaced vs non, comminution, vascular integrity, reduction, fixation.
-high risk thrombosis/embolism
-intertrochanteric: between trochanters
-subtrochanteric: below trochanters
monitor for AVN and non-union
compression fx more stable than tension fx

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5
Q

Hx with hip fx

A

-older adult
-trauma vs spont.

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6
Q

sxs hip fx

where pain is

A

severe groin and anterior thigh pain (more likely than lateral pain)

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7
Q

Hip fx examination

A

-shortening of LE
-limited/painful squat
-painful/limited AROM/PROM all directions
-pain/weakness with strength testing
+fulcrum and PPT

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8
Q

Hip fx surgical procedures

A

arthroplasty
external fixation (rare, temp.)
ORIF- full WB 8-12 wks postop
intramedullary fixation

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9
Q

AVN of the femoral head

basically what it is

A

-Progressive ischemia w/ secondary bone cell death
-Collapsing of bone, leads to degenerative arthropathy
-managed surgically

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10
Q

Hx AVN

A

30-50s
Rfs: trauma, corticosteroid use, alcys, coagulation disorders, HLD, smoking, autoimmune disease, etc

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11
Q

AVN pain location

A

deep groin, buttock, and knee pain

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12
Q

AVN examination

A

-Limited squat
-limited/painful AROM and PROM (IR especially)
-pain/weakness w/ resistive testing

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13
Q

AVN prognostic indicators

A

Extent of lesion
Location
Bone marrow edema presence

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14
Q

Osteoarthopathy stats

A

> 65 w/ hip or knee OA
radiography: joint space loss, osteophytes, sclerosis
-symp. vs asymp.

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15
Q

Osteoarthropathy hx

A

-insidious
-hx of trauma
-family hx
-obesity
-hypermobility
-joint shape abnormality
-physical activity levels
->50yo

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16
Q

Osteoarthropathy sxs

A

-dull and achy most, but sharp buttock, groin, thigh, and knee pain when aggravated
-C-sign
-hip stiffness (sitting/inactivity)
-difficulty donning pants, socks, shoes
-Stair ambulation issues

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17
Q

Osteoarthropathy examination

A

-limited hip AROM/PROM, painful at end range (especially IR, flexion, ABD)
-+Scower
+/- weakness/pain w/ resistive testing (bc we avoid end range with MMT)
joint hypomobility

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18
Q

CPR for hip OA

A
  1. report squatting as an aggravating activity
  2. lateral pain w/ active hip flexion
  3. passive hip IR <=25
  4. pain with active hip ext
  5. +scower w/ ADD
    (having >=4 is best predictor)
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19
Q

Labral tear correlated with

A

degenerative oa
developmental hip dysplasia
aspherical femoral head
slipped capital epiphysis
legg-calve-perthes disease
hip trauma
athletics with repetitive pivoting/flexion
FAI

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20
Q

Most common sxs of labral tear

A

-insidious onset
-groin pain mostly
-activity related pain
-night pain
-locking, pain in walking and pivoting
-limping slight
-requires banister with stairs

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21
Q

FAI 2 types

A

Cam: increased size of femoral head, irregular junction with neck
-leads to anteriosuperior labral and cartilage damage
Pincer: increased protrusion of acetabular rim

most common is a mixture

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22
Q

FAI hx

A

hockey players, golfers, dancers, football and soccer players

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23
Q

FAI sxs

A

sharp, deep anterior pain
pain/limit with deep squat (deep flexion motions)
cutting, lateral movements
hip IR/ ABD motions
-may have painful ER motions with extensive lesions

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24
Q

FAI examination

Cam especially

A

Cam: hip flex/ABD/IR ROM painful/limited (may have bony end feel)
+ FABER and FADDIR
MRA/MRI to measure angle and identify lesions

