Musculoskeletal 2 > Hip > Flashcards

Hip Flashcards

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1
Q

primary osteoarthritis

A
  • increasing age
  • obesity
  • “wear and tear”
  • fam hx of OA
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2
Q

secondary OA

A
  • AVN
  • infection
  • trauma
  • pediatric hip dz (congenital dysplasia, SCFE, Legg-Calve Perthes)
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3
Q

sx of a OA

A
  • groin pain or anterior thigh pain
  • stiffness in hip joint
  • decreasing ROM
  • locking or grinding (crepitus) w/ movement
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4
Q

PE of hip w/ OA

A
  • leg length discrepancy (LLD)
  • gait: antalgic, trendelenburg, toe-in, toe out
  • progression of dz leads to decreased flexion, extension, abduction
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5
Q

what is the first motion to lose in hip OA?

A

internal rotation

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6
Q

XR for OA

A
  • AP and lateral views
  • joint space narrowing
  • osteophytes
  • cyst formation
  • sclerosis
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7
Q

conservative tx for OA

A
  • activity modification (weight loss/low impact exercise)
  • correct LLD w/ shoe lift
  • NSAIDs
  • corticosteroid injection
  • assistive devices like can (opposite hand)
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8
Q

surgery for OA

A
  • total hip arthroplasty

- hip resurfacing (not really done any more)

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9
Q

osteonecrosis aka AVN

A
  • hip is MC site of AVN
  • b/l in 50%
  • occurs when blood supply to femoral head is disrupted and the bone in head of femur dies and gradually collapses
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10
Q

possible causes of AVN

A
  • trauma/injury
  • long term steroid use
  • alcoholism
  • sickle cell
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11
Q

common population of AVN

A
  • M>F

- MC b/w ages of 40-65

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12
Q

legg-calve-perthes

A
  • AVN in pediatric hip

- congenital

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13
Q

sx of AVN

A
  • groin pain and/or buttock pain
  • decrease in ROM losing IR and abd first
  • pain is usually gradulat but can be acute onset if collapse occurs
  • develops in stage and progression can be from several months to over a year
  • stages I-IV
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14
Q

PE for AVN

A
  • LLD
  • loss of motion in all directions
  • antalgic gait
  • pain localized to groin w/ ROM testing
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15
Q

imaging for AVN

A

-XR:
-opacity in femoral head
-collapse of femoral head
MRI: used for staging AVN

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16
Q

conservative tx of AVN

A
  • meds to relieve pain but most successful tx are surgical

- if diagnosed in the early stage then these pts are good candidates for hip preserving procedures

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17
Q

surgery for AVN

A
  • core decompression
  • drill holes into femoral head to relieve pressure in the bone and create channels for new blood vessels
  • for early stages to prevent collapse of femoral head
  • often combine w/ bone grafting to regenerate healthy bone
  • usually NWB for 3 mos
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18
Q

trochanteric bursitis

A
  • inflammation of greater trochanteric bursa
  • F>M
  • can be hard to distinguish from tendinosis of gluteus medius and minimus
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19
Q

causes of trochanteric bursitis

A
  • repetitive stress (overuse)
  • previous surgery (THA)
  • injury/falling on hip
  • LLD
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20
Q

sx of trochanteric bursitis

A
  • pain localized to the greater trochanter that can radiate to lateral thigh
  • pain w/ increased activity
  • pain at night w/ sleeping on affected side
  • pain after prolonged sitting and then standing
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21
Q

PE of trochanteric bursitis

A
  • point TTP over greater trochanter
  • pain w/ adduction and IR localized to greater trochanter
  • XR nl
  • pain exacerbated w/ active hip abduction
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22
Q

tx of trochanteric bursitis

A
  • activity modications
  • NSAIDS (oral and topical)
  • steroid injection: 2cc celestone/3cc 1% lidocaine using spinal needle (1 per mo. x 3 mos)
  • PT
  • surg. is rare
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23
Q

iliopsoas bursitis

A
  • located on inside (groin side) of hip
  • pain localized to groin
  • not as common as trochanteric bursitis but tx is similar
  • <30 yo
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24
Q

