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MSK 1 > Hip/Thigh > Flashcards

Hip/Thigh Flashcards

1
Q

OA of hip

A

articular cartilage of the femoral head and acetabulum degenerates over time (PRIMARY) or secondarily from disorder of hip during childhood or trauma

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2
Q

hx OA of hip

A

progressive and gradual onset of anterior thigh or groin pain

typically only pain with activity, but progresses to all the time

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3
Q

PE OA of Hip

A

limp when walking

decreased AROM and PROM with internal rotation

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4
Q

diagnostic w.u of OA of Hip

A

loss of joint space and osteophytes on XR

if XR –> MRI

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5
Q

prevention of OA of hip

A

activity modification

hip girdle strengthening program

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6
Q

sx tx OA of hip

A

young: femoral head resurfacing with acetabular resurfacing (RSA)
older: total hip replacement or bipolar replacement

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7
Q

rx tx OA of hip

A

NSAID rx of choice

AVOID narcotic analgesics

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8
Q

hip impingement syndrome

A

abnormal wearing and contact b/t ball and socket of hip joint

result in increased friction during hip movement

CAM and PINCER lesions

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9
Q

cause of hip impingement syndrome

A

hip bones do not form normally during childhood yrs

athletic people may experience pain earlier but exercise DOES NOT cause FAI

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10
Q

crossover sign

A

radiographic finding associated with acetabular retroversion = pincer type FAI in pt with hip pain

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11
Q

arterial blood supply to hip

A

via obturator and medial and lateral circumflex femoral arteries

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12
Q

osteonecrosis of hip

A

compromised of arterial blood supply cause death to cells of femoral head

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13
Q

osteonecrosis of hip hx

A

trauma (dislocation or fracture) or inadequate blood Flow (I.e. sickle cells, alcohol abuse, steroid use, RA, SLE)

20s-40s

gradual onset of dull aching pain in groin, butt, hip

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14
Q

osteonecrosis of hip PE

A

antalgic gait
tenderness of groin

decreased AROM or PROM in IR of hip

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15
Q

osteonecrosis of hip dx studies

A

AP of pelvis and AP and Frog leg veins of hip

progressive patchy areas of sclerosis

crescent sign

change in shape of head that collapse of cortical bone

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16
Q

osteonecrosis of hip will look like ___ on XRAY (progression)

A

normal –> patchy sclerosis –> crescent sign –> change in shape of head and collapse of cortical bone

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17
Q

crescent sign

A

subchonral fracture of articulate surface

found in osteonecrosis of hip

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18
Q

prevention of osteonecrosis of hip

A

prior to collapse

avoid steroids, address EtOH use, control other dz

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19
Q

non rx tx osteonecrosis of hip

A

prior to head collapse: core decompression w/wo graft

after collapse: bipolar hemiarthroplasty (potential head resurfacing)

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20
Q

iliotibial band (ITB)

A

long tendon of tensor fascia late and gluteus Maximus

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21
Q

snapping hip

A

ITB band snaps over greater trochanter

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22
Q

what other tendons could cause snapping hip

A

iliopsoas tendon (snap over pectineal eminence)

labrum of femoral head (can tear and snap with motion)

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23
Q

hx of snapping hip ITB

A

pt points to greater trochanter area

MC occurs w/walking ration of hip

SNAP when affected side up, rotating leg

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24
Q

iliopsoas hx snapping hip

A

snap when risking from seated position

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25
Q

labral tears hx snapping hip

A

early warning side of OA

snap may be sudden when walking and cause patient to grab hold to keep from falling

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26
Q

snapping hip PE

ITB

A

INSPECT

motion of hip when recreate snap, should feel snap

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27
Q

iliopsoas snapping hip PE

A

inspect

observe reaction during rise of the hand

feel snap on extension of hip from flexed position

28
Q

labrum snapping hip PE

A

inspect

shortening of leg, limp with walk

29
Q

best diagnostic study snapping hip labral tear

A

MR arthrogram with gadolinium

30
Q

snapping hip tx

A

non painful - reassure

NSAID or corticosteroid injection

31
Q

hip strain

A

muscles suddenly stressed to resistance

32
Q

hip strain hx

A

sudden onset (“I pulled a muscle”) although can be from over use or under condition

