Intra-articular Hip Flashcards
(43 cards)
What are 5 INTRA-articular causes of pn/sxs in the hip region?
- Acetabular labral lesions
- Hip OA
- Osteonecrosis
- Femoral fx
- Post- THA
Which portions of the hip labrum is considered the most innervated?
Anterior & Superior portions
(becomes less with aging)
What is the vascular supply like to the hip labrum?
limited vascular supply
what are the functions of the hip labrum?
- increase depth of hip jt
- disperse forces across the cartilage
- ensure optimal joint stability (though unable to undo the effect of boney dysplasia) –> further stabilization by hydrostatic fluid pressurization
- increased stability allows for more coordinated and efficient mm contraction
What is the labrum made up of?
fibrocartilage
Labral tears are classified based on location. which is the most common site for a labral tear?
a. Anterior
b. posterior
c. superior
d. combination
a. Anterior
(particularly common in pts w/ DJD)
(you see posterior with a lot of squatting postures in particular)
What is the etiology for acetabular labral lesions?
- Trauma
- FAIS
- Developmental Dysplasia of hip
- Capsular laxity
Trauma is a potential etiology for acetabular labral lesions. Describe the way in which trauma can lead to a labral lesion
- Trauma resulting in subluxation OR dislocation of femoral head
FAIS is a potential etiology for acetabular labral lesions. Describe how
FAIS is assoc w/ morphological alterations of femoral head or acetabular or both
What are the 2 types of FAI? And describe the difference
- Pincer impingement: excessive boney overhang of acetabulum, impingement in flexion
- Cam impingement: exostosis along femoral neck and head impinges labrum against acetabulum
Capsular laxity is a potential etiology for acetabular labral lesions. Describe how
Global (genetic) vs. local laxity (acquired)
Global - Ehlers-danlos syndrome, marfan’s syndrome
Local - excessive repeated ER w/ hip ext (freq w/ adolescent dancers and gymnasts)
What is the clinical presentation for a pt with acetabular labral lesion?
- Ant hip/groin pn, or C-sign
- Onset of pn = usu insidious (unelss trauma)
- Pn = constant dull, intermittent sharp pn (worse w/ activity)
- CLICKING, locking, catching, giving way
- Ant hip pn in sitting (FAIS)
- Aggravation w/ walking, pivoting, sitting, impact
What is the most consistent clinical sx for labral acetabular lesions?
CLICKING
What would you include in your exam for a pt with suspected acetabular labral lesion?
- Screen LQ (for potential biomechanical contributors)
- Assess function: gait, SLS, squat, dynamic activities as appropriate
- Core motor control hip/pelvis
- Hip ROM, flexibility & hip strength (abduction = primary!)
- Hip accessory mobility
- Special tests
What is the most common cause of hip pn in adults?
Hip OA!
Describe how Hip OA can be either primary or secondary
Primary: idiopathic
Secondary: traumatic OR result of congenital abnormalities that alter biomechanics
- hip dysplasia
- Shape of femoral head
- Leg-calve-perthes disease
- Congenital dislocation
- slipped capital femoral epiphysis
- Leg length difference
How would a pt with hip OA typically present clinically from their hx?
- Mod lat or ant hip pn w/ WB
- Pn can progress to ant thigh or knee region
- > 50 (more typical)
- Limited PROM in at least 2/6 directions (flex & IR primary)
- Morning hip stiffness, improves in < 1 hr (otherwise, consider RA and other pathologies, systemic presentations)
What nerves innervate the hip joint?
- Obturator
- Femoral
- Sciatic
What 3 locations do intra-articular hip disorders primarily refer to?
- Buttock (71%)
- Groin (55%)
- Ant thigh (27%)
What would you include in your exam of a pt with suspected hip OA? And what would you expect?
- Gait analysis
- Antalgic gait
- Excessive lumbar lordosis during
terminal stance (lack of hip ext) - Trunk lean toward AFFECTED side
(dec compressive muscle forces
acting on jt) - trendelenburg (pelvis drops on
contralateral side)
- trendelenburg (pelvis drops on
- Coxalgic gait (trunk leans over
affect leg w/ level pelvis)
- Hip ROM (expect a dec) - accessory mobility and flexibility (esp hip flexors)
- Assess mm strength/endurance
- Esp hip ABDductors, Ext rotators
What are self-reported Outcome measures for hip OA?
- WOMAC
- LEFS (MCID = 9 point change)
What is femoral osteonecrosis? (Avascular necrosis or aseptic necrosis)
= death of varying amounts of trabecular bone in femoral head
The etiology of femoral osteonecrosis/AVN is unknown but it can occur with….
- Trauma to femoral head (neck fx, femoral head dislocation)
- Vasculitis caused by inflammatory arthropathy (SLE,RA)
- Hx of alc abuse or corticosteroid use
- Idiopathic
- hx of sickle cell disease
- 30-50 yo (most common)
How would a pt’s hx clinically present if they have femoral osteonecrosis/ AVN?
- Gradual onset of pn, but can begin suddenly w/ collapse of femoral head (if sudden - severe loss of motion)
- Dull ache or throbbing in groin, lat hip, or buttock
- Pn can radiate into thigh and upper knee region (obturator n path)
- Initially, hip ROM = minimally affected –> leads to marked limitation in hip jt ROM and strength
