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PHTH 517 > Common Disorders of the Hip > Flashcards

Common Disorders of the Hip Flashcards

1
Q

Avascular Necrosis

What is the avascular necrosis?

A

areas of dead trabecular bone and bone marrow
- this goes to the subcondral plate

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2
Q

Avascular Necrosis

What are the subjective findings?

A
  • pain @ groin (radiate to lateral hip, knee or ass)
  • “throbbing and deep”
  • pain is intermittent with gradual onset
  • antalgic shift
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3
Q

Avascular Necrosis

What are common risk factors?

A
  • cumulative corticosteroid total dose
  • alcohol abuse
  • systemic lupus
  • sickle cell
  • trauma
  • cancer
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4
Q

Avascular Necrosis

What is the objective findings?

A
  • painful ROM (with forced IR)
  • pain with SLR
  • antalgic gait
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5
Q

Avascular Necrosis

What are the special tests?

A

based on:
- subjective
- physical
- imaging

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6
Q

Avascular Necrosis

What is indicated in imaging?

A
  • AP view of pelvis
  • AP frog lateral radiographs
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7
Q

Avascular Necrosis

What is the best intervention?

A

Surgery is the best result

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8
Q

Avascular Necrosis

What is the prognosis?

A

Success related to the stage when care was started

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9
Q

Avascular Necrosis

What are the complications?

A

incomplete fx and superimposed degenertative arthritis

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10
Q

What is Legg-Calve-Perthes disease?

A

An idiopathic osteonecrosis of the head aged 4-10
- formed with less blood
- unilateral in 90% of pt

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11
Q

Legg-Calve-Perthes Disease

What is the assumed cause?

A

localized manifestation of generalized disorder of the epiphyseal cartilage that happens in the proximal femur

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12
Q

Legg-Calve-Perthes Disease

What population is most affected?

A

4x more common in boys

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13
Q

Legg-Calve-Perthes Disease

What are the subjective findings?

A
  • vague ache in the groin that goes to medial thigh and inner knee
  • early stage muscle spasm
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14
Q

Legg-Calve-Perthes Disease

What are the objective findings?

A
  • limp (slight dragging)
  • atrophy of quads
  • may be small for their age
  • (+) trendelenburg
  • out-toeing
  • decreased abduction and IR
  • hip flexion contracture (0-30 deg)
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15
Q

Legg-Calve-Perthes Disease

What is the medical/imaging studies?

A
  • AP and frog-lateral radiographs of pelvis
  • normal early on
  • progress to fragmentation
  • irregularity
  • eventual collapse of head
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16
Q

Legg-Calve-Perthes Disease

What are the interventions?

A

Less than 6 y/o and min capital femoral epiphysis involvement and normal ROM = intermittent physicals and radiographs every 2 months

More severe = operative or non-op

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17
Q

What is slipped capital femoral epiphysis?

A

Displacement of head thru the physis
- usually occurs during adolescent growth spurt

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18
Q

Slipped Capital Femoral Epiphysis

What is the position of the femoral head?

A

It stays in the acetabulum while the femoral neck is displaced anteriorly from the capital femoral epiphysis

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19
Q

What is the most common disorder of the hip in adolescents?

A

Slipped capital femoral epiphysis

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20
Q

Slipped Capital Femoral Epiphysis

What is the subjective findings?

A
  • pain with activity
  • hx of groin pain or medial thigh pain
  • around 45% report knee or lower thigh for intial sx
  • pain is dull and aching
  • may be mild weakness in the leg
  • may be no hx of trauma (can be so bad that theres pain turning in bed)
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21
Q

Slipped Capital Femoral Epiphysis

What are the objective findings?

A
  • antalgic gait with limp (ofteen ER of involved foot)
  • decreased ROM hip
  • PROM will show ER of hip
  • LE is 1-3 cm shorter

affected ROM - IR, abd and flexion

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22
Q

Slipped Capital Femoral Epiphysis

What does it cause?

A

The only peds disorder that causes greater loss of IR when the hip is moved into flexion

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23
Q

Slipped Capital Femoral Epiphysis

What are the predisposing factors?

A
  • obesity
  • male gender
  • greater involvement with sport activities
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24
Q

Slipped Capital Femoral Epiphysis

What are the special tests?

A

IR with hip flexed to 90 deg

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25
Q

Slipped Capital Femoral Epiphysis

What are the medical/imaging studies?

A

AP and frog-lateral radiographs of the pelvis

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26
Q

Slipped Capital Femoral Epiphysis

What are the interventions?

