Hip Injuries and Conditions--week 10 QUIZ Flashcards by ROGER ALONSO

Hip Anatomy

Boney landmarks

 ________________= SARTORIUS and tensor fasciae latae
 Iliac crest – Gluteal muscle attachment
 ___________=Rectus femoris attachment
 Greater trochanter – Vastus lateralis and gluteal muscles
 Posterior superior iliac spine (PSIS)
 _____________Hamstring muscles
 Pubic ramus – Adductors

Anterior superior iliac spine (ASIS)

Anterior inferior iliac spine (AIIS)

Ischial tuberosity

How well did you know this?

Not at all

Perfectly

Hip Anatomy

Flexors:

Iliopsoas
______ _____
Sartorius, Pectineus, TFL

Extensors:

________ __________
Long head of Biceps Femoris,Semitendinosis
Semimembranosis, Adductor Magnus

Abductors/internal rotators:
1. Gluteus Medius/Minimus, _________

Rectus Femoris

Gluteus Maximus

TFL

How well did you know this?

Not at all

Perfectly

Hip Anatomy

Adductors:

Adductor longus, brevis & magnus
Gracilis, Pectineus

External rotators:

________ ________
Piriformis
Quadratus Femoris

No pure internal rotators

Gluteus maximus

How well did you know this?

Not at all

Perfectly

Hip Pain

Common complaint
• Etiology can be numerous
Note: patients often claim “hip pain” when in fact the pain is in ________, groin, pelvis etc.

low back

How well did you know this?

Not at all

Perfectly

Hip Pain

Appropriate History
• Rule out more _______ _________
– ask about night sweats, fevers, weight loss
– history of menstrual irregularities, amenorrhea
• To help r/o ______ _____ of the hip pain – ask about nausea, vomiting, diarrhea, changes in stools, or presence of blood in stools
• To help r/o _______ _________
– ask about LBP; radiation of pain down the leg into the calf, foot, or toes
– numbness, tingling, or weakness in the leg or foot

dangerous pathologies

abdominal sources

spinal causes

How well did you know this?

Not at all

Perfectly

Differential Diagnoses of Hip/Groin Pain

Metabolic bone diseases
 – e.g. Paget’s
• Neoplasms
– e.g. Osteoid osteoma, metastatic disease
• \_\_\_\_\_\_\_\_\_ condition 
– e.g. Osteomyelitis
• Referred pain
– e.g. L/S, pelvic viscera: prostatitis, UTI, GYN disorders
• \_\_\_\_\_\_\_\_\_ conditions
– e.g. AS, Reactive Arthritis (Reiter’s)
• Hernia

Infectious

Inflammatory

How well did you know this?

Not at all

Perfectly

Hip Examination

Exam of the ____ and __________ _______
Important – > establishes if the patient’s hip pain is referred pain from these sites

knee

lumbosacral spine

How well did you know this?

Not at all

Perfectly

General NMS Diagnosis

What is the source of the patient’s problem?
• Is it vascular? _____ ________
• Is it neural? Neural tension tests
• Is it muscular? Muscle tests
• Is it ligamentous? Stretch tests
• Is it joint? ___________ tests
• Is it disc? Patient position/compression tests

Check pulses

Compression

How well did you know this?

Not at all

Perfectly

Allis Test

Positive Finding: femur protrudes farther caudally and/or tibia protrudes higher

• Indication: femoral length discrepancy and /or tibial length discrepancy

Know

How well did you know this?

Not at all

Perfectly

Ortolani’s Test

Positive Finding: A palpable or audible click or clunking sensation (as the head of the femur slips back into the socket)

• Indication: Displacement of the femoral head in or out of the acetabular cavity

Know

How well did you know this?

Not at all

Perfectly

Muscle Strains/Ruptures

• Most common athletic injury of the hip
Mechanism of injury:
– Violent contraction OR forceful stretching
– May also occur from sudden stopping, rapid __________ & _________
• Increased chance w/muscles that move 2 joints (ie: hamstrings, quadriceps)

deceleration & acceleration

How well did you know this?

