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MSK Conditions > MOD 4 Hip Pathology > Flashcards

MOD 4 Hip Pathology Flashcards

(42 cards)

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1
Q

What is avascular necrosis?

A

pathology where blood supply to femoral head is compromised and the bone degenerates and dies

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2
Q

What are the risk factors of avascular necrosis?

A
  • alcohol use
  • steroid ue
  • hip BMI
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3
Q

How does avascular necrosis present?

A
  • limited ROM (full range in all directions rules out)
  • pain with weight bearing and even at rest
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4
Q

How do you treat avascular necrosis?

A

refer

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5
Q

What is a fatigue stress fracture?

A

normal bone subject to abnormal stress

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6
Q

What is an insufficiency stress fracture?

A
  • abnormal bone subject to normal stress
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7
Q

What are the common stress fracture locations of the hip?

A
  • femoral neck
  • pubic rami
  • acetabulum
  • femoral head
  • sacrum
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8
Q

What is the location of a stress fracture if it occurs on the tension or compression side of the femoral neck?

A
  • tension: superior, unstable
  • compression: inferior, stable
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9
Q

What are the risk factors of hip stress fracture?

A
  • female
  • low fitness starting intense exercise
  • overuse
  • smoking
  • steroid use
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10
Q

How do patients with a hip stress fracture present?

A
  • pain during exercise, poorly localized in deep hip, groin, and thigh pain
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11
Q

What are the common objective findings for a patient with hip stress fractures?

A
  • pain t extreme range of hip IR
  • palpation tenderness of inguinal area
  • positive active leg raise
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12
Q

How should a hip stress fracture be managed?

A
  • cease weight bearing and obtain imaging
  • tension: NWB 6 weeks, partial WB 6 weeks, return 3-6 months
    compression: 6-8 weeks of limited WB
  • return 12-28 weeks
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13
Q

What is the mechanism of hip fracture?

A

compression trauma, direct lateral impact (fall or collision)

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14
Q

What are the common hip fracture locations?

A
  • neck
  • intertrochanteric
  • subtrochanteric
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15
Q

What type of injury (intra-capsular vs extra-capsular) is a hip fracture?

A
  • intracapsular
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16
Q

What are the implications since a hip fracture is intra-capsular?

A
  • healing less certain due to blood supply being damaged
  • high mortality risk
  • high risk for avascular necrosis
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17
Q

How do you treat hip fracture?

Study These Flashcards
A

ORIF, hemiarthoroplasty, and total hip replacement

rehab early

18
Q

What are the guidelines for a hip fracture rehabilitation?

Study These Flashcards
A
  • early mobilization (24-48)
  • high intensity PT with 3 daily session
  • functional mobility and endurance

post acute:
- gait and balance 6-9 months
- muscle strength
- HEP

19
Q

What are the risk factors of a hip dislocation?

Study These Flashcards
A
  • falling, chronic instability, laxity, structural abnormalities, reduced muscle mass
20
Q

What is the mechanism of hip dislocation?

Study These Flashcards
A

compression trauma: blunt force to bent knee and flexed hip

rotational trauma: extreme IR with hip flexed (skiing)

21
Q

What is the most common site of hip dislocation?

22
Q

How does hip dislocation present?

Study These Flashcards
A
  • pain
  • swelling
  • deformity
  • immobility
  • inability to WB
23
Q

How do you manage a hip dislocation?

Study These Flashcards
A
  • surgical: open reduction
  • conservative: closed reduction

after immobilization 2-3 months, impairment driven

24
Q

What are avulsion fractures?

Study These Flashcards
A

violent contraction of muscle, pulling boney attachment from bone

25
What are the common sites of hip avulsion fractures?
ASIS, AIIS, lesser trochanter, ischial tuberosity
26
How do hip avulsion fractures present?
- pain at injury - boney tenderness - muscle bulging away from attachment - swelling
27
How do you manage hip avulsion fractures?
- early: immobilization, PROM, atrophy prevention - later: functional movement retraining, strength, proprioception
28
What is the most common cause of hip pain in people over 50?
osteoarthritis
29
What is osteoarthritis?
progressive deterioration of articular cartilage which leads to narrow joint space
30
How will people with osteoarthritis present?
anterior groin or lateral groin pain (C sign) anterior thigh pain (L3 dermatome) stiffness after prolonged rest
31
What are some related impairments with osteoarthritis?
- loss of quad strength - gait asymmetry, slow speeds
32
What are the CPG diagnosis for hip osteoarthritis?
- older than 50 - moderate anterior or lateral hip pain in WB - morning stiffness for longer than an hour - hip IR < 24 deg or hip IR and flexion < 15 compared to other limb and/or hip pain with passive IR
33
What is cluster 1 in Altman's criteria for hip OA?
- hip pain - hip IR < 15 deg - flexion < 115 deg
34
What is Altman's cluster 2 for hip OA diagnosis?
- painful hip IR - older than 50 y.o - morning hip stiffness <60 min
35
What would direct you to use Altman's cluster 2 over Altman's cluster 1?
if hip IR is greater than or equal to 15 deg
36
What is the clinical prediction rule for hip OA diagnosis?
if 4 or more present - squating aggravates symptoms - active hip flexion = lateral hip pain - scour test: lateral hip or groin pain - active hip extension causing pain - passive IR less than or equal to 25 deg
37
What is conservative management for hip OA?
- NSAIDs and corticosteroid injections - modalities: heat and ultrasound
38
What is the rehab management of hip OA?
- manual therapy 1-3x week, 6-12 weeks - exercise 1-5x week, 6-12 weeks * working strength, balance, flexibility, coordination
39
What is surgical management for hip OA?
- total hip - partial hip - joint resurfacing
40
What are the predictors someone will respond well to PT with hip OA?
if 3 or more present - unilateral vs bilateral hip pain - younger or equal to 58 y.o - pain more or equal to 6/10 - 40m SPWT of less or equal to 25.9 sec - symptoms less than a year
41
What provides better outcomes with hip OA?
manual therapy is better than exercise alone
42
What are the PT management strategies to be used for hip pain?
- manual therapy + exercise - impairment driven - adequate challenge for strength gains - strength linked to functional tasks - CV and physical activity counseling

MSK Conditions (13 decks)

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