Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Sport FRCS > Hip sports injuries > Flashcards

Hip sports injuries Flashcards

1
Q

What is a snapping hip?

A
  • A condition characterised by a snapping sensation in the hip
  • caused by motion of the muscles and tendons over bony structures around the hip
  • common in dancers and atheletes
  • 3 types of snapping hip
    • external = caused by iliotibial tract sliding over GT
    • internal= most common form
      • iliopsoas tendon sliding over
      • femoral head
      • prominent iliopectioneal ridge
      • extostoses
      • iliopsoas bursa
    • intra-articular snapping hip
      • loose bodies in hip
      • seen in synovial chondromatosis
      • labral tear
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the presentation of a snapping hip?

A
  • Snapping sensation
    • painful or painles
    • lockng/clicking- indicative of intra-articular pathology
  • External snapping- can seen this
  • palpate GT when hip is actively flexed
  • Internal snapping hip
    • reproduced passively moving hip from a flexed and externally rotated position to an extended and internally rotated position.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the tx of a snapping hip?

A

Non operative

  • Activity modification
    • acute onset <6 months
    • Physio, injection corticosteriods

Operative

  • Excision of GT bursa with z plasty of iliotibial band
    • painful external snapping hip
    • tendon either partially/completely released
    • maybe done with arthroscope
    • variety of approaches
  • Release of iliopsoas tendon
    • painful internal snapping hip failed non op tx
  • Hip arthroscopy w removal of loose bodies or labral debridement/repair
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Discuss the epidemiology of labral tears?

A
  • Traumatic tear of acetabular labrum that may lead to pain, intra-articular snapping hip
  • highest incidence in pt with acetabular dysplasia
  • all ages
  • >F
  • Location: anterosuperior labrum
  • aetiology
    • femoroacetabular impingement
    • hip dysplasia
      • floopy labrum more susceptible to tearing
    • trauma
      • hip dislocations/subluxations are a common cause
    • capsular laxity
      • increased translational forces across labrum due to joint hypermobility
    • joint degeneration
      • causes acetabular edge loading
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the anatomy of the labrum?

A
  • Horse- shoe appearance shaped structure continuous with transverse acetabular ligament
  • 2 parts
    • articular= fibrocartilage
    • capsular- dense connective tissue
  • Vascularity
    • capsule and synovium at acetabular margin
  • Innervation
    • branch of nerve to quads femoris
    • obturator nerve
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the presentation of a labral tear?

A
  • Hip pain and snapping
  • vague groin pain
  • sensation of locking

O/E

  • anterior labral tear provocation= pain if hip is brought from fully flexed, external rotated, and abducted to extension, internal rotation and adduction
  • posterior labral tear= pain if hip brought from a flexed, adducted and IR to abduction, ER and extension
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the imaging of choice in labral tears?

A
  • Xrays- to rule out hip dysplasia, arthritis and acetabular cysts
  • MRI arthrogram study of choice
    • 92% sensitive for detecting labral tears
    • combined with intra-articular injections and steriod for dx adn therapeutic purposes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the tx of labral tears?

A

Non operative

  • rest, nsaids, physio, steriod injections
  • most first line

Operative

  • Arthroscopic labral debridement
    • those not amenable to repair
    • post op LWB x4/52, flexion and abduction limited 4-6 wks
    • outcomes 70-85% short term relief of symptoms following arthroscopic debridement, long term study not available
  • Arthroscopic labral repair
    • full thickness tear at labral- chondral junction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is femoroacetabular impingment? What is its aetiology?

A
  • A common cause of
    • early onset hip dysfunction
    • secondary OA
  • aetiology
    • Cam impingement
      • refers to femoral based disorder
      • usually male athletes
      • includes
        • decreased head/neck ratio
        • aspherical femoral head
        • decreased femoral offset
        • femoral neck anteversion
          • previous SUFE
    • Pincer impingement
      • refers to acetabular based disorder
      • usually Active middle aged women
      • includes
        • anterosuperior acetabular rim overhang
        • acetabular retroversion
        • acetabular protrusio
        • coxa profunda
    • Combined Cam/Pincher impingement
      • can include both pt populations
      • refers to combo of above 80%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Describe the mechanism of femoroacetabular impingment?

