EXAM 2- Hip Patho Flashcards
what conditions can cause pathological hip fx
osteoporosis
osteomalacia
osteogenesis imperfecta (peds)
pagets disease
tumors
where is the most common site of the fx in a pathological hip fx
femoral neck
what are the symptoms of pathological hip fx
fx S&S
painful snap then giving way
groin pain (increase with WB)
what can we see in a scan for pathological hip fx
ob- shortened, ER LE
painful and asymmetric gait
ROM- several but IR limited
sp test- patellar- pubic percussion
possible sign of buttock
what is the notable observation of pathological hip fx
shortened, ER LE due to ER pulling the limb after the fx
what can cause the sign of the buttock
fx
tumor
infection
hematoma
what is in the SCAN for the sign of the buttock
hx- possible cancer, infection, or fx S&S
ob- gluteal swelling
ROM- limited hip flx in both directions, empty end feels
RST- weak and painful glutes
what is the referral if the sign of buttock is present
urgent
if fx, emergent if vascular compromise is thought
what is the referral for pathological hip fx
immobilize and emergent
who is most prevalent for pathological hip fx
older
women 65, men 70
osteoporosis type patient
what is the biggest concern with pathological hip fx for vascular damage
ER pull fx and can cause damage to the artery
What is osteonecrosis
Avascular necrosis or AVN femoral head
What is the cause of osteonecrosis through trauma
Fx
Dislocation
Slipped femoral epiphysis
What supplies the femoral head
Ligamentum teres houses an artery
What is the cause of osteonecrosis through gradual onset
Vascular abnormalities
Toxicity (radiation, smoking, alcoholism)
Sickle cell disease
Chronic corticosteroid and oral contraceptive
Bone marrow pathology
Metabolic syndrome
What is the pathology of osteonecrosis
Ischemia of bony tissue
Rapid ARJC
Labral tears
What are the symptoms of osteonecrosis
Groin, anteromedial thigh pain to the knee
Sign of buttock
Intermittent pain but worsening
Painful and asymmetric gait
ARJC S&S
What is different for osteonecrosis scan findings compared to ARJC
Hx of corticosteroid use
Colder to touch
What is the referral for osteonecrosis
Urgent referral
What if osteonecrosis is referred to PT
Gait training with AD to protect femur
Protection of motion, improve circulation, bone/cartilage integrity
What is Legg-Calve-Perthes
Coxa plana or flat hip
AVN femoral head in children
What can cause legg-calve-perthes
Trauma
Exposure to 2nd hand smoke
Prenatal factors
Developmental dysfunction of bone or vasculature
What is the pathology of legg-calve-perthes
Impaired vascular supply to epiphyses that changes the shape the femoral head and acetabulum
What are the symptoms of legg-calve-perthes
Gradual and unknown onset
Unilateral
Painful and asymmetric gait
Painful groin, anteromedial thigh pain to knee
Possible hip atrophy
Limited IR and ABD
What is the referral for legg-calve-perthes
Urgent referral
What can we do if legg-calve-perthes
Gait training with AD
Protect motion, improve circulation bone/cartilage integrity
periodically bracing, splinting or casted in ABD position
how does casting in ABD position for legg-calve-perthes help bone/cartilage integrity
better femoral head contact
maintain and help femoral head shape with acetabulum
prone to contractures
what can happen to a pt with legg-calve-perthes later in life
ARJC
corrective sx or early THA
earlier LB and knee pain due to gait dysfunction
what is slipped capital epiphysis
anterior displacement of femoral neck on femoral head
adolescent coxa vara
most significant epiphyseal plate disorder
what can cause slipped capital epiphysis
idiopathic
endocrine, renal disorder and down syndrome
hypothyroidism
what are the RF for slipped capital epiphysis
obesity
male
rapid growth
radiation
femoral torsion
what is the prevalence of slipped capital epiphysis
early adolescence
african american boys
obesity
bilateral
what is the patho of slipped capital epiphysis
displacement of femoral neck relative to the head though the growth plate due to shear forces and/or weakened epiphyseal plate