Not at all

Perfectly

Risk Factors for Hip Injury
• Inadequate flexibility&warm-up
• Muscle strength imbalances
• Weakened by previous injury (_____ ______) & lack of rehab or faulty rehab & Muscle weakness.
Increasedage
• Muscle fatigue
• Poor technique with sport
• Muscles subjected to prolonged exposure to cold
• Sports demanding maximum muscular work

scar tissue

How well did you know this?

Not at all

Perfectly

Classification of Muscle Strains

Grade I Strain:
• Mild injury
• Overstretching w/ rupture of NONE or

pull

structural

How well did you know this?

Not at all

Perfectly

Classification of Muscle Strains

Grade II Strain:
• Moderate injury
• ________ _______ of muscle- tendon unit–partial rupture

Incomplete rupture

Pop

How well did you know this?

Not at all

Perfectly

Classification of Muscle Strains

Grade III Strain:
• Severe injury; possible \_\_\_\_\_\_\_
• Complete rupture
• Moderate to severe functional loss
• Palpable defect across entire belly
• Muscle may ‘bunch up’ &amp; form a lump
• Unable to contract muscle
• Tenderness &amp; swelling
• After 24 hrs: bruising
• X-ray to r/o avulsion fx

avulsion

How well did you know this?

Not at all

Perfectly

Hamstring Strain

Classic Presentation
• Athlete or weekend warrior, sudden pull or pop
• Onset of pain following forceful knee ________
– Over contraction while in position of stretch

• Strength imbalance hamstrings
– Strength imbalance of _____% or more between right & left hams OR
– Flexor-extensor strength ratio of

extension

How well did you know this?

Not at all

Perfectly

Hip Adductor Strain (Groin Pull)

Classic Presentation
• Athlete,sudden I ncapacitating pulling in groin
– Kicking, sprinting, sideways kicks in soccer, hard track running, ice hockey, skiing, hurdlers, high-jumpers
• MC site = _______ ________
• Pain at pubic attachment or w/in adductors itself
– PN with _________ and resisted adduction
• Contributing factors:
– Inadequate warm-up
– Poor flexibility, endurance
– Leg length discrepancy

adductor magnus

abduction

How well did you know this?

Not at all

Perfectly

Hip Adductor Strain
DDX
• _______ muscle injury,osteitis pubis,hernia, disorder of bowel, bladder, testicles, kidneys

Abdominal

How well did you know this?

Not at all

Perfectly

Rectus Femoris Strain

Classic Presentation
• Pain just above hip joint or ant thigh
• Sudden contraction of _____
• Sudden stopping

Physical Examination
• Palpable tenderness
• Pain w/active knee extension
• Pain with resisted hip flexion/knee extension
• Pain w/isometric quad contraction w/ leg ext
• Possible defect on resisted extension
• Strength imbalance w/hamstring

quads

How well did you know this?

Not at all

Perfectly

Treatment of Muscle Strain

GOAL:
Restore strength, stability & fxn
1. Decrease _______
2. Promote ST healing
3. _______ muscle
4. Regain muscle power, strength and flexibility
5. Regain endurance and aerobic conditioning

pain

Stretch

How well did you know this?

Not at all

Perfectly

“R.I.C.E.”

Rest:
–

Crutches

Hemorrhage

How well did you know this?

Not at all

Perfectly

“M.I.C.E”

“Addition of a talocrural _________] to the RICE protocol in the management of ankle inversion injuries necessitated fewer treatments to achieve pain-free dorsiflexion and to improve stride speed more than RICE alone.”

Early mobilization within pain-free range of motion

mobilization

How well did you know this?

Not at all

Perfectly

M.E.T.H.–End of the ice age?
Mobilization Elevation Traction Heat

“These data suggest that topical cooling, a commonly used clinical intervention, seems to not improve but rather delay recovery from
________ exercise–induced muscle damage”.

eccentric

How well did you know this?

