Common Pathologies of the Lower Limb 1

Question 1

What is a normal Centre Edge Angle at the hip and what is classed as dysplasia?

Answer 1

Normal - 25-40 degrees

Dysplasia - <20 degrees

Question 2

Describe the 2 mechanisms of hip impingement

Answer 2

Cam - Type - extra bony growth on femoral head-neck junction, suggested to develop in adolescent athletes
Pincer - Type - excessive acetabular coverage of femoral neck, global (coxa profunda) or focal anteriorly (acetabular retroversion)

Question 3

What are the symptoms of FAI?

Answer 3

Difficulty sitting cross legged
Difficulty putting on shoes/socks
Slight or more severe limp
Adductor related symptoms
Pain with walking long distances that doesn't disappear with rest
40% buttock/ low back pain

Question 4

What are the risk factors for FAI?

Answer 4

Repetitive hip motion
High level sport
Paediatric hip disease
Femoral neck # or previous surgery

Question 5

What is the cause of Greater Trochanteric Pain Syndrome?

Answer 5

Tendinopathy of Glut Med and/or Min +/- bursa pathology, compressive forces cause impingement of these structures onto greater trochanter

Question 6

What are the risk factors for Greater Trochanteric Pain Syndrome?

Answer 6

Females 40-60y
Postmenopausal
Lower femoral neck shaft angle
Increased BMI

Question 7

What causes internal/ external Snapping Hip Syndrome?

Answer 7

Internal - Illipsoas over Iliopectinial eminence, paralabral cysts
External - ITB over greater trochanter OR hamstring tendon over ischial tuberosity, fascia latae or glut max over greater trochanter

Question 8

What acute and chronic conditions can lead to an Osteochondral Defect?

Answer 8

Separation of Osteochondral fragment caused by acute traumatic injury
As an end result of an unstable fragment in osteochondritis dissecans
Acute osteochondral impaction of bone with resultant contour deformity
Collapse of the subchondral bone in a subchondral insufficiency fracture or AVN

Question 9

What is the suggested causes of a Subchondral Cyst?

Answer 9

Suggested to be due to elevated pressure in knee leading to joint fluid entering underlying bone through small cracks in articular cartilage
Or consequence of traumatic bone necrosis after impaction