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Hip conditions Flashcards

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1
Q

Snapping hip syndrome

A

Characterised by audible ‘snap’ or ‘pop’ typically occurring with dynamic hip movement
Source of pain + snapping noise produced by subluxation of iliopsoas tendon during ROM

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2
Q

What its snapping noise associated with for snapping hip syndrome

A

Thickened IT band, causing slippage back and forth over greater trochanter –> pain + audible snapping

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3
Q

Epidemiology of snapping hip

A

tight muscle
Internal- Iliopsoas tendon snapping over ant aspect of fem head
External- Tight IT band snapping over greater trochanter

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4
Q

Age groups affected by snapping hip

A

Younger people (athletes) as hips become very tight during growth spurts

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5
Q

Risk factors of snapping hip

A

Overuse- particularly in sport, repetitive strain on a muscle

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6
Q

Clinical presentation of snapping hip

A

Palpable or audible snapping sensation that is heard during movement
Commonly localise pain to greater trochanter

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7
Q

Prognosis for snapping hip

A

May asymptomatic, therefore benign condition, amenable by stretching/conservative treatment
If Pt not relieved by 6 months surgical options may be necessary

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8
Q

Iliopectineal bursitis

A

Inflammation of bursa located beneath iliac muscle

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9
Q

Epidemiology of iliopectineal bursitis

A

Acute trauma
Overuse injury

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10
Q

Age groups affected by iliopectineal bursitis

A

Seen predominately in males, generally doesn’t occur till after skeleton has matured
40-60

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11
Q

Risk factors of iliopectineal bursitis

A

Having OA or RA

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12
Q

Clinical presentation of iliopectineal bursitis

A

Variable symptoms
Pain, mass lesion, or compression syndrome of inguinal compartment

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13
Q

Prognosis of iliopectinal bursitis

A

RICE
Should get better on own

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14
Q

Ischial/trochanteric bursitis

A

Condition of inflammation of bursa between ischial tuberosity + gluteus mediums

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15
Q

Epidemiology of ischial/trochanteric bursitis

A

Receptive stress/microtrauma on ischial bursa, causing inflammation
Can happen when sitting for long periods
Playing sports which require repetitive motion

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16
Q

Age groups affected by ischial/trochanteric bursitis

A

Seen predominately in male, generally doesn’t occur till skeleton has matured
40-60

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17
Q

Risk factors of ischial/trochanteric bursitis

A

Having OR or RA

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18
Q

Clinical presentation of ischial/trochanteric bursitis

A

Gluteal pain
Aching in lateral hip, localised to area lying over greater trochanter/palpable tenderness
Sharp/intense
Radiation down outer thigh towards knee, rarely beyond IT band insertion
Exacerbated while lying on affected side/climbing stairs

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19
Q

Prognosis for ischial/trochanteric bursitis

A

NSAIDs and PT to strengthen and stretch surrounding muscles
Some don’t respond to conservative treatment, therefore may need surgery

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20
Q

Trochanteric bursitis DDX

A

Snapping hip

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21
Q

Meralgia parasthetica

A

Disorder characterised by tingling, numbness, and burning pain in outer side of thigh
Compression of lateral femoral cutaneous nerve

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22
Q

Epidemiology meralgia parasthetica

A

Obesity
Pregnancy
Local trauma
Diseases such as diabetes (related to nerve injuries)
Tight clothes

