CLINICAL CARE OF THE HIP, THIGH, AND KNEE Flashcards
What Dx/ Tx Occurs when the femoral head is displaced from the acetabulum Clinical symptoms (1) Severe pain (2) Fixed extremity (3) Numbness/tingling common Physical exam (1) Posterior dislocation: Affected limb short, hip is fixed in adducted and internally rotated position (2) Anterior dislocations: hip held in abduction and external rotation (3) Severe tenderness (4) Decreased ROM (5) Assess neurovascular status
Hip Dislocation. Treatment (1) MEDEVAC (2) Reduction --(a) Performed ASAP to reduce risk of osteonecrosis ------1) Disrupts blood supply to the femoral head in about 10% of cases --(b) Reassess neurovascular status (3) SIQ until eval by ortho
Diagnostic tests hip dislocation
(1) Radiographs of ____, _____ and _____
(2) CT scan to eval for ______
1) Hip knee and pelvis
2) fracture pattern
What Dx/Tx Mostly caused by high energy trauma (1) Associated with many severe, life threatening injuries (2) Pulmonary (3) Vascular complications (4) Intra-abdominal injuries (5) Head injuries Clinical symptoms (1) Severe pain in thigh (2) Unable to bear weight Physical exam (1) Obvious deformity, edema, possible open injury (2) Severe tenderness over fracture (3) Evaluate neurovascular status --(a) Femoral, peroneal, posterior tibial nerves --(b) Femoral, popliteal, posterior tibialis, dorsalis pedis pulses
Femur shaft Fx Treatment (1) Immediate splinting and traction (2) MEDEVAC (3) Surgical management required (4) If open wound, apply dressing
What Dx/Tx
Often misdiagnosed or completely missed
(1) Occurs in patients who undergo repetitive impact
(2) Military recruits, athletes, runners
Clinical symptoms
(1) Vague pain in anterior groin or thigh
–(a) Exacerbated by activity and weight bearing
–(b) Relieved with rest
(2) Story of increasing activity prior to pain onset
–(a) Increasing mileage as a runner, for instance
Physical Exam
(1) Antalgic gait
(2) Tenderness to proximal thigh/groin
(3) Limited ROM
–(a) Particularly internal rotation
(4) Pain to groin or thigh with straight leg raise
Stress Fracture of the Femoral Neck Treatment (1) Analgesics (2) Ortho evaluation (3) Activity modification --(a) Crutches --(b) Non weight bearing
Dx/Tx Clinical Symptoms (1) Pain in groin area with attempted weight bearing (2) Sensation of “coming apart” at the hip with bearing weight (3) High energy fractures --(a) Other distracting injuries ----1) Head, chest, abdomen --(b) Shock, multisystem trauma c. Physical exam (1) Presentation depends on severity (a) Antalgic gait vs gross deformities (b) Edema/echymmosis (2) Tender to palpation (3) Limited ROM (4) Assess neurovascular status --a) Peripheral nerve injuries common --(b) Complete vascular exam
Fracture of the Pelvis Treatment (1) MEDEVAC (2) Hemodynamic resuscitation (3) Activity modification --(a) No weight bearing (4) Pain management --(a) Narcotics (5) Pelvic binder
Pelvis Fx diagnostic testing considerations
(1) Radiographs
- -(a) Pelvis, hip, head, cervical, chest
(2) Urinalysis
- -(a) Hematuria common
(3) Hematocrit
- -(a) Evaluating blood loss
What Dx/TX
Vigorous muscle contraction while muscle is on stretch causes the injury
(1) Results from acute or overuse injury to ether the Iliopsoas, Sartorius, Rectus Femoris.
