Physio Amp 1 (lower Body) > Hip Pathologies > Flashcards

Hip Pathologies Flashcards

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1
Q

What is the pathology of avascular necrosis?

A

Impaired vascular supply to the anterior and superior aspect of the femoral head.

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2
Q

What are the causes (aetiological) factors for avascular necrosis?

A

Traumatic: femoral neck fracture, dislocation. Non-traumatic: deep-sea diving, sickle cell anaemia, steroids, excess alcohol, recent pregnancy.

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3
Q

What is the mean age of patients with avascular necrosis in the UK?

A

58 years.

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4
Q

What is the likelihood of avascular necrosis?

A

2 per 100,000 patients.

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5
Q

In which gender is avascular necrosis more common?

A

More common in men.

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6
Q

What is the highest likely age range for men and women with avascular necrosis?

A

Men: 25-44 years, Women: 55-75 years.

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7
Q

What is avascular necrosis?

A

Significant death of bone tissue due to loss of blood supply.

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8
Q

What is the management for traumatic cases of avascular necrosis?

A

Need surgery to restore blood flow to femoral head as soon as possible.

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9
Q

What is the only option once the bone collapses in avascular necrosis?

A

Total Hip Replacement (THR).

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10
Q

What are the clinical signs and symptoms of avascular necrosis?

A

Limp, severe pain (usually groin), pain on weight bearing.

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11
Q

What is the earliest radiological sign of avascular necrosis?

A

The crescent sign.

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12
Q

What is considered the gold standard for diagnosing avascular necrosis?

A

MRI.

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13
Q

What should clinicians be suspicious of in the history of avascular necrosis?

A

Long term steroids and/or excess alcohol intake. These are red flags.

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14
Q

What is a femoral neck fracture

A

Loss of continuity of bone tissue between the articular cartilage to 5 cm below the lesser trochanter.

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15
Q

What are the causes (aetiologies)of hip fractures?

A

Traumatic - related to trauma; Pathological - related to underlying disease; Stress - related to overuse repetitive motions.

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16
Q

What are the types of hip fractures?

A

Intertrochanteric fracture; Subtrochanteric fracture.

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17
Q

What is the management recommendation for hip fractures?

A

recommend surgery within 48hrs of admission. 50% of cases require partial or total hip replacement (THR)

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18
Q

What are the clinical signs and symptoms of a hip fracture?

A

A limp or inability to weight bear, pain, externally rotated hip, bruising and/or swelling around joint, injured leg may appear shorter.

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19
Q

What are the radiological investigations for suspected hip fractures?

A

Plain x-rays;
MRIs and CTs more when fracture is suspected despite negative x-ray.

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20
Q

What is the pathology of Slipped Capital Femoral Epiphysis (SCFE)?

A

Displacement of the epiphysis from its normal position relative to the femoral neck.

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21
Q

What is the cause (aetiology) of SCFE?

A

Exact cause is unknown but associated with sex, rapid growth, obesity, and congenital deformity. Can occur with or without trauma.

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22
Q

What are the clinical signs and symptoms of SCFE?

A

Antalgic gait/ limp, external rotation of affected limb, reduced internal rotation.

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23
Q

What radiological investigations are used for SCFE diagnosis?

A

X-Rays - Anteroposterior pelvis and frog lateral views.

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24
Q

What is the management for SCFE?

A

Surgical screw fixation of the epiphysis to stabilise it and prevent further slip.
Child should be non weight bearing (NWB) on crutches until admitted.

