Hip Flashcards
(102 cards)
1
Q
primary osteoarthritis
A
- increasing age
- obesity
- “wear and tear”
- fam hx of OA
2
Q
secondary OA
A
- AVN
- infection
- trauma
- pediatric hip dz (congenital dysplasia, SCFE, Legg-Calve Perthes)
3
Q
sx of a OA
A
- groin pain or anterior thigh pain
- stiffness in hip joint
- decreasing ROM
- locking or grinding (crepitus) w/ movement
4
Q
PE of hip w/ OA
A
- leg length discrepancy (LLD)
- gait: antalgic, trendelenburg, toe-in, toe out
- progression of dz leads to decreased flexion, extension, abduction
5
Q
what is the first motion to lose in hip OA?
A
internal rotation
6
Q
XR for OA
A
- AP and lateral views
- joint space narrowing
- osteophytes
- cyst formation
- sclerosis
7
Q
conservative tx for OA
A
- activity modification (weight loss/low impact exercise)
- correct LLD w/ shoe lift
- NSAIDs
- corticosteroid injection
- assistive devices like can (opposite hand)
8
Q
surgery for OA
A
- total hip arthroplasty
- hip resurfacing (not really done any more)
9
Q
osteonecrosis aka AVN
A
- hip is MC site of AVN
- b/l in 50%
- occurs when blood supply to femoral head is disrupted and the bone in head of femur dies and gradually collapses
10
Q
possible causes of AVN
A
- trauma/injury
- long term steroid use
- alcoholism
- sickle cell
11
Q
common population of AVN
A
- M>F
- MC b/w ages of 40-65
12
Q
legg-calve-perthes
A
- AVN in pediatric hip
- congenital
13
Q
sx of AVN
A
- groin pain and/or buttock pain
- decrease in ROM losing IR and abd first
- pain is usually gradulat but can be acute onset if collapse occurs
- develops in stage and progression can be from several months to over a year
- stages I-IV
14
Q
PE for AVN
A
- LLD
- loss of motion in all directions
- antalgic gait
- pain localized to groin w/ ROM testing
15
Q
imaging for AVN
A
-XR:
-opacity in femoral head
-collapse of femoral head
MRI: used for staging AVN
16
Q
conservative tx of AVN
A
- meds to relieve pain but most successful tx are surgical
- if diagnosed in the early stage then these pts are good candidates for hip preserving procedures
17
Q
surgery for AVN
A
- core decompression
- drill holes into femoral head to relieve pressure in the bone and create channels for new blood vessels
- for early stages to prevent collapse of femoral head
- often combine w/ bone grafting to regenerate healthy bone
- usually NWB for 3 mos
18
Q
trochanteric bursitis
A
- inflammation of greater trochanteric bursa
- F>M
- can be hard to distinguish from tendinosis of gluteus medius and minimus
19
Q
causes of trochanteric bursitis
A
- repetitive stress (overuse)
- previous surgery (THA)
- injury/falling on hip
- LLD
20
Q
sx of trochanteric bursitis
A
- pain localized to the greater trochanter that can radiate to lateral thigh
- pain w/ increased activity
- pain at night w/ sleeping on affected side
- pain after prolonged sitting and then standing
21
Q
PE of trochanteric bursitis
A
- point TTP over greater trochanter
- pain w/ adduction and IR localized to greater trochanter
- XR nl
- pain exacerbated w/ active hip abduction
22
Q
tx of trochanteric bursitis
A
- activity modications
- NSAIDS (oral and topical)
- steroid injection: 2cc celestone/3cc 1% lidocaine using spinal needle (1 per mo. x 3 mos)
- PT
- surg. is rare
23
Q
iliopsoas bursitis
A
- located on inside (groin side) of hip
- pain localized to groin
- not as common as trochanteric bursitis but tx is similar
- <30 yo
24
Q
causes of iliopsoas bursitis
A
- repetitive stress
- leg length discrepancy
- RA
25
PE of iliopsoas bursitis
- present in hip flexion
- pain w/: passive hip extension, resisted hip flexion
- bursa TTP
- psoas sign
- obturator sign
26
psoas sign
Place patient in L lateral
| decubitus and extend R leg at the hip. If there is pain with this movement, then the sign is positive
27
obturator sign
Passively flex the R hip and knee and internally rotate the hip. If there is
increased pain then the sign is positive
28
tx of iliopsoas bursitis
- activity modification
- NSAIDs
- PT: massage, ice, heat, US
- steroid injection vs oral steroid
- surgery is rare
29
snapping hip
- snapping or popping sensation of the hip usually caused by tendons sliding over bony prominences
- can lead to trochanteric bursitis
30
MC site of snapping is where?
IT band moving over the greater trochanter
31
sx of snapping hip
- pt will describe it as hip is dislocating
- common when climbing stairs or rising from seated position
- if mild usually resolves w/ time
32
MC to see snapping hip in . . .