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25
Loose bodies - what is it? Characteristics?
-free floating body (cartilage/bone) within joint -vary in size -secondary to degen. changes in hip - may cause muscle inhibition (weak, discoordination)
26
Hx loose bodies
-chronic hip pain -advances OA -prior traumatic hip dislocation -Prior AVN
27
Loose bodies sxs
-anterior hip/groin pain -catching, locking, clicking, giving way LE (mechanical issue) -sudden pain w/ WB activities
28
Loose bodies examination
limited AROM/PROM with catching/grinding springey end-feel w/PROM
29
Loose Bodies implications
identify, refer, managed with arthroscopy
30
Snapping hip 3 categories
Intra-articular Internal External
31
Intra-articular SHS
synovial chondramatosis (tumor) loose bodies labral tears long head biceps over ischium and iliofemoral lig over femoral head
32
Internal SHS
iliopsoas over femoral head, lesser trochanter, pectineus, iliopectineal eminence fibrosis/tenosynovitis of iliopsoas tendon snapping/ painful anterior hip (especially extending from flexed position) pain/snap with movement from FABER position to ext, ADD, IR
33
External SHS
ITB/glut max over GT lateral hip pain/snapping aggravated by running on slanting surfaces, directional change on planted LE -observed at: hip: increased compression on soft tissue structures btw GT and ITB knee: btw lateral femoral condyle and ITB ITB contracture vs weak glut med and hip ERs Painful Ober test lead to GT bursitis
34
Tendon acute injury Phase 1
inflammatory first 3 days
35
tendon healing phase 2
reparative/collagen within first week increased fibroblasts through week 4 collagen fibers initially disorganized and random they become more aligned and perpendicular to long axis over time
36
tendon healing P3
remodeling collagen/cell re-alignment typically complete by ~2 months
37
Why do we want controlled tensile loading for healing?
parallel organization associated w/ improved tissue strength motion can aid in preventing cross-linkage between tendon tissue and sheath tissue
37
tendinopathy- involved structures
rectus femoris iliopsoas gluts
38
tendinopathy hx
internal SHS
39
Tendinopathy sxs
anterior thigh/groin pain
40
Tendinopathy examination
painful/weak resisted hip flex painful/limited hip ext and IR ROM (guarded/empty end feel)
41
Muscle tissue injury- strain degrees
-DOMS possibly -Contusion (bruise) -Strain: 1st: min. structural damage 2nd: partial tear 3rd: rupture
42
Muscle strain healing
excellent regenerative capacity outcome and time affected by type, severity, extent
43
Muscle strain phases
Destruction: gap forms with disrupted fibers -tissue necrosis and development of local hematoma /edema Repair: hematoma forms, primary matrix forms/ fibroblasts synth. proteins, collagens produced Remodeling: tissue matures and contracts
44
Muscle strain examination
tender to palp. muscle bellies with palpable defect antalgic gait ecchymosis/edema several days pain/weak RT, limited/pain AROM w/ concentric contraction pain/limited A/PROM placing stretch on musculotendinous unit (90-90, SLR test)
45
Strain: Hamstrings | what muscle is difficult rfs RTS criteria
Biceps femoris: greater recovery time and risk for recurrence Rfs: prior hx, hammy weakness, older athletes RTS criteria: jogging 70% baseline, RTS at 90-95% baseline
46
Hamstring strain hx
distinct injury/audible pop MOI: sprint w/ trunk flex and fast running
47
Strain: ADDS | rfs, MOI, sx
rfs: prior hx, decreased ROM hip ABD soccer,hockey MOI: directional change when running sx: groin pain (worse quick stops/starts)
48
Strain: Iliopsoas | MOI sxs
MOI: forced hip ext during active hip flex sx: anterior hip/groin pain, painful high stepping
49
Strain: Quads | most difficult muscle rfs MOI
Rectus femoris worse prognosis- longer recovery rfs: older athletes, dry playing field, shorter, dom. LE strength/flex MOI: kicking while running, sprinting (accel/decel)
50
Strain: glut med/min hx
fall, increased duration/frequency of loading, sport-related injury middle-aged women
51
Strain: glut med/min sxs
buttock/lateral hip/ groin pain
51
Bursitis- Trochanteric
greater risk: 40-60y/o W>M lateral hip pain, tender GT, +FABER, pain rotation, ABD/ADD, radiating pain down lateral thigh pain hip ABD against resistance
52
Bursitis- Iliopasos/Iliopectineal