Not at all

Perfectly

Treatment
Conservative Treatment:
– Massage
– Ultrasound
– Electrical muscle stimulation
– Rehabilitation
• Sign and symptoms of injury resolve but ________ deficits persist;
TX / REHAB GOAL: restore ______] function
– CMT
– Stretch: gentle w/ caution as early as possible when tolerable – Re-strengthen: begin when ___% of normal ROM available – Nutritional advice, anti-inflammatory diet

Study These Flashcards

functional

normal

Treatment Early: Initiate ____ _____ to prevent atrophy & promote healing – Stationary bike, pool therapy, proprioceptive exercises Conventional Treatment – NSAIDs, muscle relaxants, etc.

muscle action

``` Return to Activity • When strength is within ____% of uninjured side – Guided by symptoms & objective signs • Coordination • Strength balance • Speed, endurance • Painless athletic participation • Full flexibility • Grade1:w/ncoupleweeks • Grade2:w/n4-6weeks • Grade3 (full rupture):w/n3-4months ```

``` Hip Fracture Classic Presentation • Elderly ______ patient • Hip pain,unable to bear weight(?) • Possible fall on to hip – _______ trauma - such as a stumble or fall from standing height ``` Causes • Elderly:MC = ___________ • Young:(other than major trauma or stress fracture if active) r/o tumor – Benign: fibrous dysplasia, unicameral bone cyst – malignant: Osteogenic sarcoma, Ewing’s sarcoma

female Minimal osteoporosis

Hip Fracture • Relatively common in older adults,often lead to devastating consequences. Disability frequently results from persistent pain and limited physical mobility • Associated w/substantial morbidity & mortality. Approximately ____-____% of patients die within 1-year of hip fracture Complications of surgery and/or immobilization: including development of deep vein thrombosis, pulmonary embolism, pneumonia, congestive heart failure, muscular deconditioning (loss of _______)

15-20 function

Slipped Capital Epiphysis (Adolescent Coxa Vara) Classic Presentation • MC hip condition in _______ – Ball at upper end of the femur slips off in a ________ direction - cause unknown • Overweight child or young, tall rapidly growing adolescent (8-17 yoa) • Trauma, but may be minor – ___% have no obvious traumatic HX --Occurs due to weakness of the growth plate.Often develops during periods of accelerated growth, shortly after the onset of puberty. • Acute: Salter-Harris type 1 epiphyseal FX • Chronic: gradual hip pain with antalgia • May only have knee pain Management • Surgical pinning is often used • Manipulation of slippage is contraindicated: may result in dire consequences including avascular necrosis

adolescents backward 50%

Bilateral slipped capital femoral epiphysis - Chronic: evidence of remodeling of the neck and an _______ bone bump that restricts flexion - Acute: absence of any evidence of __________

anterior remodeling

Avascular Necrosis (AVN) Cellular death of bone components due to ____________ of the blood supply – Bone structures then collapse, resulting in bone destruction, pain, and loss of joint function

interruption

Avascular Necrosis of Hip ``` ____________________ Disease  One form of AVN Classic Presentation • Male, MC 4---9yoa • Mild hip pain,limp,insidious onset • 15%have knee pain only • HX of trauma or metabolic disease NOTE: The younger the age of onset the _________ the prognosis- Children >10 yoa have a very high risk of developing OA. Cause • Believed to be due to disruption of vascular supply to _________ _________. ```

Legg Calve-Perthes better femoral head

AVN of Hip ***NOTE: May be asymptomatic and occasionally discovered incidentally on radiographs! Classic Presentation • _____ is typically the presenting symptom • Patients with AVN of the femoral head often report ______ pain that is exacerbated by weight bearing. • The pain may initially be mild but progressively worsens over time and with use. • Eventually, pain is present at rest and may be present at night.

