ECOS 1 Midterm Clinical Flashcards
Developmental Dysplasia of the Hip “Hip Dysplasia”
Newborns
Infants with DDH, whether treated or untreated, have a higher incidence of early-onset hip osteoarthritis in adulthood.
Hip clunk -Distinct and pronounced palpable (and at times audible) shift of femoral head, felt as the femoral head is dislocated or reduced on examination with the Ortolani (abducting legs) and Barlow (going back to midline) maneuvers
another sign: uneven height of knees when baby is lying down with legs flexed
Legg Calve Perthe’s disease (Perthes Disease)
Very rare, 3-12y/o, More in boys
Blood supply to the head of femur interrupted, necroses, weak bone → fractures. Bone reforms, return of blood supply however new bone shape can lead to degenerative joint disease (osteoarthritis) later in life.
Symptoms: limping, limited ROM of hip joint, pain worse with activity, better with rest
Risks/causes: hereditary, skeletal immaturity, obesity and lower socioeconomic status
Diagnosis: History and Exam (Problems rotating the leg, muscle atrophy of the LE, affected leg may be shorter than the normal leg), X-ray, MRI
Slipped Capital Femoral Epiphysis (SCFE)
more common than Perthe’s disease
8-15 y/o, more in boys
the growth plate is damaged and the femoral head moves (“slips”) from the rest of the femur. Head of the femur stays in the cup of the hip joint while the rest of the femur is shifted. This can happen slowly, over time, or it can happen immediately from trauma.
Risks/causes: obesity, growth spurt, endocrine disorder (hypothyroidism & osteodystrophy), or genetic predisposition
Symptoms: Leg rotated outward (impaired internal rotation). Hip pain (onset gradual or sudden) with limping.
Avascular necrosis (AVN)
Temporary or permanent loss of blood supply to the bone, the bone tissue dies and the bone collapses. If avascular necrosis happens near a joint, the joint surface may collapse.
Anyone but MC is 30-50 y/o (Like Perthes but in Adults (no growth plate))
ROM, joint pain, pain with activity & rest
Risks/Causes: Injury, Blood disorders, Long-term use of medicines, such as corticosteroids, Autoimmune disease, Chemotherapy and/or Radiation treatments, Pancreatitis, Alcoholism, Hyperlipidemia
Diagnosis: History, Exam, X-ray, CT, MRI, Radionuclide bone scan, Biopsy, Functional evaluation of bone. Abnormal head of femur, no growth plate
Trochanteric Bursitis
inflammation of bursa
More common in women, middle-aged, and older people. (>50 yo at onset, female > males)
Risks/Causes: injury (MCC), overuse (MCC), spinal/postural abnormalities, arthritis, or surgery, obesity, knee pain, IT band tenderness, low back pain
Symptoms: pain outside hip & thigh, or in butt, hurts sleeping, going up stairs (activity), getting out of a chair.
Diagnosis: Xray not indicative. MRI shows bursitis. Blood test to see if infection is the source.
Osteoarthritis (OA) of the Hip
one of the most common conditions
Primary (no cause) or Secondary (other disease, injury, etc,)
OA causes breakdown of cartilage in joint, bony spurs (growth, bone ends thickened), bits of bone and cartilage in joint space, limiting joint movement
Develops around 20-30 y/o, but most people over 60 yrs have OA
Risks/Causes: Heredity,excess weight, injury or overuse; often an underlying reason, such as joint injury or repetitive joint stress from overuse
Symptoms: pain & stiffness after overuse or inactivity (during sleep) of a joint. Develop slowly over years, less movement in the joint over time. A grinding feeling of the joint when moved, as the cartilage wears away (in more advanced stages).
Degeneration of joint, thinning of cartilage around femur head, weak labrum
Meralgia Paresthetica
Tingling, numbness, burning pain in outer thigh
Compression of lateral femoral cutaneous nerve (pinched by inguinal L.), which supplies sensation to your upper leg
Symptoms: occur on side of your body & might intensify after walking or standing
Risks/Causes: Tight clothing or belts, obesity or weight gain, and pregnancy. Local trauma or a disease, such as diabetes.
Diagnosis: imaging, EMG, Nerve conduction studies and nerve blockade can be used to rule out other conditions.
Femoroacetabular Impingement (FAI)
aka Hip impingement
common cause of hip pain in Adolescents, adults, and athletes of all ages.
Hip impingement, is a condition where the hip joint is not shaped normally. This causes the bones to painfully rub together
Symptoms: Limping, Pain & stiffness in the hip that worsens during physical activity or long periods of sitting
Labral Tear
Hip impingement when the ball of the hip pinches against the socket. This can cause damage to the labrum, the cartilage that surrounds the hip socket, and lead to stiffness, pain and/or arthritis in the hip.