A
  • sx relief
  • containment of femoral head
  • ROM restoration
  • surgical fixation
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27
Q

What is the description of stress fx on the femoral neck?

A

because of the accelerated bone remodeling from repeated stress

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28
Q

Stress fx

What is the population affeected with this?

A

In military recruits and athletes (runners especially)

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29
Q

Stress fx

In older populations, where is the fracture?

A

on the superior side of the neck

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30
Q

Stress fx

In younger populations, where is the fracture?

A

in the inferior side of the neck (compression-side fracture)

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31
Q

Stress fx

What is the subjective findings?

A
  • suddeen hip pain (associated with revent changes in training or surface)
  • pain the deep thigh (early sx)
  • pain during WB or at extremes of hip motion = radiate to knees
  • night pain happens with fx progression
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32
Q

Stress fx

What are the objective findings?

A
  • physical exam is usually (-)
  • may be empty end feel
  • pain at extremities of hip ER or IR
  • pain with resisted hip ER
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33
Q

Stress fx

What are the special tests?

A

Not one test
- resisted SLR = (+) pain @ thigh or groin
- patellar-pubic percussion tests can be +
- Flucrum test = (+) sharp pain and apprehension

Patellar-pubic
- sensitivity = 0.96
- specificity = 0.76

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34
Q

Stress fx

What are the medical/imaging studies?

A
  • radiographs taken too soon only (+) in 20% of cases
  • best dx/d with MRI
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35
Q

Stress fx

For tension side fractures, how are they treated?

A

treated surgically

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36
Q

Stress fx

If there is no fx line but sclerosis, what is the intervention?

A

modified best rest to NWB on crutches until no sx
- pain free = progress to wt-bearing
- significant PWB is pain free = cycling and swimming
- weekly radiograph until full w/o pain

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37
Q

Stress fx

If there is a fx but no displacement, what is the intervention?

A

intial period of best rest or complete NWB then WB as sx permit

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38
Q

What is a 2 joint hamstring strain?

A

the strain/rupture of 1 or more of the 3 hammies
- muscle tears are usually partial
- eccentric phase of the muscle usually are the time for tears

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39
Q

Hamstring Strain

What are the subjective findings?

A
  • distinct MOI w/ pain right away during full stride running or while quick deceleration
  • can hear a “pop”
  • posterior thigh pain
  • gets worse with knee flexion
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40
Q

Hamstring Strain

What is the objective findings?

A
  • tenderness with PROM stretching of hammies
  • tender to palpation
  • Pain w/ resisted knee flexion (IR/ER to isolate)
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41
Q

Hamstring Strain

What is the medical studies needed?

A

Radiographs are rarely needed unless there is a question of a fracture or bony avulsion injury

Avulsion - tendon tear with bone

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42
Q

Hamstring Strain

What is grade 1 intervention?

A

continue with activities as much as possible

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43
Q

Hamstring strain

What is grade 2 intervention?

A

5-21 days of rehab or 3 weeks

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44
Q

Hamstring Strain

What is grade 3 intervention?

A

3-12 weeks of rehab

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45
Q

Hamstring Strain

What are the important components of hamstring interventions?

A

Be sure to emphasize eccentric loading of the hammies

be able to address any biomechanical factors:
- excessive anterior pelvic tilt
- SI or lumbar dysfunction
- leg length issues
- other factors

46
Q

What is hip adductor tendinopathy?

A

most commonly proximal adductor pathology that comes from repetitive loading

47
Q

Hip adductor tendinopathy

What are the muscles that are affected?

A

Gracilis
pectineus
adductor long / brev / magnus

48
Q

Hip adductor tendinopathy

What is the most common muscle injured?

A

Adductor longus

49
Q

Hip adductor tendinopathy

What is the primary movement that is associated with MOI?

A

Repetitive loading that has to do with twisting and turning
- possible muscle imbalance of the muscles stabilizing the hip joint and pubis

50
Q

Hip adductor tendinopathy

What are the subjective findings?

A
  • twinging or stabbing pain @ groin that starts and stops quickly
  • edema or ecchymosis several days post injury
  • sx are bad with running, directional changes, kicking, SL exercises, cutting and lunges
51
Q

Hip adductor tendinopathy

What are the objective findings?

A
  • pain w/ passive abduction
  • manual resistance to hip adduction at different angles of hip flexion:

0 = gracilis
45 = add longus and brevis
90 = pectineus

52
Q

Hip adductor tendinopathy

What are the interventions?

