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Chapter 16 Pelvic, Hip and Thigh Conditions Flashcards

1
Q

What is coxa valga?

A

angle of inclination of the hip greater than 125 degrees

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2
Q

What is coxa vara?

A

angle of inclination of the hip less than 125 degrees

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3
Q

what is retroversion?

A

decrease angle between femoral condyles and femoral head (leads to internal rotation of the femur)

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4
Q

What is anteversion?

A

increase angle between femoral condyles and femoral head (leads to external rotation of femur)

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5
Q

What is a hip pointer?

A

Refers to a contusion of the iliac crest over the tensor fascia latae muscle belly with an associated hematoma

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6
Q

What is a hip pointer used to identify?

A

Also used to identify tearing of the external oblique muscle from the iliac crest, periostitis of the crest, trochanteric contusions

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7
Q

What are the signs and symptoms of a hip pointer?

A

S/S – movement of truck increase pain (coughing, laughing, breathing), discolouration, spasm, tenderness

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8
Q

What is the management of a hip pointer?

A

rest, ice, mild stretching

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9
Q

What are the clinical presentations of a grade 1 hip pointer?

A

Grade I – normal gait/posture, slight pain on palpation, little/no swelling, full trunk ROM, return to activity may take 3-7 days

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10
Q

What are the clinical presentations of a grade 2 hip pointer?

A

Grade II – abnormal gait pattern, posture flexed toward side on injury, POP of iliac crest with visible swelling, AROM trunk is painful and limited, return to activity may take 5-14 days

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11
Q

What are the clinical presentations of a grade 3 hip pointer?

A

Grade III – severe pain/swelling/ecchymosis, gait is slow/short stride length, posture has severe tilt to injured side, trunk ROM limited and painful, return to activity may take 14-21 days

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12
Q

What is the most common site for a quadriceps contusion?

A

anterolateral thigh

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13
Q

What are quad contusions associated with?

A

with greater tearing, hemorrhage and pain

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14
Q

What happens immediately after impact in quad contusions?

A

pain/swelling

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15
Q

What are the clinical presentations of a grade 1 quadriceps contusion?

A

Grade I – mild pain and swelling, able to walk without a limb, passive flexion beyond 90 degrees painful, discomfort with RROM knee extension

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16
Q

What are the clinical presentations of a grade 2 quadriceps contusion?

A

Grade II – 45-90 degrees of knee flexion, walks with limp, swelling

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17
Q

What are the clinical presentations of a grade 3 quadriceps contusion?

A

Grade III – within 24 hours progressive bleeding and swelling, palpable firm hematoma, inability to contract quadriceps

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18
Q

What are myositis ossificans?

A

Abnormal ossification involving bone deposition within muscle tissue

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19
Q

How do myositis ossificans start?

A

stem from a single traumatic blow or from repeated blows to the quads

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20
Q

Where are most myositis ossificans located in the thigh?

A

anterior or lateral thigh

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21
Q

When are myositis ossificans visible on radiographs?

A

after 2-4 weeks

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22
Q

What can be felt on palpation with myositis ossificans?

A

palpable firm mass can be felt in the deep tissue

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23
Q

What happens after 6-7 weeks with myositis ossificans?

A

the mass stops growing and resorption occurs

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24
Q

What are the signs and symptoms of myositis ossificans?

A

S/S – warm, firm, swollen thigh nearly 2-4 cm larger than unaffected side, limit passive knee flexion, difficult active quadriceps contractions