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23
Q

Age groups affected by meralgia parasthetica

A

People aged between 30-60 at higher risk

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24
Q

Risk factors of meralgia parasthetica

A

Age
Diabetes
Pregnancy
Obesity

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25
Clinical presentation of meralgia parasthetica
complaints of pain, burning, numbness, muscle aches in lateral thigh Pt may have mild symptoms with spontaneous resolution or may have more severe pain that limits function
26
Prognosis of meralgia parasthetica
Good prognosis Improvements seen with conservative treatments Can spontaneously resolve
27
Acquired dislocation of hip
Native dislocations or dislocations after total hip replacement
28
Epidemiology of acquired dislocation of hip
Motor vehicle accident- occur when knee hits dashboard in a collision force drives thigh backwards, driving head of femur out of socket High level fall
29
Age groups affected by acquired hip dislocation
16-40
30
Risk factors of acquired hip dislocation
Majority occur from motor vehicle accidents
31
Clinical presentation of acquired hip dislocation
Severe pain- separation of femur head from acetabulum, surrounding muscles and tendons damaged Radiating knee pain
32
Prognosis of acquired hip dislocation
Complications include post-traumatic arthritis, femoral head fracture, recurrent dislocation Nerve damage, may impact sciatic nerve
33
Protrusion acetabuli
Socket too deep and bulges into cavity of pelvis
34
Epidemiology of protrusion acetabuli
Unilateral may be caused by tuberculosis arthritis fibrous dysplasia (increase in abnormal cell growth)
35
Age groups affected by protrusio acetabuli
Reported cause of hip pain in OA young adults
36
Risk factors of protrusio acetabuli
BMI >25 Female- develops soon after puberty, at this stage usually no symptoms just limited ROM May occur later in life secondary to bone softening disorders
37
Clinical presentation of protrusion acetabuli
Radiographs of pelvis with an acetabular line projecting medial to ilioischial line Limited ROM Pain
38
Prognosis of protusio acetabuli
Total hip arthroplasty recommended for older adults
39
Coxa vara
Rare disorder or early childhood When child starts to crawl or stand, femoral neck bends or develops stress fracture, with continued weightbearing it collapses into virus
40
Epidemiology of coxa vara
Defect of endochondral ossification in medial part of femoral neck
41
Age groups affected by coxa vara
Infants Signs do not arise until early adulthood of femoral shaft
42
Clinical presentation of coxa vara
May be shortening or bowing of femoral shaft
43
Prognosis of coxa vara
If shortening is progressive the deformity should ne corrected by an ostomy
44
Femoral anti-version epidemiology
Excessive anteversion of femoral neck Int rotation of hip is increased and ext rotation diminished
45
Age groups affected
Infants Children should adopt buddha position (knees turned outwards)
46
Clinical presentation of femoral ante version
Toes point inwards
47
Prognosis of femoral ante version
Usually improves with growth
48
Slipped upper femoral epiphysis
Displacement of proximal femoral epiphysis Uncommon If one side slips there is a 30% risk of other side slipping
49
Epidemiology of slipped upper femoral epiphysis
2/3 Pt are overweight and sexually under developed Usually tall and thin
50
Age groups affected by slipped femoral epiphysis
Confined to children going through pubertal growth spurts Boys affected more than girls Boys 14-15
51
Risk factors of slipped upper femoral epiphysis
30% case have history of trauma
52
Clinical presentation of slipped upper femoral epiphysis
Pain in groin/anterior part of thigh or knee May limp Onset may be sudden On examination leg is externally rotated Leg tends to be 1-2cm shorter Limitation in abduction and int rotation
53
Prognosis for slipped upper femoral epiphysis
Following surgery improvements should be
54
Pyogenic arthritis
Staphylococcus reaches joint Unless infection is aborted rapidly the femoral head is destroyed by proteolytic enzymes of bacteria and puss
55
Age groups affected by pyogenic arthritis
Usually seen in children under 2
56
Clinical presentation of pyogenic arthritis
Child is ill and in pain Movement attempts are resisted Local signs of inflammation absent and blood samples are normal X-ray shows lateral displacement of femoral head, suggesting presence of joint effusion
57
Prognosis of pyogenic arthritis
Once given ABs symptoms should alleviate
58
Tuberculosis