- adolescents
- dancers
- gymnasts
33
PE snapping hip
- normal ROM and gain
- some pts can reproduce the snapping while standing w/ leg adducted and rotating the hip
- can sometimes visualize the IT band subluxing over the greater trochanter
- nl XR
- positive ober test
34
tx of snapping hip
- pt education and observation
- NSAIDs
- stretching exercises of IT band
- activity modification
- surgery is rare
35
lateral femoral cutaneous nerve impingement aka meralgia paresthetica
pain and/or tingling and numbness radiating to the lateral part of thigh
36
causes of meralgia paresthetica
- obesity
- direct compression from tight clothing or straps around waist
- scar tissue from previous surg
- injury to nerve from anterior approach THA
- pregnancy
37
PS of meralgia paresthetica
- decreased sensation along distribuation of the nerve
- positive tinel sign medial to ASIS
- normal ROM and gail
38
diagnostic studies for meralgia paresthetica
- XRs are nl
| - EMG or NCS to help diagnose nerve damage
39
tx of meralgia paresthetica
- avoidance of clothes or activity that compresses the n.
- weight loss for obese pts
- local anesthetic injection or nerve block which can also confirm diagnosis
- oral steroids
- neurontin or lyrica sometimes
- surgical decompression only indicated for persistent or severe sx
- NSAIDs
40
possible causes of labral tear
- trauma (injury or dislocation of the hip) such as contact sports
- structural abnormalities can accelerate wear and tear of the joint causing a labral tear
- repetitive motions including sudden twisting or pivoting motions
41
sx of labral tear
- locking, clicking, or catching in hip joint
- groin pain or "C" sign
- stiffness and decreased ROM secondary to pain
42
PE of labral tear
pain or reproducible click w/ ROM most commonly when taking the hip of IR to extension
43
imaging for labral tear
- XRs are normal
| - MR arthogram is best study to determine labral tear **have to use dye or it won't get picked up!
44
conservative tx of labral tear
- NSAIDs
| - injection of corticosteroid into hip joint
45
surgical tx of labral tear
- hip arthroscopy will determine debridement vs repair of labrum
- repair rehab: restore ROM w/i the restrictions
46
femoroacetabular impingement
- condition where extra bone grows along one or both of the bones that form the hip joint - giving the bones an irregular shape
- over time this friction can damage the joint resulting in tears of the labrum and OA
47
types of FAI
- pincer
- cam
- combined
48
pincer type FAI
-occurs because extra bone extends out over the normal rim of the acetabulum
-The labrum can be crushed under the prominent rim of
the acetabulum
-clinically is probably more common
49
cam type FAI
-the femoral head is not round and cannot rotate
smoothly inside the acetabulum
-A bump forms on the edge of the femoral head that grinds the cartilage inside the acetabulum
-more painful
50
combine FAI
-both princer and cam are present
51
causes of FAI
- occurs b/c hip bones don't form normally during childhood growing years
- little that can be done to prevent it
- some never develop sx
52
what does symptomatic FAI indicate?
if sx present = already damage to cartilage or labrum
53
sx of FAI
- pain (groin)
- stiffness
- limping
- worse w/ turning, twisting, and squatting and may cause sharp, stabbing pain
54
PE of FAI
- impingement test: bring knee towards chest and then rate it inward towards opposite shoulder (pain = positive)
- imaging: XR, CT, MRI
55
tx of FAI
- activity modification
- NSAIDs
- PT
- surgical: hip arthroscopy
56
90% of hip dislocations are what type?
posterior
57
associated injuries w/ hip dislocations
-acetabular or femoral head fractures
58
causes of posterior hip dislocations
- high energy impact on the knee while pt is sitting w/ hip flexed and adducted
- ex: MVA when person is not wearing seatbelt and knees hit dashboard
59
causes of anterior hip dislocation
- common in sporting events
| - forceful abduction and ER
60
PE of posterior hip dislocation
- leg presents w/ hip in flexion, adduction and IR/shortening of limb
- knee and foot will appear rotated toward the middle of body
61
PE of anterior hip dislocation
- leg presents in abduction and ER
- leg rotated out and away from body
- check NV status
62
tx of hip dislocation
- prompt reduction to prevent osteonecrosis of femoral head
- closed reduction (recommended to use sedation or general anesthesia)
- palpable clunk
- get post reduction XR
- get CT to assess for associated injuries
- protected WB and activity modification (2-3 mos)
63
what is used to classify acetabular fxs?
