Hip Pain Flashcards
(25 cards)
Where may hip pain refer?
- Buttock
- Groin
- Anterior thigh
- Lat thigh
Innervation of the hip joint?
Hip joint is innervated by articular branches from the:
- Femoral and obturator nerves (L2-L4)
- superior gluteal nerve and nerve to quadratus femoris (both L4 - S1)
How to assess symptom severity / impact?
- PADL, DADL, CADL limitations
e. g. walking distance/ mobility, sleep disturbance - Analgesics / NSAID use
DDx for hip pain?
- Local: bone/joint, soft tissue
- Referred: spine, SIJ
Pathology: fracture, arthritis, bursitis, tendinopathy,
-DON’T MISS: infection, tumour
RFx for AVN?
- Steroid use
- EtoH
- Idiopathic
- Fractures / trauma
What is the screening rheumatological exam?
GALS: gait, arms, legs and spine. Rate appearance, movement.
What is the Thomas test?
-Pt lying flat (spine flat)
-flex both hips
-straighten either leg
Fixed flexion deformity = failure of extension on affected side
Apparent leg length vs true leg length?
- Apparent: measure from umbilicus to medial malleolus (may be due to scoliosis, contracture etc)
- True: measure from ASIS to MM
What is the Trendelenburg test?
Checks abductor mechanisms of pelvis: normally holds pelvis level. Sound side sags.
Positive in any problem with hip joint, lever arm or power arm (with neck and abductors being lever / power)
Benefits of exercise for OA?
- strengthening muscular support around the joints
- helps weight reduction
- promotes endurance
Non-operative OA management?
- Exercise
- PTs (aids etc)
- Pharmaceutical therapy
- Corticosteroid injection
Pharmaceutical options for OA Mx?
- Analgesics: paracetamol, stronger analgesics (tramadol, codeine etc; generally use when pt on op waiting list)
- NSAIDs (problematic with renal / GI issues esp in elderly)
- Glucosamine and chondroitin: studies show only minor benefit
- Intra-articular corticosteroid injections
When are intra-articular corticosteroid injections most effective?
Early in natural Hx of OA when major contribution to pain is inflammation, before joint damage is more significant component
Indications for THR?
- disabling pain with failed non-op treatment for 3-6 mo
- painful hip joint at rest and at night
- severe impairment ADLs
What are the goals of hip arthroplasty?
- Relieve pain
- Correct deformity
- Restore ROM and ADLs
Components of pre admission assessment?
- FBE, UEC
- Coags (INR, APTT)
- Blood group and hold
- MSU, MRSA screen (nose, perineum)
- ECG for known IHD
- Adequacy of BP control, Sx of cardiac failure
Components of pre op informed consent?
- Dx and Natural Hx of condition; expected course if surgery not pursued
- Recommended treatment and alternative treatment
- Risks and complications (general and specific)
- Give pt opportunity to ask questions
What are the complications of hip replacement?
Intra OP: injury to neurovascular structures, fracture
Early post op: haematoma, infection, wound dehiscence
Late post op: dislocation, leg length disrepancy, #, loosening, heterotopic ossification
Indications for inpatient rehabilitation post op?
- Medical complications / comorbidities
- Pre existing functional impairment
- Post op weight bearing restrictions
- Persistent pain, decreased ROM
- Poor social support
Anti coagulation post THR?
6weeks Clexane OR rivaroxaban
D1 post op Mx THR?
- ABx: 1g Cephazolin q8h x3
- Xray pelvis and hip lat view
- Blood test: FBE, U&E
- PCA analgesia
- PT: bed/standing exercises, breathing exercises
Hip precautions for 3 months?
- Keep bend at hip
Red flags for hip pain?
-Try and rule out
Tumour
Infection
Trauma
What is gluteus medius tendinopathy?
- Part of spectrum of greater trochanteric pain syndrome (GTPS)
- Tendon tears and calcification may be associated
- Analogous to rotator cuff tendon degeneration
