Hip and Lumbopelvic Clinical Correlations

Question 1

Meralgia Paresthetica

Answer 1

• A sight of entrapment of the lateral cutaneous nerves
• Causes paresthesia over lateral groin/thigh regions

Question 2

What are some effects aging has on Lumbar vertebrae and discs?

Answer 2

-Decreased bone density/strength
- vertebral end plates bow inwards
-Increased compressive forces of periphery of vertebral body and zygapophyseal joints
- Spondylosis

Question 3

What is Spondylolisthesis and what does it do/occur?

Answer 3

It is a facture of “ pars interarticularis” between superior and inferior facet
- Or a fracture of lamina
- Results in anterior slippage of top vertebra on the bottom vertebra
-Can compress spinal cord or cauda Equina

Question 4

What is Stenosis and what are some causes?

Answer 4

• Stenosis means narrowing/spinal stenosis= narrowing of vertebral canal
• Spinal cord compression
• Causes: bony growth, bulging disc

Question 5

Foraminal Stenosis what is it and what are some causes?

Answer 5

• Narrowing of intervertebral foramen
• Nerve root compression
• Causes: bony overgrowth, osteophytes, posterolateral disc bulges

Question 6

What is a Disc Bulge? What are some reasons it occurs?

Answer 6

• degeneration due to age
• Habitual postural movement that causes loss of lumbar lordosis
• Slouched, forward bending

Question 7

Slipped Capital Femoral Epiphysis SCFE

Answer 7

• Adolescents 10-17 years old
• Femoral Head dislocates d/t weak epiphyseal plate
• Cause:
  
  • Acute trauma
  • Repetitive microtrauma
• Symptoms; Hip pain that radiates down knee

Question 8

Femoral Neck Fracture

Answer 8

• Most frequently fractured
• Narrowest and weakest part of femur
  -Sits at angle to line of gravity and body weight

Question 9

Femoral Proximal Femur

Answer 9

• transcervical
• intertrochanteric

Question 10

Femoral Intracapsular fracture

Answer 10

• Femoral head degeneration or necrosis d/t loss of blood supply

Question 11

Greater Trochanter and Shaft fractures

Answer 11

• Spiral
  -Comminuted

Question 12

Distal Femur Fracture

Answer 12

• Femoral condyle separation
• Blood loss to lower leg

Question 13

Total Hip Arthroplasty THA

Answer 13

• osteoarthritis is main reason for this surgery
• Acetabulum and Femoral head replaced with prosthetic components
• Structures that were painful ( bone ends without cartilage) have been removed
  -PT is important for rehab after this surgery to restore movement and function

Question 14

Hip Dislocation

Answer 14

• Congenital
  
  • neonates ( 1.5/1,000)
  • Femoral head sits higher than acetabulum and limb appears shortened
    -Acquired
  • Posterior dislocation
    - Position: flex + adduction + IR
    - A-P force, tears posterior capsule
    
    • Anterior Dislocation
      - Position: extension + abduction + ER
      - Acetabulum usually fractures

Question 15

Avulsion Fractures

Answer 15

• Small Piece of bone torn away from rest of bone
  
  • Common at apophyses( Lack secondary ossification center)
    Causes:
• Sudden acceleration/deceleration
  Sports
• Football
  -soccer
  -hurdles
  -basketball
  -martial arts
  Common Sites On Pelvis
• ASIS/AIIS
  -Ischial Tuberosity
• Ischiopubic ramus

Question 16

Hamstring Strain

Answer 16

-tear of proximal or distal hamstring tendons at their insertion points
-Common in sports/activates requiring hard running, kicking or quick starts
- Usually occurs due to inadequate warm up
- Hematoma results from torn blood vessels

Question 17

Trochanteric Bursitis

Answer 17

• Glute MAx. and TFL fibers move back and forth over Greater Trochanter
  -Sport: running
• Greater Trochanter TTP
• Pain with resisted abduction of ER
• Pain local but may radiate down IT band

Question 18

Ischial Bursitis

Answer 18

-Repetitive hip extension while seated
-Sports; Cycling , rowing
- Ischial tuberosity TTP
- Pain with sitting
- Pain local

Question 19

Trendelennburg

Answer 19

Gluteus Medius
- Abducts a free leg
- Stabilizes the pelvis on a fixed leg
Trendelenburg Sign
- Opposite side of pelvis drops with contralateral leg lifted
Causes:
- Superior Gluteal Nerve injury
- Spinal cord injury L4-S1
- Gluteus Medius Injury
Gluteus Medius weakness/atrophy
Trochanteric Bursitis

Question 20

Piriformis Syndrome

Answer 20

• Compression of Sciatic nerve by piriformis
  Causes:
• Excessive use of gluteal muscles
  -Trauma= piriformis spasm
• 12% of population = fibular division runs through piriformis
  Complete section of Sciatic nerve= no hip extension & no knee flexion
  Incomplete section of sciatic Nerve
• Inferior Gluteal nerve and Posterior Cutaneous nerve of thigh may be affected

Question 21

Hip and Thigh Contusions

Answer 21

“Hip Pointer”
- Contusion of iliac crest- Satorius attachment to ASIS
-May refer to avulsion fractures ( Satorius at ASIS of Rectus Femoris at AIIS)
“Charley Horse”
- Severe Cramping, pain, muscle stiffness
- Due to ischemia or contusion resulting in hematoma

Question 22

Psoas Abscess

Answer 22

Causes
- TB- Retroperitoneal pyogenic infection
- Crohn’s disease- regional enteritis of ileum
Fascia thickens, pus passes inferiorly to inguinal ligament and appears in superior thigh
Palpable in abdomen, may be observable in inguinal region
- mistaken for hernia

Question 23

Iliopsoas and Posterior Abdominal Pain

Answer 23

Iliopsoas has relations to : kidneys, ureters, cecum, appendix , sigmoid colon, pancreas, lumbar lymph nodes, nerve of posterior abdominal wall
- Adenocarcinoma of pancreas invades surrounding muscles (iliopsoas) causing excruciating pain
- Disease of intervertebral joints or SI joints causes iliopsoas spasm and protective reflex

Question 24

Groin Pull

Answer 24

Strain or tear of proximal attachment of flexor and adductor muscles
- Common in sports with:
- Quick starts/turns
- Extreme stretching

Question 25

Femoral Hernias

Answer 25

Protrusion of abdominal viscera through Femoral Ring into Femoral Canal - May enlarge through Saphenous opening More common in Females - Wider pelvis, smaller inguinal canals - Multiple pregnancies enlarge femoral ring and push fat into femoral canal