Approach to Hip Complaint

Question 1

Developmental Dysplasia of the Hip (Hip Dysplasia)

Answer 1

• pediatric hip disorder
• abnormal development of ball and socket
• joint may become unstable, leading to inability to walk
• risk factors: difficult birth and pregnancy, family hx, breech position, females
• Signs & Sxs: asymmetry in hip height, hip clunk on PE (shift of the femoral head as it is dislocated or reduce with the Ortolani and Barlow Maneuvers)

Question 2

Ortolani Sign

Answer 2

• used to diagnose Hip Dysplasia
• flex knees and hips to 90 and gently abduct while pishing trochanter anteriorly
• if positive, then femoral head dislocates or reduces

Question 3

Barlow Maneuver

Answer 3

• used to diagnose Hip Dysplasia
• hip is gently adducted with light downward pressure, a palpable clunk may be felt

Question 4

Legg-Calve-Perthes Disease

Answer 4

• pediatric hip disorder
• avascular necrosis of the hip; blood supply to head of femur is interrupted
• risk factors: boys, skeletal immaturity, obesity, family hx
• Signs & Sxs: limping, pain or stiffness in the hip/groin/thigh/knee, pain on anteromedial thigh or knee, pain worse with activity and better with rest, limited internal rotation and abduction, muscle atrophy

Question 5

Slipped Capital Femoral Epiphysis (SCFE)

Answer 5

• pediatric hip disorder
• growth plate is damaged and the femoral head “slips” backwards and downwards with respect to the rest of the femur
• femoral head stays in the cup of the hip joint while the rest of the femur is shifted
• risk factors: obesity, endocrine disorder, boys, fall or other injury
• Signs & Sxs: pain in groin/hip/thigh/knee, limp, activity increases pain, leg rotated outward with decreased internal rotation

Question 6

Transient Synovitis

Answer 6

• pediatric hip disorder
• acute, non-specific, inflammatory process affecting the joint synovium
• etiology is unclear
• common in 3-8 YO boys
• Signs & Sxs: acute unilateral hip pain, low grade fever, thigh/groin/knee pain, limp, able to bear weight, restrictions to ROM esp in abduction and internal rotation

Question 7

Avascular Necrosis

Answer 7

• death of bone tissue due to loss of blood supply; progresses to bone collapse
• risk factors: fx, corticosteroids, alcohol
• Signs & Sxs: minimal joint pain in early stages, progresses to limited ROM with internal rotation and abduction, advance stages leads to bone collapse

Question 8

Trochanteric Bursitis

Answer 8

• inflammation of the bursa
• causes: direct injury, prolonged pressure, overuse, inflammation, infections, obesity, female
• Signs & Sxs: lateral hip pain, pain when lying on affected side, pain with getting up from deep chair or walking up stairs, tenderness to palpation greater trochanter

Question 9

OA of the Hip

Answer 9

• breakdown of cartilage that leads to bone spurs and fluid filled cyst formation
• causes: age, joint injury, obesity, genetics, females
• Signs & Sxs: pain in groin area, stiffness, swelling, unilateral, decreaed ROM

Question 10

Meralgia Paraesthetica

Answer 10

• compression of the lateral femoral cutaneous nerve as it passes under the inguinal ligament
• characterized by tingling, numbness, and burning pain in the outer part of your thigh
• Signs & Sxs: pain, decreased sensation, unilateral, worse with prolonged walking and standing, decreased sensation to light touch in upper lateral thigh
• ***strength and DTR are normal

Question 11

Labral Tear

Answer 11

• injury to hip labrum
• risks: runners, soccer players, football players, trauma, hip impingement, OA
• Signs & Sxs: pain in hip or groin, stiffness, limited ROM, locking or catching sensation

Question 12

Typical position of injured leg after hip fx:

Answer 12

injured leg is shortened and externally rotated

Question 13

Pelvix Fractures

Answer 13

• break in one or more pelvic bones
• significant hemorrhage occurs with pelvic injuries
• risk factors: falls, MVA crash, high-energy blunt trauma
• Signs & Sxs: pain/numbness in groin/hip/low back, difficulty walking, LE weakness or decreased sensation, loss of nerve function to bowel or bladder leading to incontinence

Question 14

The 5Ps of Acute Extremity Compartment Syndrome

Answer 14

• Pain
• Paresthesia
• Pallor
• Paralysis
• Pulselessness