Common Pathologies LL 1

Question 1

When are avulsion injuries most common

Answer 1

Adolescence as tendons are stronger than apophyses

Question 2

Avascular necrosis

Answer 2

Loss of blood supply to bone
Bone death then collapse
Hip stiffness, pain, limp, groin, buttock and or thigh pain

Question 3

Hip dysplasia

Answer 3

Normal centre edge angle is 25-40°
< 25-30 borderline dysplasia
< 20 dysplasia
<16 certain osteoarthritis

Question 4

CAM type FAI hip impingement

Answer 4

Irregular osseous prominence of proximal femoral neck
Symptomatic in physically active young males
Bony protrusion located at the anteriosuperior aspect of femoral head neck junction

Question 5

Pincer type FAI hip impingement

Answer 5

Result of excess acetabular coverage of femoral neck
Over coverage= global (coxa profunda) or focal anteriorly (acetabular retroversion)
Rim presses up against labrum

Question 6

Symptom summary of FAI hip impingement

Answer 6

Pain/difficulty crossing legs
Difficulty putting socks/shoes on
Unable to sit for long periods
Limp
Adductor problems
Painful walking long distances
Pain after sport activities
Buttock/lower back pain

Question 7

Greater trochanter pain syndrome (GTPS)

Answer 7

Common cause lateral hip pain
Tendopinopathy of gluteus medius/minimus/bursal pathology
Compressive forces cause impingement of these into greater trochanter by ITB

Question 8

Typical patients of GTPS

Answer 8

Female 40-60
Post menopause
Lower femoral neck shaft angle
Increased BMI

Question 9

Snapping hip syndrome- coxa saltons

Answer 9

Internal- iliopsoas over iliopectineal eminence, paralabral cyst
External- ITB snapping over trochanter

Proximal hamstring tendon rolling over Ischial tuberosity, TFL, Gluteus maximus over greater trochanter

Question 10

Osteochondral defect

Answer 10

Focal area of damage to articular cartilage and piece of underlying bone

Question 11

Osteochondral defect acute/develop chronically

Answer 11

Separation of osteochondral fragment casued by acute traumatic injury or unstable fragment in osteochondritis dissecans
Acute- impaction of bone with resultant contour deformity
Collapses of subchondral bone in subchondral insufficiency fracture (SIF) or avascular necrosis (AVN) or bone collapse uncovering lsrge subchondral cyst

Question 12

Subchondral cyst

Answer 12

Synovial fluid intrusion theory: articular surface defects and increased intra Articular pressure allow intrusion of synovial fluid into bone forming cavities

Bone contusion theory: non communicating cysts arise from subchondral foci of bone necrosis, results in opposing articular surfaces coming in contact with one another