33
Q

PE hip strain

A

stretch affected muscle or use muscle against resistance

34
Q

dx studies hip strain

A

AP pelvis, frog leg

MRI only indicated for possible torn muscle/tendon

35
Q

ddx hip strain

A

fracture to ASIS or AIIS (get XR to rule this out)

36
Q

hip strain tx

A

phase 1: RICE 48-72 hrs

2: PROM exercise, heat 72 hrs -1 week
3: isometrics (week 1-3)
4: strength and condition 2-4

37
Q

thigh strain QUADS

A

direct blow (I.e. football or soccer)

38
Q

thigh strain HAMSTRINGS

A

most often injured

sudden onset (pain and pop while running)

39
Q

Pe thigh strain

A

possible antalgic gait and ecchymosis (if torn(

hamstrings - flexion of hip and extension of knee cause pain

quads - flexion of knee causes pain

40
Q

trochanteric bursa

A

lie between greater trochanter of femur and ITB

41
Q

trochanteric bursitis

A

inflamed from tight ITB or associated OA, leg length discrepancies, idiopathic

42
Q

hx trochanteric bursitis

A

pain over lateral hip (greater trochanter) esp when standing from seated position or lying down

43
Q

trochanteric bursitis PE

A

pain worse with abduction

tenderness

44
Q

trochanteric bursitis Dx studies

A

AP pelvis and frog leg (r/o boney pathology)

45
Q

prevention and tx trochanteric bursitis

A

don’t lie on that side

NSAID, corticosteroid if tx fails

46
Q

hip dislocation

A

strong ligaments surround hip so this is hard to do

typically due to high energy trauma

47
Q

hip dislocation mc

A

Posterior dislocation 90% of them

48
Q

hip dislocation PE

A

must check NV status

posterior will hold tight flexed, adducted, and internally rotated, NV STATUS

anterior: thigh minimally flexed, abducted, externally rotated

49
Q

dx studies hip dislocation

A

AP pelvis, and AP/lateral femur (including knee)

posterior = head of femur appears smaller 
anterior = head of femur appears larger

CT may be needed

50
Q

hip dislocation complications

A

orthopedic emergency

loss of blood supply can cause osteonecrosis, post traumatic OA and femoral or sciatic n palsy

51
Q

hip dislocation non rx tx

A

immediate reduction (w/in 3 hrs)

surgical stabilization may be needed (acetabulum fracture)

52
Q

femur shaft fx

A

high energy impact

Osteoporosis is more common in neck region

53
Q

PE femur shaft fx

A

look for deformity, edema, open wounds

inspect whole extremity

gently feel for crepitus and NV status

54
Q

tx femur shaft fx

A

long leg posterior splint or traction splint until sx

if open - surgical debridement, tetanus prophylaxis and IV ABX

55
Q

pelvis fracture

A

ring that supports the worse

disruption = loss of function until fixed/healed

56
Q

hx pelvis fracture

A

low energy (elderly)

pain with motion of affects LE

acetabular fas often associated with hip locations

57
Q

dx studies pelvis fracture

A

low energy - AP pelvis

high energy - AP pelves, inlet and outlet (judet) and oblique pelvis

ENTIRE BODY (CT PAN SCAN)****

58
Q

what do we use to classify the young burgess for?

A

classification of pelvis fracture

59
Q

pelvis fracture compilations

A

abdominal organs and pelvic organs damaged

SHOCK

chest injuries, head injuries, neck injuries, fat emboli

60
Q

pelvis fracture tx

A

WBAT and assist (low energy)

high engird 0 hemodynamic stabilization with pelvic girdle, ORIF once stable

IV morphine

61
Q

proximal femur fx

A

neck fracture due to osteoporosis (elderly women)

62
Q

risk factors proximal femur fx

A 
smoking
sedentery lifestyle 
alcohol abuse
psych meds
dementia
63
Q

hx proximal femur fx

A

fall to side
land on hip
unable to stand or ambulate
pain in groin/thigh

64
Q

what classification do we use for a proximal femur fx

A

garden classification

65
Q

proximal femur fx tx

A

surgical intervention
admit NWB with external traction for comfort
IM/IV narcotic (caution of respiratory depression)

MSK 1 (9 decks)

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