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25
Femoroacetabular impingement What is CAM?
where extra bone grows along the hip joint, causing the femoral head and/or acetabulum (hip socket) to rub abnormally against each other. CAM associated with vigorous hip loading during adolescence (when growth plate are still open)
26
What is the cause (aetiology) of CAM?
vigorous hip loading during adolescence when the growth plate is still open.
27
What is Femoroacetabular impingement (FAI)?
Abutment of the femoral neck against the acetabular rim due to extra bone.
28
What are the clinical signs and symptoms of FAI?
Motion related pain in hip or groin, positive FADIR test, may include clicking, catching, locking, giving way, and restricted ROM (mostly IR in flexion).
29
What radiological investigations are used for FAI?
X-rays:Anteroposterior pelvis and lateral femoral neck.
30
What is the conservative management (non medical strategised management)for FAI?
Education and activity modification, rehab to address hip stability, NMC, strength, and ROM.
31
What is the surgical management for FAI?
To improve bone morphology and repair damaged tissue,commonly done by arthroscopic surgery
32
What is Hip Dysplasia?
Hip Dysplasia is a condition where the femoral head is not seated sufficiently in the acetabulum due to deformities, leading to instability.
33
What are the common causes (aetiology) of Hip Dysplasia?
Common causes include breech birth, being a first-born child, family history, and swaddling practices.
34
What is the management for newborns with Hip Dysplasia?
Management for newborns includes the use of a hip abduction splint.
35
What is the management for adults with Hip Dysplasia?
Adults may require conservative management, education, activity modification, hip strengthening, or surgical management to improve congruence.
36
What are the clinical signs and symptoms of Hip Dysplasia?
Signs include insidious onset of groin or lateral hip pain, often accompanied by a limp and Trendelenburg sign, aggravated by weight-bearing activities and abduction movements.
37
What radiological investigation is used for Hip Dysplasia?
X-Rays are used, with a lateral centre edge angle < 20 degrees considered positive for dysplasia.
38
What is the effect of pathological biomechanical stress on joint tissue?
It disrupts homeostasis between joint tissue synthesis and degradation, resulting in thinning of subchondral bone and cartilage microdamage.
39
What mediators are involved in the biochemical exchange between joint structures?
Pro-inflammatory mediators are thought to be involved.
40
How does hip osteoarthritis affect males and females?
It affects males and females equally.
41
What is hip osteoarthritis?
It is the deterioration of articular cartilage covering the acetabulum and femoral head.
42
What are some joint level risk factors for hip osteoarthritis?
Joint morphology (Dysplasia, FAI) and joint injury (SCFE, labral tears).
43
What are some person level risk factors for hip osteoarthritis?
Age, increased BMI, sedentary behaviors, genetics, ethnicity, and occupation.
44
What are the clinical signs and symptoms of hip osteoarthritis?
Pain, difficulty walking and performing activities of daily living (ADLs), fatigue, disturbed sleep, restricted internal rotation <25 degrees, and endurance/mobility score <60 minutes.
45
What is the radiological investigation method for diagnosing hip osteoarthritis?
Plain AP X-ray using the Kellgren and Lawrence grading system.
46
What are the conservative management strategies for hip osteoarthritis?
Education, land-based exercise, manual therapy, and joint protection strategies.
47
What surgical option is available for hip osteoarthritis?
Total hip replacement (THR).
48
What are the types of groin related pain pathology?
Acute strains and overuse injuries.
49
What are the aetiological factors for groin related pain?
Previous groin injury, higher level of sport, reduced hip adduction strength, reduced add:abd strength ratio.
50
What proportion of groin injuries involve the adductors?
Two-thirds of groin injuries involve the adductors.
51
What are the management strategies for groin related pain?
Education, activity modification, strengthening, and flexibility.
52
What are the types of groin pain related to specific muscles?
Adductor-related, Iliopsoas-related, Inguinal-related, and Pubic-related groin pain.
53
What is important in the clinical diagnosis of groin pain?
Palpation is important and must be precise; pain on resisted testing is a key indicator.
54
When is imaging necessary in the diagnosis of groin pain?
Imaging has a role if serious pathology is suspected; otherwise, it may not be needed.
55
What does pinpoint pain indicate in groin injuries?
Pinpoint pain is more likely extraarticular and is reproduced on resisted testing and on stretch.
56
What happens to gluteal tendons and associated bursa in pathology?
They become compressed between the greater trochanter and iliotibial band (ITB), causing structural changes within the tendon resulting in tendon thickening.
57
What is the SAID principle in relation to tendons?
Tendons adapt to compression through the SAID principle, but this results in reduced tensile loading capacity, increasing the risk of further injury.
58
What are the aetiological factors contributing to gluteal tendinopathy?
Excessive compressive loads influenced by anatomical positions such as standing in hip adduction, sitting with legs crossed or together, and reduced frontal plane control during dynamic function.
59
What is the common area of pain in gluteal tendinopathy?
The area of pain is in the lateral hip, particularly around the greater trochanteric bursa.
60
Who is most commonly affected by gluteal related pain?
It is a common presentation among distance runners and women over 40 years.
61
What are the clinical signs and symptoms for gluteal tendinopathy diagnosis?
Pain and tenderness over the greater trochanter, particularly when lying on the side at night, may radiate down the lateral aspect of the thigh. Single-leg activities and plyometric activities frequently aggravate the pain.
62
What is a positive test for gluteal tendinopathy?
Positive resisted external rotation de-rotation.
63
What are the management strategies for gluteal tendinopathy?
Education, activity modification to manage provocative loads, avoiding ITB and gluteal stretches, and abductor strengthening with respect to hip position.
64
What radiological investigations can be used for gluteal tendinopathy diagnosis?
Diagnostic ultrasound can detect thickening of the bursa and tendons. MRI is the gold standard and is useful for recalcitrant cases.
Physio Amp 1 (lower Body)
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