A
  • Result of impingment of the femoral neck against anterior edge of acetabulum
  • Proximal femur abuts acetabulum with ROM, esp flexion
    • occurs if femoral head/neck bone is too broad in Cam impingement
    • occurs if acetabular bone/labrum overhang is too broad in Pincer impingement
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the presentation of femoroacetabular impingment?

A
  • Activity related groin/hip pain, exacerbated by flexion
  • diffculty sitting
  • mechanical hip symptoms
  • can present gluteal/trochanteric pain- due to aberrant gait mechanism

O/E

  • Limited hip flexion o esp IR o
  • anterior impingement test- Flexion, adduction, IR = pain
  • ER extremity= due to post SUFE
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is seen on xray of femoroacetabular impingment?

A
  • xrays
    • asphericity and contour of femoral head
    • Pistol grip deformity = Cam impingement
    • Crossover sign= indicated acetabular retrovesion in Pincer impingement
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the tx of femoroacetabular impingment?

A
  • Non operative
    • minimally sympomatic pts

Operative

  • Arthroscopic hip surgery
    • mechnical / symptomatic pts
    • similar results to open
  • Open surgical hip dislocation
    • gold standard for mx of FAI for pts with clinical signs and structural evidence of impingment
    • Preserve cartilage, correctable deformity, resonable expectations
    • CI morbid obseity, age >55, advanced joint disease
  • periacetabular osteotomy
    • structural deformity of acetabulum w poor coverage of femoral head
    • osteotomy and fixation
  • Total hip replacement
    • age >60 yrs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the technique of arthroscopic hip surgery in FAI?

A
  • Ports
    • supine/lateral decubitus
    • load joint with saline to distent it
    • traction with well padded perineal posts
    • anterolateral scope place first
      • 2cm ant, 2cm sup to anteriosuperior border of GT. arthroscopic insertion over guidewire
    • anterior port placed second- hip flexed and IR to loosen capsule
      • located at intersection between superior ridge of GT adn ASIS
    • Posterior port last
      • located 2cm posterior to tip of GT
  • Trim femoral head/neck Cam impingement
  • Acetabular rim labral debridement vs repair
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the complications of hip arthroscopy?

A

Direct injuries

  • Chondral injuries from scope

Neurovascular injuries

  • traction related
    • Pudendal
      • most common injury
      • due to traction post in groin for traction
      • neuropraxia or compression
    • peroneal nerve injury
      • traction neuropraxia
  • Anterolateral port= risks Superior gluteal n
  • Posterolateal port= risks Sciatic nerve
  • anterior port= risks lateral femoral cutaneous nerve,femoral NV bundle, ascending branch of lateral femoral circumflex artery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Describe the technique for open surgical hip dislocation?

A
  • Approach
    • anterior ( smith - peterson) approach
    • best for femoral head/neck pathology due to limited exposure
    • acetabular tx involves take down of rectus femoris reflected head
    • femoral osteotomy and fixation
    • uses a trochanteric flip for access to prox femur and acetabulum
    • provides best visualisation
    • preserves all external rotators and blood supply to femur head
17
Q

What is the epidemiology and pathophysiology of trochanteric burisitis?

A
  • female runners
  • assoc w training on banked surfaces
  • pathoanatomy
    • repititive trauma caused by iliotibial band tracking over trochanteric bursa
    • can irritate the bursa-> inflammation
18
Q

What is the anatomy of the trochanteic bursa?

A
  • Superifical to hip abductor muscles
  • Deep to iiotibial tract
19
Q

Describe the presenation of trochanteric bursitis?

A
  • Lateral sided hip pain
  • Pain on palpation over GT
20
Q

What is the tx of trochanteric bursitis?

A

Non operative

  • Nsaids, stretching, Physio, corticosteriod injection
  • first line

Operative

  • Open vs arthroscopic trochanteric bursectomy - if consx fails
21
Q

What is femoral neck stress fx?

A
  • Fracture of the femoral neck 2ary to repetitive loading of the bone
  • 2 types
    • Compression side- (Inferior-medial neck)
    • Tension side- (superior-lateral neck)
  • ​Common in runners
  • mechanism
    • repetitive loading of femoral neck-> microscopic f x in femoral neck
      • crack initation
    • Continued repetitive loading does not allow for healing response and stress fx occurs
      • crack propagation
22
Q

Name assoc conditions of femoral neck stress fx?

A
  • Females triad
    • amenorrhoea, eating disorder, osteoporosis
    • must be considered in any female athlete with stree fx
23
Q

Describe the blood supply to femoral neck?