causes of iliopsoas bursitis

A
  • repetitive stress
  • leg length discrepancy
  • RA
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25
PE of iliopsoas bursitis
- present in hip flexion - pain w/: passive hip extension, resisted hip flexion - bursa TTP - psoas sign - obturator sign
26
psoas sign
Place patient in L lateral | decubitus and extend R leg at the hip. If there is pain with this movement, then the sign is positive
27
obturator sign
Passively flex the R hip and knee and internally rotate the hip. If there is increased pain then the sign is positive
28
tx of iliopsoas bursitis
- activity modification - NSAIDs - PT: massage, ice, heat, US - steroid injection vs oral steroid - surgery is rare
29
snapping hip
- snapping or popping sensation of the hip usually caused by tendons sliding over bony prominences - can lead to trochanteric bursitis
30
MC site of snapping is where?
IT band moving over the greater trochanter
31
sx of snapping hip
- pt will describe it as hip is dislocating - common when climbing stairs or rising from seated position - if mild usually resolves w/ time
32
MC to see snapping hip in . . .
- adolescents - dancers - gymnasts
33
PE snapping hip
- normal ROM and gain - some pts can reproduce the snapping while standing w/ leg adducted and rotating the hip - can sometimes visualize the IT band subluxing over the greater trochanter - nl XR - positive ober test
34
tx of snapping hip
- pt education and observation - NSAIDs - stretching exercises of IT band - activity modification - surgery is rare
35
lateral femoral cutaneous nerve impingement aka meralgia paresthetica
pain and/or tingling and numbness radiating to the lateral part of thigh
36
causes of meralgia paresthetica
- obesity - direct compression from tight clothing or straps around waist - scar tissue from previous surg - injury to nerve from anterior approach THA - pregnancy
37
PS of meralgia paresthetica
- decreased sensation along distribuation of the nerve - positive tinel sign medial to ASIS - normal ROM and gail
38
diagnostic studies for meralgia paresthetica
- XRs are nl | - EMG or NCS to help diagnose nerve damage
39
tx of meralgia paresthetica
- avoidance of clothes or activity that compresses the n. - weight loss for obese pts - local anesthetic injection or nerve block which can also confirm diagnosis - oral steroids - neurontin or lyrica sometimes - surgical decompression only indicated for persistent or severe sx - NSAIDs
40
possible causes of labral tear
- trauma (injury or dislocation of the hip) such as contact sports - structural abnormalities can accelerate wear and tear of the joint causing a labral tear - repetitive motions including sudden twisting or pivoting motions
41
sx of labral tear
- locking, clicking, or catching in hip joint - groin pain or "C" sign - stiffness and decreased ROM secondary to pain
42
PE of labral tear
pain or reproducible click w/ ROM most commonly when taking the hip of IR to extension
43
imaging for labral tear
- XRs are normal | - MR arthogram is best study to determine labral tear **have to use dye or it won't get picked up!
44
conservative tx of labral tear
- NSAIDs | - injection of corticosteroid into hip joint
45
surgical tx of labral tear
- hip arthroscopy will determine debridement vs repair of labrum - repair rehab: restore ROM w/i the restrictions
46
femoroacetabular impingement
- condition where extra bone grows along one or both of the bones that form the hip joint - giving the bones an irregular shape - over time this friction can damage the joint resulting in tears of the labrum and OA
47
types of FAI
- pincer - cam - combined
48
pincer type FAI
-occurs because extra bone extends out over the normal rim of the acetabulum -The labrum can be crushed under the prominent rim of the acetabulum -clinically is probably more common
49
cam type FAI
-the femoral head is not round and cannot rotate smoothly inside the acetabulum -A bump forms on the edge of the femoral head that grinds the cartilage inside the acetabulum -more painful
50
combine FAI
-both princer and cam are present
51
causes of FAI
- occurs b/c hip bones don't form normally during childhood growing years - little that can be done to prevent it - some never develop sx
52
what does symptomatic FAI indicate?
if sx present = already damage to cartilage or labrum
53
sx of FAI
- pain (groin) - stiffness - limping - worse w/ turning, twisting, and squatting and may cause sharp, stabbing pain
54
PE of FAI
- impingement test: bring knee towards chest and then rate it inward towards opposite shoulder (pain = positive) - imaging: XR, CT, MRI
55
tx of FAI
- activity modification - NSAIDs - PT - surgical: hip arthroscopy
56
90% of hip dislocations are what type?
posterior
57
associated injuries w/ hip dislocations
-acetabular or femoral head fractures
58
causes of posterior hip dislocations
- high energy impact on the knee while pt is sitting w/ hip flexed and adducted - ex: MVA when person is not wearing seatbelt and knees hit dashboard
59
causes of anterior hip dislocation
- common in sporting events | - forceful abduction and ER
60
PE of posterior hip dislocation
- leg presents w/ hip in flexion, adduction and IR/shortening of limb - knee and foot will appear rotated toward the middle of body
61
PE of anterior hip dislocation
- leg presents in abduction and ER - leg rotated out and away from body - check NV status
62
tx of hip dislocation