Judet-Letournel Classification
| -10 fx patterns based on degree of columnar damage
64
PE of acetabular fxs
- d/t high impact falls of MVA
| - need to assess sciatic, femoral and obturator nerve function
65
imaging for acetabular fxs
- AP and Judet views
| - CT scan
66
conservative vs. surgical tx for acetabular fxs
- conservative: only if < 2-5 mm of displacement in the dome and femoral head maintains position
- surgical: displaced > 2-3 mm and can't maintain congruent joint
67
common causes of femoral head fx
- secondary to MVA (MC)
- axial load impact proximally through the femur
- high energy trauma
- can be associated w/ hip dislocation
68
sx of femoral head fx
groin pain esp. w/ WB
69
PE of femoral head fx
- check NV status
| - severe groin pain
70
imaging for femoral head fx
- XR: AP and Judet view
| - CT to evaluate for associated acetabular fxs
71
tx for femoral head fx
- closed tx for stable fxs and adequate reduction
| - ORIF for inadequate reduction or unstable fxs
72
femoral neck fx
- 50% of hip fxs are this type
- 80% occur in women
- average age is 77 for women and 72 for men
73
causes of femoral neck fx
- for older pts: fall onto greater trochanter (valgus impaction)
- younger pts: high energy trauma
- stress fxs seen in athletes, military recruits, ballet dancers
- osteoporosis/osteopenia
74
PE of femoral neck fx
- athletes describe insidious onset of pain over 2-3 weeks localized to groin that can radiate to the knee
- displaced fxs will be nonambulatory w/ shortening and ER of lower extremity
- TTP to groin and pain w/ ROM
75
imaging of femoral neck fx
- AP and IR view on XR
| - MRI to rule out suspected stress fx
76
Garden Classification of femoral neck fxs
- Type I: incomplete fx
- Type II: complete fx w/ no displacement
- Type III: complete fx w/ partial displacement
- Type IV: complete fx w/ complete displacement
77
treatment for stress fx of femoral neck
- NWB on crutches until asymptomatic
| - follow XRs closely since the risk for displacement is high
78
tx for nondisplaced fx of femoral neck
-ORIF w/ 3 cancellous screws
79
tx for displaced fx of femoral neck
- bipolar/hemiarthroplasy reserved for need for faster full WB, poor health, pathologic fx, poor ambulatory status before surgery (NOT for young active pt)
- THA for active young or eldery person if preexisting DJD
80
intertrochanteric fx
- b/w the greater and lesser trochanter of proximal femur
| - MC > 60 y/o
81
what attaches to the greater trochanter?
-gluteus medius
-gluteus minimus
(hip extensors and abductors)
82
what attaches to the lesser trochanter?
-iliopsoas
| hip flexor
83
causes of intertrochanteric fx
- most result from direct impact to greater trochanteric area from a simple fall
- younger pts = high energy
84
PE of intertrochanteric fx
- nondisplaced: may be ambulatory w/ minimal pain
- displaced fxs: nonambulatory w/ lower extremity shortened and ER
- ROM is painful
85
tx of intertrochanteric fx
- ORIF indicated unless extreme medical risk for surgery
- sliding hip screw vs. gamma nail
- to THA unless hardware failure
86
causes of greater trochanteric fx
- rare
- from direct blow from fall in elderly
- may occur following THA
87
PE of greater trochanteric fx
- lateral hip pain
| - pain w/ abduction
88
imaging in greater trochanteric fx
-MRI recommended
| b/c up to 95% may have an associated fx such as an intertrochanteric fx
89
tx of greater trochanteric fx
- usually nonoperative
- partial WB until callus visible on XR (4-6 weeks)
- gradually progress to WBAT
- ORIF only if pt is young and active w/ widely displaced greater trochanter
90
lesser trochanteric fx causes
- rare as isolated fx
- MC: adolescent males 13-17 y/o typically secondary to forceful iliopsoas contracture
- if in elderly: should be concern for pathologic fx
91
lesser trochanteric fx is usually a component of what?
IT fx
92
PE of lesser trochanteric fx
- pain in inguinal area
| - pain w/ passive ROM in all directions w/ max pain in extension and relief when seated
93
tx of lesser trochanteric fx
-nonsurgical tx w/ limb resting in flexion obtains excellent functional results
94
subtrochanteric fx
- b/w lesser trochanter and a point 5cm distal to the lesser trochanter
- high rates of malunion and nonunion
- usually associated w/ other injuries
95
causes of subtrochanteric fx
- elderly: low energy falls
- young: high energy falls from height or MVA or gunshot wound
- frequent site for pathological fx
96
PE of subtrochanteric fx
- unable to ambulate
- gross deformity usually present
- painful hip ROM and TTP and swelling of the proximal thigh
- NV exam needed
- susceptible to compartment syndrome d/t hemorrhage into the thigh
97
tx of subtrochanteric fx
- operative tx indicated
- ORIF of femur
- TTWB 4-8 weeks and FWB at 8-12 weeks
98
Ddx of subtrochanteric fx
- gilmore's groin (sports hernia)
- sacroilitis
- piriformis syndrome
99
how do you know on imaging that the injury to a forearm is high energy
there is a fx of the tibia and fibula at the same level
100
two very important things to present to an orthopod when presenting a case
- age of pt
| - date of injury
101
what type of injury should you keep in mind when a pt has pain w/ weight bearing?
think bone
102
approximately when do you lose the ability to remodel bone?
age 10