A
  • Medial femoral circumflex
  • lateral femoral circumflex
24
Q

Describe the muscle insertions around the femoral neck?

A
  • iliopsoas
  • Quadratus femoris
  • gluteus medius
  • piriformis
25
Q

Can you describe the biomechanics of the femoral neck?

A
  • Compression side
    • inferior medial neck with WB
  • Tension side
    • superior lateral neck with WB
26
Q

Describe the anatomy of iliopsoas?

A
  • Origin: anterior surfaces and lower border of transverse processes L1-5 and bodies and disc T12-L5
  • Insertion: lesser trochanter
  • action: flex the torso and thigh with respect to each other
  • inervation: direct fibers of L1-3 lumbar plexus
  • arterial supply- lumbar branch od iliopsoas of iliac internal artery
27
Q

Describe the anatomy of quadratus femoris?

A
  • origin: lateral margin of obturator ring above ischial tuberosity
  • insertion: Quadrate tubercle and adj bone of intertrochanteric crest of proximal posterior femur
  • action: rotates hip laterally, helps adduct the hip
  • innervation: quadratus femoris of the nerve to quaratus femoris and inferior gemellus L5-S1
  • arterial supply: medial cicrcumflex artery, infeerior gluteal artery, 1-4th perforating arteries, obtruator artery
28
Q

Describe the anatomy of gluteus medius?

A
  • origin: dorsal ilium inferior to iliac crest
  • insertion: lateral and superior surfaces of greater trochanter
  • action: major abductot of hip, anterior fibres help to rotate hip medially, posterior fibres help to rotate hip laterally
  • innervation: superior gluteal nerve (L4,5,S1)
  • Artery- superior gluteal artery
29
Q

Describe the anatomy of piriformis?

A
  • origin: anterior surface of lateral process of sacrum adn gluteal surface of ilium at the margin of the sciatic notch
  • insertion: superior border of greater trochanter
  • action: lateral rotator of the hip joint; also helps abduct the hip if it is flexed
  • piriformis nerve L5,S1,S2
  • Arterial suply- superior and inferior gluteal and internal pudendal arteries
30
Q

What is the presentation of femoral neck stress fx?

A
  • Overuse or increase in normal training programme
  • symptoms of insidious onset of pain
  • improves with cessation of activity
  • ant thigh/groin pain on WB
  • benign exam
31
Q

What imaging help dx femoral neck stress fx?

A
  • MRI
    • sensitive and specific
    • defects early changes
    • modality of choice when xray normal
32
Q

What is the tx of femoral neck stress fx?

A
  • Non operative
    • NON WB and activity restriction
    • for Compression side stress fx - inferior/medial neck
  • Surgery
    • ORIF w percutanous screw fixation
    • all tension side stress fx- superior lateral neck
    • compression fx that extend over 50% across neck
33
Q

Describe femoral shaft stress fx?

A
  • Overuse injuries in which abnormal stress are placed on trabecular bone resulting in microfx
  • common young adults
  • RF
    • metabolic bone disease
    • long term bisphosphonates
    • assoc ostepenia/osteoporosis of endurance athletes
  • mechanism
    • occurs thru crack propagation in bone
    • repetitive loads that exceed the threshold of intrinsic bone healing
    • repetitve stress on normal bone= fatigue fx
    • repitive stress on abnormal bone = insufficiency fx
      *
34
Q

What is the presentation of femoral shaft stress fx?

A
  • Overuse hx
  • insidious onset of pain
  • pain during activity is localised to involved bone
  • pain imporves with rest

O/E

  • focal tenderness and swelling
  • three pont fulcrum test ellciit pain
35
Q

what is seen on imaging of femoral shaft stress fx?

A
  • Xray
    • endosteal and cortical thickening
    • lineal cortical radiolucency
    • periosteal reaction
  • CT
    • cortical lucency
  • MRI
    • T2
    • periosteal high signal is the earliest finding
36
Q

Describe the tx of femoral shaft stress fx?

A
  • Non operative
    • rest, activity modification, protected WB
      • most femoral shaft fx
      • restricted wb until heals
  • Operative
    • Locked reamed intramedullary reconstruction nail
    • prophylaxic fx if
    • pt with low bone mass
    • pts >60 years
    • fx completion or displacement

Sport FRCS (26 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions