MS: Hip

Question 1

What is a femoral neck fracture?

Answer 1

This type of break occurs in the femur about 1 or 2 inches from where the head of the bone meets the socket.

Increased AVN
Treated with hemi arthroplasty: Only replacing femoral part.
3% sport injury
SX: Groin pain 
Return to sport:3-6 months

Question 2

What is an Ischial Bursitis?

Answer 2

Occurs with pressure on Ischial Tuberosity: sitting, sedentary lifestyle, can be direct trauma or a hamstring injury.

Question 3

What is an Iliopectineal Bursitis?

Answer 3

Repetitive use of Iliopsoas: running, swimming

Question 4

What is a Trochanteric bursitis?

Answer 4

Overuse along greater trochanter. Running, standing, climbing stiars, falling on lateral hip, LLD, laying on side.

Avoid activities that aggervate.
Strengthen Glute med
Pain with palpation

Question 5

What is a strain?

Answer 5

Contractile lesion.
Most commonly strained mm: hamstrings, dductor, iliopsoas, rectus femoris
Mainly in athleted
Overuse

Question 6

Normal angle of inclination in adults

Answer 6

120 degrees

Question 7

Coxa Valga

Answer 7

> 130 degrees
Longer leg
Compensates with Genu Varus
Angle will add length

Question 8

Coxa Vara

Answer 8

<110
Shorter leg
Compensates with genu valgus

Question 9

Management for Coxa vara/valga

Answer 9

Surgery to normalize angle: Osteotomy

- take out bone to re- align angle

Question 10

Normal femoral torsion

Answer 10

15 degrees anterior to frontal plane
Retroversion is under 15
anteversion is over 15

Question 11

Consequences of excess anteversion or retroversion?

Answer 11

Children with anteversion= in-toeing (pigeon toe)
Children with retroversion= Duck walk
Can grow out of it

Question 12

Structural/functional compensations of anteversion/retroversion?

Answer 12

Anteversion: IR
Retroversion: ER, overpronation

Question 13

Indications of a THA?

Answer 13

Severe hip pain which limit ability to preform ADLs
Major functional loss
Instability of hip
AVN/ Osteomylitis
Failed previous surgery

Question 14

Posterior Lateral incision

Answer 14

Most common
Split glute max and short ER muscles are released
Highest risk of dislocation

Question 15

Precautions of Posterior-Lateral incision?

Answer 15

Do not: Cross legs, sleep on side, bend forward, squat

No IR/ADD/flexion past 90

Question 16

Antero-lateral incision

Answer 16

TFL + GLute med: some portion og hip abductor is released from greater trochanter.
Less chance of dislocation
More gait distribution

Question 17

Precautions of Antero-lateral incision?

Answer 17

Do not: Hip ext, ER, ADD, flex greater than 90

No AROM of hip abd for 6 weeks

Question 18

Anterior approach

Answer 18

Becoming more popular
Does not split muscles, moves muscles apart (goes between muscle groups)
heals better and less restrictions
Will not do this if pt has high BMI and tissue over front or if it is a revision

Question 19

Precautions of anterior approach

Answer 19

No extension and excessive ER

Avoid bridges an prone lying due to lordosis stress

Question 20

Cemented THA vs Porous THA

Answer 20

Cemented: WBAT after surgery, most common.
Pourous: (biological) NWB for a span after surgery

Question 21

What is trochanteric osteotomy?

Answer 21

Sometimes preformed in conjunction to THA.
Cut trochanter to access acetabulum
No AROM hip ABD for 6-8 weeks, only PROM.

Question 22

Hip resurfacing

Answer 22

Younger patients to preserve more bone
femoral head and acetabulum covered in metal
postero-lateral approach
less risk of dislocation, less restrictions, easy THA conversion

Question 23

Entrapment syndrome (Piriformis syndrome)

Answer 23

Compression of sciatic nerve by shortened piriformis
Beneath or through shortened muscle
Sharp/shooting pain down back of leg
Pain increased with walking, decreases with sitting
Pain replicated with FLEX,IR,ADD (FAIR) Test
Patient may stand with LE in hip ER (takes tension off piriformis)

Question 24

FIndings of patients with piriformis syndrome?

Answer 24

Decreased hip IR an flex ROM
tight hamstrings
positive piriformis test

Question 25

What would we do with a pt who has piriformis syndrome?

Answer 25

Stretch tight muscles, we want IR and flexion.
Figure 4 stretch
Correct standing and walking alignment, neutral femur (less ER)
Lengthen muscles with heat then use stretch window
Re-train muscle balance of ABD and ADD
ex) pillow between knees and do sit to stands

Question 26

Labral Tears

Answer 26

Arthroscopic surgery
labrum is pimarily avascular
Labrum holds ball & socet
SX: groin pain, anterior hip pain, clicking, pain with passive  hip flex/add/IR, minimal to no restrictions with ROM
C sign for pain spot