Buttock pain Flashcards
________typically presents in the obese adolescent
(10–15 years) with knee pain and a slight limp
SCFE
Every newborn infant should be tested for ______
which can usually be treated successfully when
diagnosed early
DDH,
The _______ is the most likely cause of pain in the
buttock in adults
spine
If a woman, especially one with many children,
presents with bilateral buttock or hip pain, consider
_____________ as the
cause
dysfunction of the sacroiliac joints (SIJs)
If a middle-aged or elderly woman presents with
hip pain, always consider the underdiagnosed
conditions of_______ or _________
trochanteric bursitis or gluteus medius
tendonitis (greater trochanteric pain syndrome).
___________is prone to develop in the
metaphysis of the upper end of the femur and must
be considered in the child with intense pain, a severe
limp and fever
Osteomyelitis
Tuberculosis may also present in
children (usually under 10 years) with a presentation
similar to _____
Perthes disease
________ or _________ is the most
common cause of hip pain and limp in childhood
Transient synovitis or ‘irritable hip’
Retroperitoneal haematoma can cause referred
pain and ________
femoral nerve palsy.
Childhood disorders that must not be missed
include:
- DDH and acetabular dysplasia
- Perthes disease
- SCFE
- stress fractures of the femoral neck
‘Red flag’ pointers to potentially serious
hip conditions
- Swelling, redness, very limited joint motion
- Pain, fever, systemic features (in absence of trauma)
- Neurological changes (e.g. loss of power)
- Rapid joint swelling after trauma
- Constant localised pain unaffected by movement
__________ commonly causes
shoulder girdle pain in the elderly but pain around
the hip girdle can accompany this important problem
Polymyalgia rheumatica
Chilblains around the upper thighs occur in cold
climates and are often known as_________ chilblains
because they tend to occur during horse riding in very
cold weather
‘jodhpur’
___________is a nerve entrapment
causing pain and paraesthesia over the lateral aspect
of the hip
Meralgia paraesthetica
If a man presents with ‘sciatica’, especially confined to the buttock and upper posterior thigh (without local back pain), consider the possibility of pressure on the sciatic
nerve from a wallet in the hip pocket.
‘hip pocket nerve’ syndrome
Paget disease can involve the upper end of the______________
femur and the pelvis
A common finding in psychoneurotic
patients complaining of buttock and thigh pain is _________
90 °
limitation of flexion at the hip joint.
if after VC, the leg is, shortened and externally rotate, what is the provisional dx?
fractured neck of femur is the provisional diagnosis;
if after VC, the leg is internally rotated, what is the provisional dx?
posterior dislocation of the hip
In children it is most important to measure
rotation and abduction/adduction with the knee and
hip flexed to detect __________
early Perthes disease or SCFE.
How to measure leg length
True leg length __________
Apparent leg length ____________
(ASIS to medial malleolus)
umbilicus to medial malleolus
- Unequal true leg length =_________
* Unequal apparent leg length =________
hip disease on shorter side
tilting of pelvis
____________—shortened stance phase of
affected leg, as patient doesn’t want to stand on
it, indicates pain with weight-bearing
Antalgic gait
__________—upper torso shifts towards painful
side due to pain in the hip
Coxalgic gait
_____________ (the gluteus medius lurch)—
similar to coxalgic but pelvis tilts
Trendelenburg gait
________—tests hip abductors (gluteus
medius): the non-weight-bearing hemipelvis
drops if abnormal
Trendelenburg test
__________—tests for fixed flexion deformity
Thomas test
Squeeze test for ________
osteitis pubis
plain AP X-ray of pelvis showing _______
both hip joints
_________ is now sensitive in children in
detecting fluid in the hip joint, and can diagnose septic
arthritis and also localise the site of an osteomyelitic
abscess around a swollen joint
Ultrasound diagnosis
In __________ previously known as congenital dislocation of the hip, the underdeveloped femoral head dislocates
posteriorly and superiorly
DDH,
RF for DDH
Risk factors include family history, breech delivery, oligohydramnios and caesarean section
Dx of DDH
Diagnosed early by Ortolani and Barlow tests
(abnormal thud or clunk on abduction); test
usually negative after 2 months
Early Mx of DDH
When diagnosed and treated from birth it is
possible to produce a normal joint after a few
months in an _______
abduction splint
What test________
_________ (IN test: gentle clunk into acetabulum)
Ortolani test
What test________
_________ (OUT test: gentle clunk
out of acetabulum
Barlow test
T or F
Plain X-ray has little or no place in the diagnosis
of DDH in the neonatal period
T
Recommended test for DDH
Ultrasound imaging is recommended
Tx for DDH
- 0–6 months—____________
- 3–18 months—____________
- > 18 months—_______
Pavlik harness or abduction splint
reduction (closed or open) and cast (pelvic spica)
open reduction and possible osteotomy
Cx of DDH
Despite early treatment some cases progress
to acetabular dysplasia (underdevelopment of the
‘roof’ of the hip joint) and to premature osteoarthritis
________ results in the femoral head becoming
partly or totally avascular (i.e. avascular necrosis
Perthes disease
Xray of Perthes disease
Joint space appears increased and femoral
head too lateral: typical changes of sclerosis, deformity
and collapse of the femoral capital epiphysis may be
delayed
This common condition is also known as ‘irritable
hip’ or observation hip and is the consequence of a
self-limiting synovial inflammation
Transient synovitis
Outcome of Transient synovitis
It settles to normal within 7 days, without sequelae.
