Common Conditions affecting the Hip Flashcards
When evaluating a patient with a hx of OA or THA what 3 safety things are you looking for? (This is asking post-surgical)
DVT, Scar healing, Infection
You want to assess their gait; what 4 factors will you want to look at?
Assistive Device, Proper use, proper fit, & gait pattern.
When treating a patient post OA or THA what are 6 things to focus on?
1) Gait Training
2) Stair Training
3) Transfers
4) ROM
5) Strengthening (don’t let pt develop bursitis)
6) Functional activities
Where are some major areas/muscles in the hip for tendonitis?
1) Adductors: sensitive areas
2) Piriformis
3) TFL/Gluteus Medius
4) Hip Flexors (Iliopsoas, Rectus Femoris, Sartorius)
What are the age ranges for Legg Calve Perthes and Slipped Capital Femoral Epiphysis?
LCP: 2-13
SCFE: girls-8-15, boys-10-17
What is most likely the cause of Legg Calve Perthes?
Disruption of blood supply to head of femur.
A 6 year old patient walks into you clinic with a limp, slight dragging of her leg, atrophy, and a trendelenberg gait. When you test her muscles she is limited in ABD and ext. What does she have? What are some other signs you would expect to see?
Legg Calve Perthes; you would also expect to see a shorter limb or higher greater trochanter.
What are your treatment options for LCP?
Atlanta Scottish Rite Hospital Orthosis or surgery. You want to keep the femoral head in the acetabulum by making them stay in ABD and ER. Surgery has a shorter time with restricted movement.
What orthotic device would you want to see on your Legg Calve Perthes patient?
Atlanta Scottish Rite Hospital Orthosis; keeps the patient in ABD and allows flexion to 90 degrees. Allows the patient to run and ride bicycle.
Your 11 year old male patient walks in holding his L leg in an flexed, ABD, and ER position. He has pain at end range and with over pressure. He has atrophy in his quads and his ADD muscles keep spasming. When you test his ROM he has a limit in flexion ABD, and IR. What are you going to diagnose your patient with and how will you treat him?
Slipped capital femoral epiphysis; current treatment of choice is surgery.
What causes slipped capital femoral epiphysis?
Displacement of the femoral epiphysis or sheer forces on the epiphysis.
Two patients walk into your clinic the same time. One is 25 year old male with a buckling, twinging, and clicking hip. He said he was playing basketball and he turned quickly on his leg and felt his leg buckle. The second is a 75 year old female who has a hx of acetabular dysplasia. She has locking in her hip. Both have pain in the anterior groin area and have pain with flexion and rotation. Do both of them have the same pathology? If so what is it?
Yes they both have labral tears, there are two mechanisms of injury for hip labral tears.
The anterior and anterior superior portions of the labrum are most torn. What contributes to this?
Lesat amount of bony constraint and relies heavily on labrum and ligaments for stability.
How would you diagnose a patient with a labral tear?
Hx and physical exam (twinging, painful clicking, buckling, locking). May have hx of trauma (may not remember), anterior groin pain, activities like forced ADD with rotation exacerbates pain.
What in the objective portion of your exam would point to labral tear?
Pain with end range and overpressure; flexion with rotation; arthography or X-ray with contrast dx for sure.
What are 4 specific tests to do for labral tears?
1) Passive ABD: pain at end range
2) Passive extension: stress on ant. capsule & labrum
3) Inner Quadrant Scour: more reliable if pain is produced rather than clicking
4) Posterior Labrum Test: prone, passively extend hip and add ER, looking for pain
Psoas Bursitis shows what S/S?
Pain in groin, refers along front of thigh to patella, PROM of hip increases pain (especially flexion, ADD, and ER)
Of the 4 bursitis which is the least likely to occur? How would you diagnose it?
Gluteal bursiits; pain lateral to posterior trochanteric area and refers to outer thigh/leg, non-capsular pattern, painful ABD and when overlying muscles contract.
A patient c/o pain with squeezing and tenderness above the ischial tuberosity. What is their problem?
Ischial bursitis
Trochanteric bursitis presents with what S/S?
Pain in lateral hip, may radiate into L5 distribution along lateral hip, deep aching pain (not like L5 dermatomal pain), pain with stairs and side lying, may shift away from side.
How would you test for trochanteric bursitis?
Flex hip fully then move into ADD and IR and compress bursa under glut max.
Palpation: pain felt behind trochanter.
How would you treat trochanteric bursitis?
1) Pulsed US
2) FIND THE CAUSE
3) Modify activities
4) Ionto
Strengthen without flaring pain
What are some possible causes of trochanteric bursitis?
1) Tight ITB/TFL
2) Weak ADD
3) Walking on uneven surfaces
4) Leg length discrepancy