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25
What is acute compartment syndrome?
Increased tissue pressure in a closed fascial compartment that compromises circulation to the news and muscles within the compartment
26
What is the cause of acute compartment syndrome?
severe blunt trauma to the thigh, femur fracture
27
What are the symptoms of anterior compartment syndrome?
pain increases during PROM knee flexion and hip extension, RROM knee extension weak, sensory deficits occur in the lateral, intermediate, and medial thigh and medial calf
28
What are symptoms of posterior compartment syndrome?
pain increases during PROM knee extension with the hip in flexion, weakness in knee flexion, PF and big toe extension, sensory deficits occur in the plantar foot, dorsal foot and first web space
29
What are the symptoms of medial compartment syndrome?
pain increases during PROM hip abduction with knee extended, weak hip abduction, sensory deficits in proximal medial thigh
30
What are the management steps for acute compartment syndrome?
refer to physician, surgery with pressure reading greater than > 40 mmHg with an incision, fasciotomy and evacuation of the hematoma
31
Where is the greater trochanteric bursa located?
greater trochanteric bursa lies between the greater trochanter and the gluteus maximus and TFL
32
Why is greater trochanteric bursitis 4x more common in women than men?
due to larger Q-angle and wider pelvis
33
What are the greater trochanteric bursitis signs and symptoms?
burning, aching pain, aggravated with hip abductors, hip flexion/extension sudden sharp pain - snapping hip problem
34
What is the iliopectineal bursa?
largest bursa in the body
35
Where is the iliopectineal bursa located?
Lies under the iliopsoas muscle where it passes over the iliopectineal eminence in the pubis and inserts onto the lesser femoral trochanter
36
What MOI causes iliopectineal bursitis?
repeated compression of the bursa against either the joint capsule of the hip and the lesser trochanter of the femur
37
What are the signs and symptoms of iliopectineal bursitis?
pain more medial and anterior to the joint, hard to palpate, PROM of hip and RROM hip flexion, abduction and ER produces pain
38
What can lead to compression of the ischial bursa?
direct bruising from a fall
39
A history of what can lead to ischial bursitis?
History of prolonged sitting, especially with the legs crossed or on a hard surface
40
What are the s/s of ischial bursitis?
pain is aggravated by prolonged sitting, uphill running, P with passive and resisted hip extension
41
What is an external snapping hip syndrome?
thickened IT band, TFL or gluteus maximus tendon snapping over greater trochanter during hip flexion
42
What is an internal snapping hip syndrome?
iliopsoas tendon snapping over the anterior hip capsule, lesser trochanter, femoral head or iliopectineal eminence
43
What is an intra-articular snapping hip syndrome?
labral tear, hip subluxation, osteochondral fractures or intra-articular loose bodies
44
What are the S/S snapping hip syndrome?
snapping sensation rather than pain
45
How can sprains and dislocations of the hip occur?
Can occur in violent, twisting actions or in catastrophic trauma when the knee strikes a stationary object
46
What are the S/S of sprains and dislocations of the hip?
pain in hip rotation, inability to walk or move hip
47
how common are quadriceps strains and where are they mostly located?
Less common than hamstring strains Mid-substance of the muscle belly, rectus femoris
48
What are the clinical presentations of a grade 1 quadriceps strain?
Grade I – tightness in anterior thigh, gait is normal, no swelling or pain palpated, passive knee flexion beyond 90 degrees painful
49
What are the clinical presentations of grade 2 quadriceps strain?
Grade II – snapping or tearing sensation during explosive motions, immediate pain and loss of function, pain on passive knee flexion 45-90 degrees, weakness during resisted knee extension
50
What are the clinical presentations of a grade 3 quadriceps strain?
Grade III – extremely painful, obvious defect in muscle, RROM knee extension not possible, limited ROM
51
What is the most frequently strained muscle in the body?
hamstring
52
What are hamstring strain caused by?
Caused by rapid contraction or the muscle during ballistic action or a violent stretch
53
What increases the risk of hamstring strains?
increase risk: poor flexibility/posture, muscle imbalance, improper warm-up, muscle fatigue, lack of neuromuscular control, previous injury, overuse, improper technique
54
In what kind of activities are adductor strains common?
common in activities that require quick change of direction, explosive propulsion and acceleration
55
What is usually found when adductor strains occur?
strength imbalance between abductors and adductors
56
What are the S/S of adductor strains?
initial pull, unable to walk because of the intense sharp pain, weakness in hip adduction and flexion, increase pain during hip extension, abduction and ER
57
What is the percentage of the population that has the sciatic nerve passing through the piriformis muscle?
10-15%
58
What can cause compression of the sciatic nerve?
Nerve compression from trauma, hemorrhage or spasm of piriformis muscle
59
What clinical history leads to piriformis syndrome?
history of prolonged sitting, stair climbing, repetitive squatting
60
What are the S/S of piriformis syndrome?
dull ache in the mid buttock region, weakness/numbing down back of leg, pain and weakness on hip ER, passive hip flexion, adduction, IR and resisted hip ER, patient stands in ER, limited SLR
61
What is Legg-Calvé-Perthes Disease?
Avascular necrosis of the capital femoral epiphysis Osteochondrosis condition of the femoral head caused by diminished blood supply to the capital region of the femur
62
In which sex is Legg-Calvé-Perthes Disease more prominent?
boys>girls
63
What is stage 1 of Legg-Calvé-Perthes Disease?
edema develops at the synovial membrane and capsule over 1-6 weeks
64
What is stage 2 of Legg-Calvé-Perthes Disease?
necrosis of the femoral epiphysis occurs, lasting from several months to 1 year
65
What is stage 3 of Legg-Calvé-Perthes Disease?
regeneration last 1-3 years
66
What is stage 4 of Legg-Calvé-Perthes Disease?
repair occurs when new/normal bone replaces dead bone
67
What are the S/S of Legg-Calvé-Perthes Disease?
pain referred to groin region, gradual onset of limp
68
What is thrombophlebitis?
acute inflammation of a vein superficial - more painful, varicose veins visible under skin Deep venous thrombosis - dangerous, can't be seen or felt
69
What is phlebothrombosis?
clotting in a vein without overt inflammatory signs and symptoms
70
What is homan's sign?
clinical tool to diagnose deep vein thrombosis
71
What is toxic synovitis?
Infrequent condition, occurs largely in children Most common cause of acute hip pain Painful hip joint, antalgic gait and limp Referral to physician
72
What is obturator nerve entrapment?
May occur where it enters the thigh as a result of pelvic tumours, obturator hernias or pelvic/proximal femoral fractures S/S – medial thigh pain from the adductor muscle Surgical intervention necessary
73
When do apophysitis and avulsion fractures often occur?
Often occur during adolescent growth period between 11-15 years old
74
What are common avulsion fracture sites?
ASIS, AIIS, ischial tuberosity, lesser trochanter
75
What is a femoral epiphysis?
growth plate at the femoral head?
76
What are risk factors for fractures of the capital femoral epiphysis?
adolescent boys 12-15 years old, obese, underdeveloped sexual characteristics, rapid growing
77
What happens with slipped capital femoral epiphysis?
Femoral head slips at the epiphyseal plate and displaces inferiorly and posteriorly relative to femoral neck
78
What are signs of slipped capital femoral epiphysis and what is necessary to diagnose it?
Painful limp with groin pain Radiograph necessary
79
What is osteitis pubis?
Inflammatory process involving continued stress on the pubic symphysis from repeated overload of the adductor muscles

NCE (18 decks)

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