Approach To Hip Complaint Flashcards
What is developmental dysplasia of the hip (hip dysplasia)?
A common musculoskeletal condition in newborns
Screening is a component of neonatal medical care
What are risks/causes for DDH?
Newborns, breech position, female and first gestation
How is a diagnosis made for DDH?
Hip clunk - distinct and pronounced palpable shift of the femoral head
Hip click - benign palpable or audible hip sound
Mild instability - hip characterized by a loose fit between femoral head and acetabulum without overt sublaxation or dislocation
What are the ortolani and Barlow sign for DDH?
Abducting the hip and feeling for a clunk (ortolani)
Then adducting and feeling for a clunk (barlow)
What is Legg-Calve-Perthe’s disease?
Blood supply to the head of the femur is interrupted
Femoral head then necroses or loses blood supply which weakens the bone and can lead to multiple fractures
What are the sx for Perthes disease?
Limping
Pain or stiffness in the hip, groin, thigh or knee with limited ROM of the hip
Pain that worsens with activity and improves with rest
What are the risks/causes for Perthe’s disease?
Between 3-12 years old and 5x more common in boys
Risk factors include skeletal immaturity, obesity and lower SES
How is Perthe’s disease diagnosed?
History and exam notes problems rotating the leg, muscle atrophy of the LE, affected leg may be shorter than normal leg
X-ray and MRI
What is slipped capital femoral epiphysis (SCFE)?
A disorder of adolescents in which the growth plate is damaged and the femoral head moves (slips) with respect to the rest of the femur
Can happen over time or from a fall, accident or trauma
What is the clinical presentation for SCFE?
Obese adolescent presenting with hip pain and limping and impaired internal rotation occasionally after minor trauma
Pain in the groin, inner thigh or knee
Stiffness and decreased ability to rotate the leg
May be a change in their gait or they may walk with the leg rotated outward*
What are risks/causes for SCFE?
Obesity in adolescent (8-15 years old)
Growth spurt, endocrine disorder, boys are more often affected than girls
What is avascular necrosis?
A disease that results from the temporary or permanent loss of blood supply to the bone
Sx include limited ROM due to pain, increased joint pain as bone and joint begin to collapse
What are risks for AVN?
Anyone can be affected by the condition is MC between the ages of 30-50
Long term use of medicines such as corticosteroids
Excessive long term use of alcohol
What is trochanteric bursitis?
Inflammation of a bursa
MCC is injury or overuse
More common in women, middle aged and older people
What are the sx for trochanteric bursitis?
Pain on the outside of the hip and thigh or in the buttock
Pain when lying on the affected side, when you press in or on the outside of the hip
Pain with walking upstairs
Worsens during activities such as getting up from a deep chair or getting out of the car
What is osteoarthritis of the hip?
Can be classified as primary or secondary
MC sx of OA is pain after overuse or inactivity of a joint
Pain, stiffness, grinding feeling of the joint when moved
Most people over the age of 60
Describe primary and secondary OA
Primary OA has no known cause
Secondary is caused by another disease, infection, or deformity
What kind of Xrays should be done when looking for OA?
Weight bearing Xrays
What is meralgia paresthetica?
A condition characterized by tingling, numbness and burning pain in the outer part of your thigh
Caused by compression of the lateral femoral cutaneous nerve which supplies sensation to your upper leg
What are the sx of meralgia paresthetica?
Tingling and numbness in the outer part of the thigh
Burning pain on the surface of the outer part of thigh
Commonly occur on one side of the body and might intensify after walking or standing
What are the risks/causes for meralgia paresthetica?
Tight clothing, obesity or weight gain, and pregnancy are common causes
Can also be due to local trauma or disease such as DM
What is femoracetabular impingement (FAI)?
Also called hip impingement
Condition where the hip joint is not shaped normally
Causes the bones to painfully rub together
What are the risks/causes and sx for FAI?
Common cause of hip pain in adolescents, adults and athletes of all ages
Sx: limping, stiffness in the hip, hip pain worsens during physical activity or long periods of sitting
What is a labral tear?
Hip impingement that occurs when the ball of the hip pinches against the socket which can cause damage to the labrum leading to stiffness, pain and OA in the hip
What are the sx of labral tear?
Pain in the hip or groin often made worse by long periods of standing, sitting or walking
A locking, clicking or catching sensation of the hip joint
What are some risks/causes of labral tears?
Trauma or injury to the hip joint
Structural abnormalities
Repetitive motions with sports related or other physical activities
What is a hip fracture?
A partial or complete break of the femur where it meets the pelvic bone
Requires immediate medical attention
MCC are falls in the elderly
What are some risks/causes of hip fracture?
Women aged >85 years are 10x more likely
White women aged >65 years are at higher risk
FHx of hip fracture or OA, tobacco or alcohol abuse, low SES or chronic medications
What are some signs and sx of hip fractures?
Inability to get up from a fall or to walk
Inability to put weight on the leg on the side of the inured hip
Shorter leg on the side of the injured hip
Fall related injures are the leading cause of what?
Injury deaths and disabilities among older adults
What is the most serious fall injury?
Hip fracture
Any older person with hip pain after a fall should be treated as what?
A hip fracture until proven otherwise
Describe pelvic fractures/crush injuries
Typically occur with significant trauma such as MVAs, falls, etc
Risks include significant trauma
Usually diagnosed by the presence of bone tenderness, difficultly walking or doing other movements and any loss of nerve function in the lower part
What is compartment syndrome?
A painful condition that occurs when pressure within the muscles builds to dangerous levels
Pressure can decrease blood flow which prevents nourishment and oxygen reaching nerve and muscle cells
Can be acute or chronic
What are the 5 P’s for compartment syndrome?
Pain, paresthesia, pallor, paralysis and pulselesseness
What are the 3 A’s for compartment syndrome?
Increased analgesic recruitment
Anxiety
Agitation
What is septic arthritis?
A pain infection in a joint
Can come from “germs” traveling through the bloodstream or from penetrating injuries
What are the risks/causes of septic arthritis?
Infants and older adults to develop SA
Knees are most commonly affected but can also affect hips, shoulders and other joints
Age >80, DM, RA, prosthetic joint surgery, skin infection, IVDA
What are the common organisms causing SA?
Staph aureus and streptococcal in healthy pts
Sexually active young pt - N gonorrhea
Immunocompromised people - gram - bacteria, mycobacterial species, fungal species
Septic arthritis typically causes what?
Extreme discomfort and difficulty using the affected joint
Joint could be swollen, red and warm
Might have a fever