Starts as synovitis, or osteomyelitis in adjacent bones Once arthritis develops, destruction is rapid and may result in pathological dislocation
59
Clinical presentation of tuberculosis
Pain in hip In late, neglected cases a cold abscess may present on thigh or buttock Pt may walk with limp Muscle wasting may be observed Limited/painful movement
60
Prognosis of tuberculosis
Early disease may heal leaving normal/almost normal hip If joint is destroyed the usual result is unsound fibrous ankylosis, leg is scarred and thin, shorter
61
The irritable hip
Probably due to non-specific, short lived synovitis with an effusion in hip joint
62
Irritable hip epidemiology
Exact cause unknown
63
Age groups affected by irritable hip
most common cause of acute limp and/or hip pain in children 14/1000 Usually occurs 3-8 years Boys 2x more affected
64
Risk factors of irritable hip
Being male
65
Clinical presentation of irritable hip
Pain around hip and limp Often intermittent and following activity Restricted ROM
66
Prognosis of irritable hip
Most children recover within a few days Deterioration in signs and symptoms require urgent assessment
67
Rheumatoid arthritis
Progressive bone destruction on both sides of joint without reactive osteophyte formation
68
Epidemiology of RA
Another rheumatoid disease Arthritis in other regions
69
Age groups affected by RA
Middle aged
70
Risk factors of RA
Women Middle-aged Family history Excess weight
71
Clinical presentation of RA
Pt normally already has rheumatic disease affecting many joints Pain in groin usually comes on gradually Advancing disease may cause difficulty getting into/out of chair Wasting of buttock/thigh Limb usually held in ext rotation and fixed flexion All movements restricted and painful
72
Prognosis of RA
Disease can be arrested by general treatment Hip deterioration may be slowed down Once cartilage and bones are eroded, no treatment will influence progression
73
Osteoarthritis
Most common form Eventual degeneration joint destruction
74
Epidemiology of OA
Obesity= significant contributing factor Ageing History of injury
75
Age groups affected by OA
More common before 45 for men More common for women over 45
76
Risk factors of OA
Obesity Female Genetics Repetitive stress on joint
77
Clinical presentation of OA
Often complain of insidious pain in groin/inguinal region Pain on side buttock/upper thigh Exacerbated through physical activity and weight bearing activities Stiffness in morning, doesn't last longer than 30 mins, eases following movement
78
Prognosis of OA
Extremely variable Different to predict course of treatment
79
Femoroacetabular impingement
Abnormal contact of femoral head or neck against acetabular rim during movement
80
CAM impingement
Fem head not round
81
Pincer impingement
Fem head pinces acetabulum
82
Epidemiology of femoroacetablar impingement
Can be related to specific osseous abnormalities (congenital or degenerative)
83
Clinical presentation of femoroacetabular impingement
Complaints of anterolateral hip and/or groin pain Pain exacerbated from activities requiring deep flexion Sharp, stabbing pain Intermittent dull ache in initial stages Complaints from prolonged sitting, rising from seat
84
Prognosis of femoroacetabular impingement
Conservative treatments used to increase flexibility and strengthen in core and hip May cause damage to chondral surface due to repetitive impingement, therefore referral to orthopaedic surgeon may be necessary
85
Perthes disease
Rare childhood condition that affects the hip Occurs when blood supply to head of femur is temporarily disrupted Without adequate blood supply, bone cells die (aka avascular necrosis)
86
Perthes Hx
P in groin Medial thigh or knee P (w/o knee patho)
87
Perthes S+S
Antalgic gait Red ROM Hip may refer P down to knee
88
Acetabular labral tear Hx
Prior trauma Deep hip/groin P Worse with full hip flexion Possible locking
89
Acetabular labral tear SSx
Audible click with motion P with full passive hip flexion
90
Hernia- inguinal or femoral Hx
M>F 9:1 Prior heavy lifting Lifting with Valsalva causes more P
91
Hernia SSx
Palpable protrusion worse with valsalva Red flags- nausea, fever, vomiting, discolouration indicative of strangulated hernia= medical emergency
92
Hernia DDx
Groin strain Testicular torsion
93
Piriformis syndrome Hx
Possible P down back of leg Worse when sitting on hard surfaces P getting out of bed P in buttock worse with movement
94
Piriformis syndrome SSx
Tender to palpation +ve SLR
95
Piriformis syndrome DDx
Lumbar radiculopathy Disc herniation Lumbar sprain/strain

Orthopaedic Conditions (11 decks)

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