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Year 3 - Musculoskeletal > Hip conditions > Flashcards

Hip conditions Flashcards

1
Q

Where is the trochanteric bursa?

A

Sandwiched between hip abductors and ITB

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2
Q

What is Trochanteric Bursitis?

A

Inflammation of the bursa, Swelling

More common in females

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3
Q

Cause of Trochanteric Bursitis?

A

1) Trauma

2) Over-use
- Athletes, often runners
- Repetitive movements

3) Abnormal movements
- Distant problem e.g. Scoliosis
- Local problem
> Muscle wasting following surgery
> Total Hip Replacement
> Osteoarthritis

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4
Q

Presentation of Trochanteric Bursitis?

A

Pain = Point tenderness, Lateral hip

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5
Q

Examination of Trochanteric Bursitis?

A

1) LOOK
- May have scars from previous surgery
- May have muscle wasting, Gluteals

2) FEEL
- Tenderness at Greater
- Tuberosity

3) MOVE
- Worst pain in active abduction

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6
Q

Investigation for Trochanteric Bursitis?

A

1) X-ray
- May be normal
- OA, THR, Spine abnormalities

2) MRI
- Shows soft tissues and fluid

3) Ultrasound
- Can be therapeutic as well as diagnostic
- Guided injection

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7
Q

Treatment of Trochanteric Bursitis?

A

1) NSAIDs
2) Relative rest / Activity modification

3) Physiotherapy
- Correct posture, abnormal movements
- Stretching
- Strengthen muscles around joint

4) Injection = Corticosteroids

5) Surgery
- Bursectomy
- Rarely required

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8
Q

What is avascular necrosis?

A

Death of bone due to loss of blood supply

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9
Q

Epidemiology of avascular necrosis?

A

Males > Females

Average age 35-50 years old

80% = bilateral

May be offset in time

3% = multifocal

3 or more joints

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10
Q

Risk factors for avascular necrosis?

A

1) Trauma
- Irradiation
- Fracture
- Dislocation
- Iatrogenic

2) Systemic
- Idiopathic
- Hypercoaguable states
- Steroids
- Haematological
> Sickle Cell Disease
> Lymphoma
> Leukaemia
- Caisson’s disease
- Alcoholism

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11
Q

If there is fracture to the neck of the femur what may occur?

A

Avascular necrosis of the femoral head due to loss of blood supply from the medial/lateral circumflex artery

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12
Q

Symptoms of avascular necrosis?

A
  • Insidious onset of groin pain
  • Pain with stairs, walking uphill and impact activities
  • Limp
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13
Q

Examination of avascular necrosis?

A

> Largely normal
May replicate early arthritis
- Reduced range of motion (partic internal rotation)
- Stiff joint

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14
Q

Investigations in avascular necrosis?

A

X-Ray (Wont identify early stages)

MRI

  • 99% sensitive and specific
  • Will identify earliest changes
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15
Q

Treatment of avascular necrosis?

A

Non-Operative

  • Reduce weight-bearing
  • NSAIDs
  • Bisphosphonates
  • Anticoagulants
  • Physiotherapy

Surgical

  • Restore blood supply
  • Core decompression
  • Core decompression and vascularised graft
  • Move the lesion away from the weight-bearing area
  • Rotational Osteotomy
  • Total Hip Replacement
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16
Q

What is the most common cause of hip pathology in younger patients?

A

Femoroacetabular Impingement (FAI)

17
Q

What can Femoroacetabular Impingement (FAI) often lead to?

A

Secondary osteoarthritis

18
Q

What is Femoroacetabular Impingement (FAI)?

A

Broadly divided into 2 categories

1) Cam lesion (Lesion on head of femur)
2) Pincer (Lesion on acetabulum)

Results in impingement of femoral neck against anterior edge of acetabulum

19
Q

Associated injuries of femoroacetabular impingement?

A

Labral degeneration and tears

Cartilage damage and flap tears

Secondary hip osteoarthritis

20
Q

Presentation of femoroacetabular impingement?

A

Groin pain = Worse with flexion

Mechanical symptoms
  -  Block to movement
  -  Pain with certain manoeuvres:
   > Getting out of a chair
   > Squatting
   > Lunging
21
Q

Examination of femoroacetabular impingement?

A

Reduced flexion and internal rotation

Positive FADIR test = Flexion, ADduction, Internal Rotation

22
Q

Investigations for femoroacetabular impingement?

A

X-ray - Identify the bony pathology

MRI = Useful for assessing associated conditions:

  • Labral tears
  • Articular cartilage damage
23
Q

Treatment in femoroacetabular impingement?

A 
Non-operative
  -  Activity modification
  -  NSAIDs
  -  Physiotherapy
    > Correct posture
    > Strengthen muscles around joint
Operative
  -  Arthroscopy
    > Shave down the defect
    > Deal with labral tears
    > Resect artic cartilage flaps
  -  Open Surgery
    > Resection
    > Periacetabular Osteotomy
    > Hip Arthroplasty
       - Resurfacing
       - Replacement
24
Q

Labral tear?

A

Most commonly anterosuperior tear

25
Q

Causes of a labral tear?

A

FAI

Trauma

OA

Dysplasia

Collagen diseases – Ehlers-Danlos

26
Q

Epidemiology of a labral tear?

A

All age groups

Commonly active females

  • Pincer
  • More flexible
27
Q

Presentation of a labral tear?

A

Groin or Hip Pain

Snapping sensation

Jamming or locking

28
Q

Examination of a labral tear?

A

Can be normal

Positive FABER test = Flexion, ABduction, External Rotation (Anterior tears)

29
Q

Investigations of a labral tear?

A

Ensure adequate imaging so identify any root causes of pathology

X-ray
- OA, Dysplasia

MRI Arthrogram
- 92% sensitive

Diagnostic injection
- Local anaesthetic

30
Q

Labral Tear - Treatment?

A

Non-Operative

  • Activity modification,
  • NSAIDs,
  • Physiotherapy
  • Injection of Steroids

Operative
- Arthroscopy
> Repair
> Resection

Year 3 - Musculoskeletal (30 decks)

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