Symptoms: Locking, clicking or catching sensation in hip joint
Risks/Causes: Trauma, Injury or dislocation, born with structural abnormalities, and repetitive motions.
Hip Fracture
Partial or complete break of femur where it meets pelvic bone
- Most common cause of hip fractures in elderly are falls*; young people from trauma
- The most serious fall related injury is hip fracture*
- Women > 85 y/o more at risk than women 60-69 y/o*, white women more at risk than black women
Risks/Causes: family hx, osteoporosis, tobacco & alcohol use, physical inactivity, chronic medications
Symptoms: Shorter leg on affected side, cannot get up or put weight on affected side leg, bruising and swelling in hip, outward turned leg
Diagnosis: Any older person with hip pain after a fall should be treated as a hip fracture until proven otherwise.
Pelvic Fractures/Crush Injuries
Causes: Significant trauma
Symptoms: bone tenderness, difficulty walking, loss of nerve function, injuries to organs within the pelvic ring such as the intestines, kidneys, bladder or genitals.
Compartment Syndrome: acute or chronic, BVs & Nerves in the girdle compressed by the pressure from muscles and bleeding. Pressure can decrease blood flow which can stop nerve and muscle cells from being nourished/oxygenated.
- 5 P’s: Pain, Paresthesia, Pallor, Paralysis, Pulselessness
- 3 A’s: Increased Analgesic requirement, Anxiety, Agitation
Septic Arthritis
Painful infection of a joint (germs through bloodstream or directly onto joint from injury)
Infants & Older Adults most likely to have septic arthritis
Risks: Age >80, DM, RA, Prosthetic joint, recent joint surgery, skin infection, IV drug abuse, previous intra-articular corticosteroid injection
Mechanism of infection: hematogenous spread to joint, bite, trauma, exposure during joint surgery, etc.
Healthy patients (staph aureus and streptococcal), sexually active, young patient (N gonorrhea), Immunocompromised
Symptoms: Discomfort, hard to use joint, swollen, red, warm, patient may have a fever (fever distinguishes Septic arthritis from just arthritis)
Septic Arthritis Diagnostic:
Synovial Fluid from Joint Aspiration (Arthrocentesis), blood test
Piriformis Syndrome
The piriformis muscle, located in the butt region, spasms and causes butt pain. Irritates the sciatic nerve and causes pain, numbness and tingling along the back of the leg and into the foot (similar to sciatic pain)
Risks/Causes: Anatomical variation, history of direct trauma to buttock
Symptoms: Pain after sitting for a while, rising from seated position. Pain improves with ambulation. Radiates to posterior thigh.
Signs and symptoms: Positive log roll with sciatic notch tenderness, Unlike sciatica from disk herniation, piriformis syndrome is exacerbated by active external hip rotation
Diagnosis: MRI excluding disc herniation. +sciatic nerve edema.
Sprain
small ligamentous tears, blood loss, bruising, hear or feel “pop”
Strain
muscle is stretching and contracting simultaneously, athletes who switch directions, carry something heavy, “grabbing sensation”
Osgood-Schlatter Disease/Syndrome
8-15 y/o, during growth spurt, growth plate injury
Bilateral (30% cases)
microtrauma to the patellar ligament insertion onto the tibial tuberosity via sports/Rapid changes of movement/anything that pulls patellar L.
Pain with climbing stairs or squatting
Diagnosis: Point tenderness over the tibial tubercle, All other ligament and structural testing is negative, X-rays not needed
Osteoarthritis
Anterior Or Generalized Knee Pain
Boney enlargement or deformity at the joint margins, genu varum deformity, and stiffness lasting ≤ 30 minutes. Crepitus.
Chronic inflammatory disease, Loss of articular cartilage, Osteophytes (boney spurs) at insertion sites of tendons or ligaments. Soft tissue thickening of joint capsule.
Patella moves laterally, Osteophytes around, Asymmetric joint space, Lipping along margins of bone (spurs)
Risk factors: Age, trauma, obesity, Varus/valgus deformities
Bursitis: Housemaid’s knee
Anterior Or Generalized Knee Pain
Chronic microtrauma from repetitive activity or pressure
Local swelling, tenderness, warmth, erythema, pain with AROM or compression (prepatellar bursa)
PE: Redness (erythema) and swelling at the site of the bursa. Tenderness and warmth. Remaining exam: Ligaments intact
Evaluation: aspiration of bursa for cell count, C & S, assess for crystals