Clinical symptoms
(1) Pain over inured muscle
–(a) Exacerbated by activity
Physical exam
(1) Mild ecchymosis or edema possibly
(2) Tenderness to affected muscle group
–(a) Groin, inner thigh, ASIS/anterior thigh
(3) Increased pain while attempting to range the hip
(4) Strength limited by pain (4/5)
(5) Special Test
–(a) Thomas test for hip flexor tightness
Hip Strain Treatment (1) Light duty/activity modification (2) NSAIDs (3) Pain free hip stretching and strengthening (4) Run-walk program --(a) Progressive return to full duty (5) Send to ortho if failed conservative management
Diagnostics Hip strain
(1) Plain films of _____ and ____ considered
(2) MRI reserved for _______
1) pelvis and hip
2) chronic pain/unclear diagnosis
Thigh Strain (hamstring muscles/quadriceps) The \_\_\_\_\_\_\_\_\_ are injured more often
posterior thigh muscles (hamstring muscles)
What Dx
Strain/tear typically occurs at the musculotendinous junction
Clinical Symptoms
(a) A patient with this typically reports a sudden onset of posterior or thigh pain that occurred while running, water skiing, or some other rapid movement
(b) A “pop” may have been perceived at the onset of pain
Physical Exam
(1) Ecchymosis is common
(2) Tenderness to palpation to affected muscle group
(3) Pain while attempting to flex at the knee
hamstring strain
-Thigh Strain
What Dx
Strain/tear typically occurs at the musculotendinous junction
Clinical Symptoms
(a) injury associated with direct blows during contact sports that results in a contusion
(b) A “pop” may have been perceived at the onset of pain
Physical Exam
(1) Ecchymosis is common
(2) Tenderness to palpation to affected muscle group
(3) Pain while attempting to extend at the knee
Quadriceps strain
Thigh Strain
Treatment Thigh strain
1) Initial treatment includes prevention of further swelling and hemorrhage by having the patient _____________________________
(2) As time passes, the patient should begin a program of rehabilitation with pain free stretching and strengthening of the injured muscle
(3) NSAIDs
(4) The degree of rehabilitation necessary depends on the patient’s general activity level and the severity of the injury
1) rest and elevate the limb while applying ice and compressive wraps as needed
What Dx/Tx
Clinical Symptoms
(1) Patients usually have pain and tenderness over the greater trochanter (ie: lateral hip pain)
(2) The pain may radiate distally to the knee or ankle (but not onto the foot) or proximally into the buttock
(3) Pain worse when going from sit to stand
(4) May decrease after warming up but return after 30 to 1 hours of walking
(5) Unable to lie on affected side
Physical Exam
(1) No deformities on exam
(2) Point tenderness over the lateral greater trochanter is essential finding
(3) Patients report increased discomfort with hip adduction or adduction with internal rotation
(4) Resisted hip abduction also causes pain
(5) Trendelenburg test
(6) Faber
Trochanteric Bursitis.
Treatment
(1) NSAIDS
(2) Light Duty- Activity modification
(3) Hip strengthening(focus on abduction) and stretching
(4) Refer to ortho if conservative management failed
Diagnostic Tests
(1) Hip radiographs usually (ARE/NOT) necessary
- -(a) to rule out bony abnormalities and intraarticular hip pathology
- -(b) Bone scans and MRI are (RARELY/OFTEN) needed to make the diagnosis
1) Not
b) Rarely
The _______ ligament is a primary stabilizer of the knee
(1) Limits anterior translation of the tibia on the femur
(2) A tear of this ligament results from a rotational (twisting) or hyperextension force
anterior cruciate ligament (ACL)
Dx/Tx
Clinical symptoms
(1) Pt’s with this tear usually report sudden pain and giving way of the knee from a twisting or hyperextension-type injury
(2) 1/3 report an audible “pop” as the ligament tears
(3) Pt’s who sustain this during athletic activity usually is unable to continue
participating because of pain and/or instability
c. Physical Exam
(1) Moderate to severe effusion
(2) Possibly hemarthrosis (bleeding in the joint)
(3) Palpation
–(a) Generalized knee tenderness
(4) ROM
–(a) Limited by pain and effusion
–(b) Locking/popping sensation
(5) Muscle Test
–(a) Limited by pain
(6) Special Tests:
–(a) Anterior drawer and Lachman. Negative in many patients who have this tear
ACL Tear
Treatment
(1) RICE
(2) Light Duty to include running or cutting activities
(3) Orthopedic Consult * Required*
(4) Physical Therapy Consult
(5) A knee immobilizer or range-of-motion brace may be used for comfort when necessary until acute pain subsides
PCL Vs ACL tear
(1) Strongest ligament in the knee
(2) Prevents posterior translation of the tibia on the femur
(3) Injury caused by stretch or complete rupture of the ligament
(4) Less common than other ligamentous/meniscal injury
PCL Tear