A
  • RICE @ acute stage
  • hip add isometrics and gentle stretching @ subacute
  • Graded resistive with concentric/eccentric and PNF
53
Q

Hip adductor tendinopathy

What is the typical prognosis?

A

Most recover fully or have min pain with high intensity activity only

54
Q

OA

What are the subjective findings?

A
  • insidious pain @ ass, groin, thigh or knee
  • pain is dull ache to sharp
  • gets worse with activity
  • limping happens
  • activity will increase pain that last hours
  • hard time with stairs, putting on socks
55
Q

OA

What are the objective findings?

A
  • early signs: IR and abd or flexion
  • pain @ end range
  • pain with resisted hip flexion and adduction
56
Q

OA

What are the special tests?

A

Scour (Rel = 0.87)
Faber (Sn = .41-.99 / Sp = .71-1.00)

57
Q

OA

What are some interventions?

It’s a goddamn lot just be careful

A
  • relieve sx
  • decrease disability
  • reduce progression
  • education (modifications)
  • modalities
  • decreased WB activities (swimming or cycling)
  • BW reduction
  • walking stick (?)
  • manual techniques
  • passive stretches
  • strengthening of hip and trunk stabilizers
58
Q

OA

How is the hip unloaded with a walking stick?

A

Possibly reduce the hip load by 20-30%

59
Q

What is a snapping hip?

A

snapping or popping sensation that happens when the tendons around the hip move over bony prominences

60
Q

Snapping Hip

What is the internal etiology?

A

the iliopsoas is snapping over structures just deep to it
= stenosing tenosynovitis of the muscle insertion

What’s deep: femoral head, proximal lesser trochanter

61
Q

Snapping hip

What is the external etiology?

A

snapping of the ITB or glute max over the greater trochanter

62
Q

Snapping hip

What is the external etiology most common in?

A

in females with wide pelvis and prominent trochanters

63
Q

Snapping hip

What is the intra-articular etiology?

A
  • synovial chondromatosis
  • loose bodies
  • fracture fragments
  • labral tears
64
Q

Snapping hip

What are the subjective findings?

A
  • feeling that snapping or poppping @ greater trochanter areea and happens when walking
  • snapping from sublux of iliopsoas tendon = pain @ groin when hip extended from a flexed position (sit to stand)
  • pain with snapping if trochanteric bursa is inflamed
65
Q

Snapping hip

What are the objective findings?

A
  • IT band sublux can be felt during standing with hip rotation while holding an adducted position
  • snapping of iliopsoas tendon while hip extension from flexed position
66
Q

Snapping hip

What are the special tests?

A

Ober and thomas

67
Q

Snapping hip

If there is an imbalance of the TFL or iliopsoas is causing sx, what is the intervention focused on?

A

reconditioning and prevention thru:
- muscle length improvement
- correcting imbalances

68
Q

Snapping hip

What is the typical prognosis?

A

If responding well to conservative management = no surgery (rarity)

69
Q

What is the most common cause of lateral hip pain?

A

Trochanteric bursitis while OA is most common

70
Q

Trochanteric bursitis

What are the subjective findings?

A

pain @ thigh, groin and glute
- especially when lying on the involved side
- pain could radiate down
- pain is bad when rising from a seat or recumbent position
- gets better after a few steps
- reoccurs after walking for an hour or so

71
Q

Trochanteric bursitis

What are the objective findings?

A
  • pain with palpation or with stretching of ITB
  • resisted abd, extension or ER of hip = pain
  • hip adductor tightness
72
Q

Trochanteric bursitis

What are the special tests?

A

obers in general (both modified or normal)

Modified - knee straight

73
Q

Trochanteric bursitis

What is the overall prognosis?

A

responds well to conservative measures
- possibly injection of a local anesthetic and corticosteroid prep into the greater trochanter

73
Q

Trochanteric bursitis

What are the interventions?

A
  • stretching the soft tissues of lateral thigh
  • flexibility of ER, quads and hip flexors
  • stronger hip abduction
  • establishing muscular balance between hip adductors and abductors
  • possibly orthotics if because of biomechanical fault
74
Q

What is the etiology of labral tears?

A
  • trauma
  • FAI
  • capsular laxity/hip hypermobility
  • dysplasia
  • degeneration

often goes undiagnosed during an extended time period

75
Q

Labral tears

What are the subjective findings?

A
  • anterior hip or groin pain
  • feeling clicking, locking and giving away
76
Q

Labral tears

What are the objective findings/special tests?

A

hip impingement test

77
Q

Labral tears

What are the interventions?

