Common Musculoskeletal Problems: Hip Flashcards
List 8 causes of hip pain
- Osteoarthritis
- Lateral hip pain syndrome
- Trochanteric bursitis
- Gluteus medius tendinopathy - Meralgia paraesthetica
- Referred from back
- e.g. facet joint syndrome - Fracture of neck of femur
- Inflammatory arthritis
- including sacroiliitis (AS) - Avascular necrosis
- Polymyalgia rheumatica
How can trochanteric bursitis be differentiated from tear of the gluteus medius tendon?
MRI
How does fracture of the femoral neck typically present?
- Pain in groin and thigh
- Usually after fall
- On weight-bearing - Leg shortening
- Leg externally rotated
How does avascular necrosis of the femoral head typically present?
Severe hip pain, groin and buttocks
- Patient with risk factors
What are the risk factors for avascular necrosis of the femoral neck? (9 in total)
- Glucocorticoid treatment
- Sickle cell disease
- SLE
- Deep sea diving (Caisson’s disease)
- Endocrine disorders (e.g. Cushing’s, diabetes mellitus)
- Trauma
- HIV infection
- Irradiation
- Excess alcohol use
A patient presents with pain over the greater trochanter which is worse going up stairs and when abducting the hip. What is the most likely diagnosis?
- Trochanteric bursitis
2. Tear of the gluteus medius tendon
What is meralgia paraesthetica?
Lateral cutaneous nerve of the thigh compression due to
- Sudden weight gain
- Injury
- Recent pelvic surgery
How does meralgia paraesthetica present?
Over anterolateral thigh:
- Numbness
- Burning dysphasia (Increased tenderness to light tough)
Usually self-limiting
A patient presents with fracture of the femoral neck after minimal trauma. What are you concerned about?
Osteoporosis
What are the radiological features of avascular necrosis of the femoral head?
X-rays diagnostic after several weeks
- Well-demarcated area of increased bone density at upper pole of femoral head
Bone scintigraphy and MRI
- Show early changes of bone marrow oedema
An elderly patient presents with bilateral hip, buttock and thigh pain that are worse in the morning. They also complain of neck and shoulder stiffness. What is the most likely diagnosis?
Polymyalgia rheumatica
Where does pain from the back typically refer?
Buttock Posterior thigh (facet joints)
What is the most common cause of hip pain in a person over 50?
Osteoarthritis
How does osteoarthritis of the hip typically present?
- Pain in buttock and groin on standing and walking
- Stiffness - difficulty dressing, walk with limp
Sudden onset pain may be due to effusion seen on MRI. Rx: US-guided steroid injection
A patient with osteoarthritis of the hip lead complains of sudden onset severe pain. What is the most likely diagnosis?
Effusion - seen on MRI
