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Musculoskeletal > Common disorders of the Hip > Flashcards

Common disorders of the Hip Flashcards

1
Q

What are some Common Disorders of the Hip

A

Osteoarthritis

Bursitis
- Gluteal tendinopathy

Avascular Necrosis (AVN)

Impingement

Labral Tear

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2
Q

What characterises osteoarthritis

A

Progressive loss of articular cartilage

Characterised by worsening pain and stiffness of the affected joint

Limiting everyday life

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3
Q

What is Trochanteric bursitis

A

Inflammation of the Fluid-filled sac sandwiched between hip abductors and ITB (the trochanteric bursa)

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4
Q

What is epidemiology of Trochanteric bursitis

A

F>M

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5
Q

What is aetiology of Trochanteric bursitis

A

Trauma
Over-use

Abnormal movements

Local problem
-	Muscle wasting following surgery
-	Total Hip 
Replacement
-	Osteoarthritis
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6
Q

Where do you feel for tenderness in Trochanteric bursitis

A

Tenderness at Greater Tuberosity

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7
Q

What is the presentation of Trochanteric bursitis

A

Pain

  • Point tenderness
  • Lateral hip
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8
Q

What investigations are used for Trochanteric bursitis

A

X-ray
MRI
Ultrasound

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9
Q

What is treatment for Trochanteric bursitis

A 
NSAIDs
Relative rest / Activity modification
Physiotherapy
-	Correct posture, abnormal movements
-	Stretching
-	Strengthen muscles around joint
Injection
-	Corticosteroids

Surgery
- Bursectomy (Rarely required)

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10
Q

What is Avascular necrosis

A

Death of bone due to loss of blood supply

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11
Q

What is Epidemiology of avascular necrosis

A 
Males > Females
Average age 35-50 years old 
80% = bilateral
-	May be offset in time
3% = multifocal
-	3 or more joints
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12
Q

What are risk factors of avascular necrosis

A

Trauma

Systematic

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13
Q

Where in particular can trauma occur and cause vascular necrosis

A

Injury to femoral Intracapsular fracture

Intracapsular fracture

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14
Q

What systematic conditions can cause vascular necrosis

A 
Hypercoaguable states
Steroids
Haematological 
-	Sickle Cell Disease
-	Lymphoma
-	 Leukaemia
Caisson’s disease
Alcoholism
Ideopathic
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15
Q

What are symptoms of avascular necrosis

A 
Insidious onset of groin pain
Pain with stairs, walking uphill and impact activities
Limp
Examination
Largely normal
May replicate early arthritis
-	Reduced range of motion (partic internal rotation)
-	Stiff joint
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16
Q

What are treatment options of avascular necrosis

A

Non-operarive

Surgery

17
Q

What are non operative treatment options of avascular necrosis

A
  • Reduce weight-bearing
  • NSAIDs
  • Bisphosphonates
    o Early AVN
    o Controversial
  • Anticoagulants
  • Physiotherapy
    o Maintain range of motion
    o Keep the ball round!
18
Q

What are operative treatment options of avascular necrosis

A
  • Restore blood supply
    o Core decompression
    o Core decompression and vascularised graft
  • Move the lesion away from the weight-bearing area
    o Rotational Osteotomy
  • Total Hip Replacement
19
Q

What is Femoroacetabular Impingement (FAI)

A

Femoroacetabular impingement (FAI) is a condition in which extra bone grows along one or both of the bones that form the hip joint — giving the bones an irregular shape. Because they do not fit together perfectly, the bones rub against each other during movement. Over time this friction can damage the joint, causing pain and limiting activity.

20
Q

What categories are Femoroacetabular Impingement (FAI) divided into?

A

Cam lesion

Pincer

21
Q

What is the pincer category of Femoroacetabular Impingement

A

Acetabulum-based impingement

Usually in active females

This type of impingement occurs because extra bone extends out over the normal rim of the acetabulum. The labrum can be crushed under the prominent rim of the acetabulum.

22
Q

What is the cam category of Femoroacetabular Impingement

A

Cam-type femoroacetabular impingement (FAI) is a known cause of groin pain and a condition that can give rise to osteoarthritis of the hip (1). Patients suffering from this condition are mainly young and experience pain when the hip is moved through internal rotation and adduction at 90° of hip flexion

Excess of bone along the upper surface of the femoral head,

23
Q

What is the presentation of Femoroacetabular Impingement

A 
Groin pain
-	Worse with flexion
Mechanical symptoms
-	Block to movement
-	Pain with certain manoeuvres
o	Getting out of a chair
o	Squatting
o	Lunging
24
Q

What is Examination for Femoroacetabular Impingement

A

Reduced flexion and internal rotation
Positive FADIR test
- Flexion, ADduction, Internal Rotation

25
Q

What are investigations for Femoroacetabular Impingement

A 
X-ray
-	Identify the bony pathology
MRI
-	Useful for assessing associated conditions
o	Labral tears
o	Articular cartilage damage
26
Q

What are non-operative treatment options for Femoroacetabular Impingement

A 
Non-operative
-	Activity modification
-	NSAIDs
-	Physiotherapy
o	Correct posture
o	Strengthen muscles around joint
27
Q

What are operative treatment options for Femoroacetabular Impingement

A

Arthroscopy
o Shave down the defect
o Deal with labral tears
o Resect artic cartilage flaps

Open Surgery
o	Resection
Periacetabular Osteotomy
o	Hip Arthroplasty
    ♣	Resurfacing
    ♣	Replacement
28
Q

What is a labral tear

A

A labral tear results when a part of the labrum separates or pulls away from the socket. Most commonly, a labral tear is the result of repetitive stress (loading) irritating the hip, often due to long-distance running or performing repeated, sharp, sports movements, such as twisting and cutting.

29
Q

What is the most common labral tear

A

Most commonly anterosuperior tear

30
Q

What is Presentation for labral tear

A

Groin or Hip Pain
Snapping sensation
Jamming or locking

31
Q

What is Examination for labral tear

A

can be normal
Positive FABER test
- Flexion, ABduction, External Rotation
o Anterior tears

32
Q

What is Investigations for labral tear

A 
Ensure adequate imaging so identify any root causes of pathology
X-ray
-	OA, Dysplasia
MRI Arthrogram
-	92% sensitive 
Diagnostic injection
-	Local anaesthetic
33
Q

What is Non-operative treatment for labral tear

A
  • Activity modification, NSAIDs, Physiotherapy

- Injection of Steroids

34
Q

What is Operative treatment for labral tear

A
  • Arthroscopy
    o Repair
    o Resection

Musculoskeletal (22 decks)

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