Pain groin

Avascular Necrosis Management • Definitive DX: Radiographs • Under ____ yoa or with minor involvement no TX is required – observation only • ________ may be indicated - Bed rest and ___________ stretching exercises are often recommended. • Surgery required only in severe cases • Healing takes ~____ months • NOTE: LCPD may result in femoral head deformity and degenerative joint disease

4 Bracing abduction 18

Hip Bursitis, Tendinitis, Tendinosis • Occur commonly in active individuals: – Runners, cyclists, cutting sports such as football, hockey, soccer, etc. • Can occur after an ____ injury,such as an adductor strain from soccer, OR • Present as a chronic pain,such as a hamstring tendinosis from repetitive activities such as running • Training errors,biomechanical issues,and sudden increases in activity levels are risk factors • In adolescents:traction Injures such as ____ _______ can occur

acute avulsion fracture

TendonITIS vs. TendinOSIS Tendinitis • Inflammation • Involve _______ injuries accompanied by inflammation • Typically resolve with rest, ice, rehab, and anti-inflammatory modalities, anti-inflammatory meds

acute

TendonITIS vs. TendinOSIS Tendinosis • Chronic degeneration without ___________ • Main problem is failed ________, not inflammation – Accumulation of microscopic Injuries that don't heal properly – Inflammation can be involved in initial stages of injury,but inability of tendon to heal perpetuates the pain & disability •____________ medication may actually impair tendon recovery • Tx designed to designed to stimulate healing – Graston, ART, laser

inflammation healing Anti-inflammatory

2003 more than 3.5 million children under 15 suffered a sports related injury requiring medical treatment. Estimated ____% are overuse injuries. 1990’s it was 20%.

Hip Bursitis Bursae – flattened synovial-lined sacs – Serve as a protective buffer between bones & overlapping muscles OR b/w bones & tendons/skin – Filled with minimal amounts of fluid to facilitate movement during muscle contraction • Inflammation caused by ________ use,trauma, _________ • Inflammation causes synovial cells to multiply, increases collagen formation and fluid production

repetitive infection

Hip Bursitis Locations • Ischial tuberosity • Iliopsoas region • Greater trochanter Causes • Friction from ______ OR trauma from direct blow

overuse

Subtrochanteric Bursitis Classic Presentation • 40-60yoa • Painful inflammation of the bursa under ITB & gluteus tendon – subgluteus medius and maximus • Local pain at greater trochanteric region of the lateral hip - May radiate to low back, lateral thigh and knee; not all the way to ______ • PN worse when the patient ______ on the affected bursa; may wake pt at night when rolls onto affected bursa

foot lies

Subtrochanteric Bursitis Causes • Acute ________ – Contusions from falls, contact sports, and other sources of impact • Repetitive, cumulative irritation – Often occurs in runners but can also be seen in less active individuals

trauma

Subtrochanteric Bursitis ``` Evaluation • Some loss of internal rotation • Tenderness and swelling over greater trochanter, pain with FABERE’s Management • Reduce inflammation • Correction of abnormal ________ – leg length discrepancy ```

biomechanics

Iliopsoas Bursitis Classic Presentation • Anterior hip pain w/antalgic gait – May radiate into ant. leg (pressure on ________ nerve) Cause • Hip flexor tightness, repetitive activity – Constant friction from overlying psoas tendon Management • Rest, stretching of hip flexors • MRT of psoas with caution

femoral

Ischial Bursitis Classic Presentation • Pt reports sitting for long periods of time,fall on buttocks, horse-back riding • Athlete,sprinter-excessive hamstring contraction • Referral down leg mimicking ________

sciatica

Osteoarthritis Classic Presentation • Primary OA:Middle aged or elderly • Secondary OA: may have HX of trauma or other joint involvement, i.e.. _____ • Hip,possible buttocks,groin or knee pain • Insidious onset • Slow stiffening (especially _________ rotation) – Pt may walk with hip in external rotation • May c/o LBP