frequently un-recognized anterior hip pain pain/limited hip flex ROM pain/limited hip ext and ER tender to palp/ between anterior joint and iliopsoas
53
GTPS | where tender may involve what correlations
TTP GT with pt side-lying may involve glut max/med/min bursae, muscle attachments, other soft tissues correlations: hip/lumbar/knee OA, tendinopathy, ER strain prevalence with mechanical LBP, and knee OA
54
GTPS hx
females obesity LBP/ chronic arthropathy of hip/knee middle age/older
55
GTPS sxs
pain greater at night aggravated w/ standing >15min radiating sxs (paresthesia/pain) limits/pain w/ donning and doffing socks/shoes sxs radiate to knee or below knee
56
GTPS examination
excess ABD vs ADD during gait TTP lateral hip ITB tight +FABER, resisted external derotation pain/limit hip ADD ROM (possibly IR too) Pain/weak hip ABD and ER RT and AROM
57
Nerve entrapments -how to find
-remember pathways -start prox, work dist -is structure sensory, motor or both -potential mechanisms for compression
58
3 categories PN injuries
-compression (low and high pressure) -interruption of axonal continuity -stretching (tensile)
59
Low pressure compression injury
-impaired circulation in epineural for prolonged time -depletion of O2 in endothelial cells of capillaries-increased vascular permeability -leaking of fluids/protein into endoneural space (edema) -Increased EFP -occludes vessels that penetrate perineurium -endoneural edema and O2 depletion
60
Sciatic N vs Obtuator N- potential areas of compression
S: piriformis, ischial tuberosity/GT, long head BF O: overlying fascia
61
S vs O -motor distribution
S: hammys, fibular and tibial distributions O: ADDs/IR
62
S vs O -sensory distribution
S: lower leg tibial and fibular dist. O: medial thigh and knee joint
63
S vs O -clinical indicators
S: Achilles and hamstring DTRs diminished O: hx pelvis fx, THA, pelvic sx, prolonged labor
64
Femoral N vs Lateral femoral Cutaneous N. -areas of compression
F: inguinal canal LFC: inguinal canal
65
F vs LFC -motor dist.
F: knee extensors LFC: N/A
66
F vs LFC -sensory dist.
F: anterior thigh/lower leg LFC: anterio-lateral thigh
67
F vs LFC -clinical implications
F: diminished patellar reflex, aggravated hip ext, EMG good prog for recovery in year LFC: latrogenic, compression from belts, obesity, pregnancy, improves with hip flex/sitting, worsens standing/walking
68
Avulsion fxs characteristics | who gets them involving?
M>W 2nd decade (young athletes, growth plates) mimics apophysitis involving: ischial tub., AIIS, ASIS, pubic symphysis, iliac crest, LT/GT
69
Avulsion fxs hx
vigorous activities
70
Avulsion fxs sxs
known trauma local pain (worse w/ activity, better w. rest)
71
Avulsion fxs examination
TTP antalgic gait/limp hematoma crepitus muscle guarding limit/pain hip ROM (stretching contractile unit) pain/weak RT (of action unit does)
72
Stress fx pathophys
repetitive microtrauma osteoblastic activity lags compares to osteoclastic activity may progress to cortical disruption (clear fx line) then complete fx
73
Fatigue fx vs insufficiency fx
F: normal bone, abnormal stress I: abnormal bone, normal stress
74
Low risk stress fxs
compressive managed w/ activity -pain free activity 4-8wks location: femoral shaft, medial tibia, ribs, ulna shaft, mets 1-4
75
High risk stress fxs
prog worsens with time required for dx prolonged NWB locations: femoral neck, patella, anterior tibial diaphysis, medial malleolus, talus, navicular, prox 5th met, 1st MTP seasmoids
76
Stress fx hx | why it happens what's affected rfs
insidious, progressive ADLs affected with progression continual pain w/ pathologic progression increased training intensity rfs: females, amenorrhea, smoking, steroid use
77
Stress fx sxs
focal pain exercise-induced pain night pain
78
stress fx examination | what pt will present like
local tenderness limited ROM at joint area (guarded or painful end feel) palpable guarding possible local swelling MRI, bone scan
79
Stress fx HIP sxs
5% of all stress fxs (that's high) exercise-induced pain hip,groin, thigh, or referred to knee pain night pain WB activity aggravates
80
Stress fx hip examination | specifically pain and dx
diffuse groin/hip pain +PPPT, fulcrum MRI, bone scan findings

MSK2 (7 decks)

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