Why do Xray in transient synovitis after 5-6 mos
Follow-up X-ray is
needed in 4 to 6 months to exclude Perthes disease
One problem of the displaced capital epiphysis of
the femoral head (SCFE) is when some patients
develop __________despite expert treatment
avascular necrosis
________ of the hip should be suspected in
all children with acutely painful or irritable hip
problems. These patients may not be obviously sick
on presentation, particularly in infants <2 years.
Septic arthritis
T or F, A negative needle aspiration does not exclude septic arthritis
T
If sepsis is suspected it is better to proceed
to an _________ if clinically indicated.
arthrotomy
Forceful contraction of muscles originating around
the pelvis can lead to _______
avulsion at their origin in those with skeletal immaturity
The most common problem in the little athlete is
pain or discomfort in the region of the iliac crest or
anterior or superior iliac spines, usually associated
with_______ or _________
traction apophysitis or with acute avulsion
fractures
Patients often give a story
of two falls—the first very painful, the second with
the hip just ‘giving way’ as the femoral head fell off.
Subcapital fractures
The displaced subcapital fracture has at least
a 40% incidence of ________ and usually
requires prosthetic replacement in patients over
70 years
avascular necrosis
RF for AVN
corticosteroid use, SLE, sickle cell disease, past hip fracture or dislocation, pregnancy, alcoholic liver disease.
_______ of the hip is the most common
form of hip disorder.
Osteoarthritis
Pain pattern of hip OA
pain worse with activity, relieved by rest, and then nocturnal pain and pain after resting
Pain radiation pattern of hip OA
Pain usually in groin—may be referred to medial
aspect of thigh, buttock or knee
Order of movement loss in hip OA is ___
IR, extension,
abduction, adduction, flexion, ER
A type of total hip replacement called _________
is becoming more popular in certain situations in
patients under 60 years of age; >90% achieve a good
result.
hip resurfacing
____________ are becoming better recognised
in motor accident victims, dancers and athletes,
especially with the use of MRI and hip arthroscopy
Acetabular labral tears
What test to dx Acetabular labral tears
The impingement test should be
performed
According to Paoloni,
____________ is
the gold standard for diagnosing hip pathology
examination after hip joint anaesthetic injection
Pain arising from _______disorders is normally
experienced as a dull ache in the buttock but can be
referred to the groin or posterior aspect of the thigh.
SIJ
When is SIJ pain worse?
It is worse in loading situations e.g. walking, running,
getting in and out of cars.
How to test SIJ problem by direct pressure?
With the patient lying prone a
rhythmic springing force is applied directly to the
upper and lower sacrum respectively
What test for SIJ?
With the patient lying
supine and with arms crossed, ‘separate’ the iliac
crests with a downwards and outwards pressure. This
compresses the SIJs
Winged compression test
What test for SIJ?
With hands placed on the
iliac crests, thumbs on the ASISs and heels of hand
on the rim of the pelvis, compress the pelvis. This
distracts the SIJs
Lateral compression test.
The patient lies supine
on the table and the foot of the involved side and
extremity is placed on the opposite knee (the hip
joint is now flexed, externally rotated and abducted).
Patrick or FABERE test
_________ disorders are usually encountered
in young people after some traumatic event,
especially women following childbirth (notably
multiple or difficult childbirth), or after a heavy fall
onto the buttocks, as well as in those with structural
problems (e.g. shortened leg).
Hypomobile SIJ
Pain pattern of SIJ disorders
Pain tends to follow rotational stresses of the SIJ
________ disorders are sometimes seen in
athletes with instability of the symphysis pubis, in
women after childbirth and in those with a history
of severe trauma to the pelvis
Hypermobile SIJ
Pain pattern of Hypermobile SIJ
The patient presents typically with severe aching
pain in the lower back, buttocks or upper thigh.
T or F
In hypermobile SIJ,
It is difficult to treat and manual therapy usually exacerbates the symptoms.
T
The cause is tendonopathy of the gluteus medius
tendon (considered to be the main pathology),
where it inserts into the lateral surface of the
greater trochanter of the femur and/or gluteus
minimus tendon with or without inflammation of
the trochanteric bursa
Greater trochanteric pain
syndrome
Pain pattern of Greater trochanteric pain
syndrome
The pain of
this condition tends to occur at night, especially after
activity such as long walks and gardening.
Advise for pts with Greater trochanteric pain
syndrome
Advise the patients to walk with
the feet turned out—‘the Charlie Chaplin gait’
Surgical Tx of Greater trochanteric pain
syndrome
Surgical intervention such as iliotibial band release ± bursectomy may be necessary.
Pain in the lateral thigh can be caused by inflammation
of the fascia lata. It is often due to overuse or weak
musculature around the hip. Treatment is relative
rest and physiotherapy
Fascia lata syndrome
Some patients complain of a clunking, clicking or
snapping hip, either palpable and/or audible. This
represents an annoying problem that may cause pain
in the groin or thigh. It is more common in females
with a wide pelvis
Snapping or clicking hip (coxa
saltans)
Causes of Snapping or clicking hip (coxa
saltans)
• A taut iliotibial band
• The iliopsoas tendon snapping across the
iliopectineal eminence at the anterior brim of the
pelvis
• The gluteus maximus sliding across the greater
trochanter
• Joint laxity