A

Be able to trial conservative management and PT
- we want to limit pivoting motions
- strengthen inhibited muscles
- assess foot motion

Arthroscopic debridgement of tear

PT around 10-12 weeks

78
Q

Labral tears

Why is it important to limit pivoting motions?

A

increase forces across the labrum

79
Q

With manual treatments, what can we do?

A
  • restore mobility and function
  • decrease pain
  • avoid surgery
80
Q

What is FAI a precursor of?

A

For OA changes in the hip
- strongly associated with labral tears

81
Q

FAI

What is the % growth rate of hip arthroscopy?

A

15% per year

82
Q

FAI

What population is FAI prevelant in?

A
  • more common in 20-40 y.o
  • athletes make up 15%
83
Q

FAI

What is the common MOI?

A

Repetitive end-range hyperextension or hyperflexion w/ abduction

Idiopathic tears from slipping and twisting injury

The sport will place the athlete at an increased risk for tears

84
Q

What is FAI?

A
  • the contact between femoral head-neck junction and the acetabular rim
  • happens with combined movements
85
Q

FAI

What is the combined movements that causes impingement?

A

Flexion and extension with adduction and either ER or IR

86
Q

FAI

What does prolonged impingement lead to?

A

damage to the labrum and subchondral bone

87
Q

FAI

What is it often misdiagnosed?

A

Snapping hip or psoas strain

88
Q

What are the 2 primary causes of labral tears?

A

hip dysplasia and FAI

89
Q

FAI

What is a clinical pearl?

A

if pt doesn’t complain of clicking, locking or catching is the best
- helps rule OUT labral tears compared to other hip pathology

90
Q

FAI

What are the two type of impingements?

A

CAM and pincer

91
Q

FAI

What is causes of CAM?

A
  • aspherical femoral head
  • bony prominence at anterolateral head-neck junction
  • impinges @ rim of labrum
  • leads to superior OA
92
Q

FAI CAM

What are the provocative tests?

A

FADDIR

93
Q

FAI

What are the causes of pincer impingement?

A
  • over coverage of fem head by the acetabulum
  • acetabulum impinges neck of femur
  • leads to posterior-inferior or central OA
94
Q

FAI CAM

Most prevalent population for CAM?

A

Young athletic males

95
Q

FAI Pincer

Most prevalent population for pincer?

A

Middle aged women

96
Q

FAI Pincer

What is the provocative test?

A

hip extension and ER

97
Q

86% of FAI has what kind of impingement?

A

both CAM and Pincer

Limited in:
- IR and ER rotation
- flexion and adduction
Gradual and progressively become more limited

98
Q

FAI

What are the common sx?

A
  • C sign
  • dull and achy pain
  • pain is worse with long term sitting
  • sometimes sharp catching pain with activity
  • increased sx with hip flex, add and IR
  • can limp
99
Q

FAI

When the sx start, what does indicate?

A

damage to the cartilage or labrum
= disease progression with pain @ anterior groin area

100
Q

FAI

What is the Warwick Agreement?

Answer is a picture

A
101
Q

FAI

What is the most common complaint regarding activity?

A
  1. Heavy work (push/pull, climbing, carrying)
  2. Twisting
  3. squatting
  4. heavy-duty housework
  5. walking 15 min or more
    …..
    least common complaint: walking down steep hills
102
Q

FAI

What are activities that should be avoided?

A
  • end ranges
  • treadmill running or narrow straight trail
  • upright cycling
  • sitting with hips flexed and neutral spine for long periods of time
103
Q

FAI

What is the end range stretching position?

A

Flexion
adduction
internal rotation

OR FADDIR

104
Q

FAI

What does running a straight line “encourage”?

A

internal rotation of LE

105
Q

FAI

Why avoid upright cycling?

A

involves flexion and combination with hip IR

106
Q

FAI

What are the non-surgical treatments?

A
  • activity changes
  • non-steroidal anti-inflammatory meds
  • PT
107
Q

FAI

What are the medications used for non-surgical treatment?

A

ibuprofen to help reduce pain and inflammation

108
Q

FAI

What are the PT treatments?

A

exercises to improve ROM in the hip and strengthen the muscles around the joint
= stress relief on injured labrum or cartilage

109
Q

FAI

What are the surgical treatments?

A
  • will repair or clean out any damage to labrum and articular cartilage
  • FAI = trimming of bony rim of acetabulum and shaving down the bump on the head
  • severe cases = need open operation with bigger incisions

PHTH 517 (16 decks)

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