- prompt reduction to prevent osteonecrosis of femoral head - closed reduction (recommended to use sedation or general anesthesia) - palpable clunk - get post reduction XR - get CT to assess for associated injuries - protected WB and activity modification (2-3 mos)
63
what is used to classify acetabular fxs?
Judet-Letournel Classification | -10 fx patterns based on degree of columnar damage
64
PE of acetabular fxs
- d/t high impact falls of MVA | - need to assess sciatic, femoral and obturator nerve function
65
imaging for acetabular fxs
- AP and Judet views | - CT scan
66
conservative vs. surgical tx for acetabular fxs
- conservative: only if < 2-5 mm of displacement in the dome and femoral head maintains position - surgical: displaced > 2-3 mm and can't maintain congruent joint
67
common causes of femoral head fx
- secondary to MVA (MC) - axial load impact proximally through the femur - high energy trauma - can be associated w/ hip dislocation
68
sx of femoral head fx
groin pain esp. w/ WB
69
PE of femoral head fx
- check NV status | - severe groin pain
70
imaging for femoral head fx
- XR: AP and Judet view | - CT to evaluate for associated acetabular fxs
71
tx for femoral head fx
- closed tx for stable fxs and adequate reduction | - ORIF for inadequate reduction or unstable fxs
72
femoral neck fx
- 50% of hip fxs are this type - 80% occur in women - average age is 77 for women and 72 for men
73
causes of femoral neck fx
- for older pts: fall onto greater trochanter (valgus impaction) - younger pts: high energy trauma - stress fxs seen in athletes, military recruits, ballet dancers - osteoporosis/osteopenia
74
PE of femoral neck fx
- athletes describe insidious onset of pain over 2-3 weeks localized to groin that can radiate to the knee - displaced fxs will be nonambulatory w/ shortening and ER of lower extremity - TTP to groin and pain w/ ROM
75
imaging of femoral neck fx
- AP and IR view on XR | - MRI to rule out suspected stress fx
76
Garden Classification of femoral neck fxs
- Type I: incomplete fx - Type II: complete fx w/ no displacement - Type III: complete fx w/ partial displacement - Type IV: complete fx w/ complete displacement
77
treatment for stress fx of femoral neck
- NWB on crutches until asymptomatic | - follow XRs closely since the risk for displacement is high
78
tx for nondisplaced fx of femoral neck
-ORIF w/ 3 cancellous screws
79
tx for displaced fx of femoral neck
- bipolar/hemiarthroplasy reserved for need for faster full WB, poor health, pathologic fx, poor ambulatory status before surgery (NOT for young active pt) - THA for active young or eldery person if preexisting DJD
80
intertrochanteric fx
- b/w the greater and lesser trochanter of proximal femur | - MC > 60 y/o
81
what attaches to the greater trochanter?
-gluteus medius -gluteus minimus (hip extensors and abductors)
82
what attaches to the lesser trochanter?
-iliopsoas | hip flexor
83
causes of intertrochanteric fx
- most result from direct impact to greater trochanteric area from a simple fall - younger pts = high energy
84
PE of intertrochanteric fx
- nondisplaced: may be ambulatory w/ minimal pain - displaced fxs: nonambulatory w/ lower extremity shortened and ER - ROM is painful
85
tx of intertrochanteric fx
- ORIF indicated unless extreme medical risk for surgery - sliding hip screw vs. gamma nail - to THA unless hardware failure
86
causes of greater trochanteric fx
- rare - from direct blow from fall in elderly - may occur following THA
87
PE of greater trochanteric fx
- lateral hip pain | - pain w/ abduction
88
imaging in greater trochanteric fx
-MRI recommended | b/c up to 95% may have an associated fx such as an intertrochanteric fx
89
tx of greater trochanteric fx
- usually nonoperative - partial WB until callus visible on XR (4-6 weeks) - gradually progress to WBAT - ORIF only if pt is young and active w/ widely displaced greater trochanter
90
lesser trochanteric fx causes
- rare as isolated fx - MC: adolescent males 13-17 y/o typically secondary to forceful iliopsoas contracture - if in elderly: should be concern for pathologic fx
91
lesser trochanteric fx is usually a component of what?
IT fx
92
PE of lesser trochanteric fx
- pain in inguinal area | - pain w/ passive ROM in all directions w/ max pain in extension and relief when seated
93
tx of lesser trochanteric fx
-nonsurgical tx w/ limb resting in flexion obtains excellent functional results
94
subtrochanteric fx
- b/w lesser trochanter and a point 5cm distal to the lesser trochanter - high rates of malunion and nonunion - usually associated w/ other injuries
95
causes of subtrochanteric fx
- elderly: low energy falls - young: high energy falls from height or MVA or gunshot wound - frequent site for pathological fx
96
PE of subtrochanteric fx
- unable to ambulate - gross deformity usually present - painful hip ROM and TTP and swelling of the proximal thigh - NV exam needed - susceptible to compartment syndrome d/t hemorrhage into the thigh
97
tx of subtrochanteric fx
- operative tx indicated - ORIF of femur - TTWB 4-8 weeks and FWB at 8-12 weeks
98
Ddx of subtrochanteric fx
- gilmore's groin (sports hernia) - sacroilitis - piriformis syndrome
99
how do you know on imaging that the injury to a forearm is high energy
there is a fx of the tibia and fibula at the same level
100
two very important things to present to an orthopod when presenting a case
- age of pt | - date of injury
101
what type of injury should you keep in mind when a pt has pain w/ weight bearing?
think bone
102
approximately when do you lose the ability to remodel bone?
age 10
Musculoskeletal 2
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