Gout internal

Osteoarthritis • Restricted passive Internal rotation and extension of hip • Radiographs: _________ joint space narrowing with subchondral cysts and osteophytes - Hallmark of OA Management • Weight loss if indicated • Non-wt bearing exercise:pool,bicycle • Strengthening joint,helps relieve pain • Stretching of hip contractures PNF or Myofascial Release • Use of cane only if pain is severe

Superior

Contusions and Myositis Ossificans Classic Presentation & Cause • MC area is _________ • Direct blow to ______ – Damages underlying muscle, subsequent hematoma formation • Swelling,___________,decreased ability to flex knee

quadriceps knee discoloration

Contusions and Myositis Ossificans Myositis Ossificans can develop if _____ is encouraged to remain. – Inflammation of muscle leading to bone formation – ________ response, seen radiographically – Contributing factors include: forceful stretching after injury, deep massage to area of injury, use of deep heat such as US

hematoma Calcification

Contusions and Myositis Ossificans Management For Contusion: • Application of tensor bandage,ice pack In ______ knee position Alternate ice on 10 min / off 10-20 min Prevents accumulation of blood in area • Moderate to severe contusion:crutches2-3d For Myositis Ossificans: • TX depends on degree of knee flexion restriction and deformity - _________ may be reabsorbed over time • Surgical excision may be necessary

flexed calcifications

Acetabular Labrum Tears Classic Presentation • Moderate to severe groin pain,limp – r/o genitourinary pathology • Night pain • Worse with activity • _______ or locking,occasionally giving away • No trauma or severe trauma • Many causes/predisposing factors: – repetitive trauma, hip dysplasia, ________ laxity • Leads to early degeneration

Clicking capsular

Acetabular Labrum Tears Evaluation & Management • Assess with FABERE,____________ Test,ROM • __________ Is considered the“gold standard” for diagnosis and treatment  Radiographs not helpful, MRI limited: ant. tear visualized / post. tear is not • Nodatacurrentlyonmanipulation • Standardmedicalapproach

Impingement Arthroscopy

The Impingement Test / Sign With patient supine,the hip and knee of the affected limb are flexed to 90° The leg is then adducted and ________ rotated in this position • Occurrence of sudden exacerbation of pain, typically in the groin, is considered a positive test ***Positive impingement test/sign shown to be present in more than ____% of patients with FAI syndrome (femoral acetabular impingement syndrome)

internally 90

Snapping Hip Syndrome Often no pain,just snapping • Audible snap or click that occurs in or around the hip • ______ of snapping Indicative of involved structure • Traumatic:consider acetabular tear • Intra-articular loose body – will present w/ signs of mechanical blockage of movement

Location

Snapping Hip Syndrome Cause • Tendon snapping over boney prominence or bursa – Lateral: ITB snapping over ________ trochanter – Anterior: iliopsoas tendon involvement or iliofemoral ligament over ant. joint capsule – Posterior: bicep femoris over ______ tuberosity

greater ischial

Snapping Hip Syndrome Management • Benign,position dependant • If painful or irritating,___________ rather than stretching involved muscles is helpful • Correct leg length inequalities,muscles imbalances – Overpronation • ITB involvement: check for weakness of Glut Med. – ITB will substitute for weak Glut Med.

strengthening

Paget’s Disease (Osteitis Deformans) ``` Classic Presentation • 90% _____________ • Increase in hat size • Insidious onset of LBP and/or hip pain IF ______________ • Middle aged, elderly ```

asymptomatic symptomatic

Paget’s Disease (Osteitis Deformans) Cause: unknown, ______ etiology suspected – metabolic disorder characterized by abnormal _________ remodeling • Radiographs: bone is thickened, more apparent trabeculae (cross-hatching) eventual distortion of femoral neck or shaft • TX: No medical treatment currently to prevent or cure

viral osseous **Patient with Paget disease > dense sclerosis involving the femoral head and neck ****

Hip Injuries and Conditions--week 10 QUIZ Flashcards

(58 cards)