what are the S&S of slipped capital epiphysis
gradual, could be benign trauma
groin pain
what can be found in a scan for slipped capital epiphysis
ob- painful and asymmetric gait
ER hip
m atrophy if long standing
ROM- limited IR, ABD, FLX
ER when fLX
possible sign of buttock
what is the referral for slipped capital epiphysis
urgent
what would we do if slipped capital epiphysis is <1 cm slip was referred to us
splint in ABD with non WB
post splint - gait training with AD, Protect motion, improve circulation bone/cartilage integrity
what would we do if slipped capital epiphysis is >1 cm slip was referred to us
sx is required
what complication are we trying to avoid with slipped capital epiphysis
avoid AVN or chondrolysis (rapid loss of articular cartilage)
what are vascular insufficiency S&S
coldness
blueish or pale discoloration
diminished pulses
impaired capillary refill
shiny skin
hair loss
emergency
what is the prevalence of colorectal cancer
3rd most common cancer
2nd cause of death
metastasize to thorax
what are the RF for colorectal cancer
> 50 yrs
family hx
male
IBS
obesity
smoking
SAD
what is the pathology of colorectal cancer
develops in large intestine
what are the S&S for colorectal cancer
cancer S&S
dull and L lower quadrant pain
change in bowel
bloody stool or black
what are the review components of colorectal cancer
ob- wavelike motion in L lower quadrant
palpate lymph nodes and L lower quadrant
vitals - fever
what can we do to help a colorectal cancer pt
exercise helps bowel function and transmit time
what should be done to prevent colorectal cancer
routine screen - colonoscopy at age of 45
urgent referral
what are the RF for cervical cancer
HPV
drug and alcohol abuse
more than 5 sexual partners
what is the prevalence of cervical cancer
3rd most common female cancer behind breast and colorectal
younger females
what is the pathology of cervical cancer
HPV limits suppressor gene and malignancy develops
what are S&S of cervical cancer
cancer S&S
pelvic and lumbar pain
excessive and untimely bleeding
bowel/bladder/sexual dysfunction
what are the review components for cervical cancer
palpation of lymph nodes
vitals- fever
what are complications of treatment for cervical cancer
radiation decreases estrogen so decreased bone density
what are preventative measures for cervical cancer
regular OBGYN visits
HPV vaccine around 11/12 yrs
where is chondrosarcoma most effected
pelvis and femur
who is most effected my chondrosarcoma
middle age males
what is the pathology of chondrosarcoma
thickening cortex
destruction of medullary and cortical bone
malignant cartilage
what are S&S of chondrosarcoma
progressive and local swelling
cancer S&S
fx S&S
what are review components of chondrosarcoma
sign of buttock
palpation of lymph nodes
vitals- fever
what is the prevalence of appendicitis
late adolescence
males
what can cause an appendicitis
unknown
obstruction due to neoplasm, infection, foreign body
what are the S&S of appendicitis
periumbilical to R lower quadrant pelvic pain
R hip/groin pain
not eating
infection/cancer S&S
worse with increased abdominal pressure
what are review components of appendicitis
ob- redness/swelling
ROM- pain and limitation with hip and trunk flexion
palpation- lymph nodes
abdominal quadrant assessment
vitals- fever
what is the pathology of inguinal hernia
weakness/tearing in the abdominal organ covering that allows portion of organs to move out of their boundary
what can cause an inguinal hernia
age
obesity
pregnancy
abdominal m weakness
trauma
what are the S&S of inguinal hernia
progressively bulges and becomes painful
worse with increased abdominal pressure
burning/pinching
may radiate into thigh or pelvic midline
what are the review components of inguinal hernia
S&S of respective organ
ROM- Pain and limitation with hip and trunk flx
palpation- pain with percussion, bulge
what is septic arthritis
active local infection on a weakened or compromised jt at primary site of infection
what are RF for septic arthritis
penetrating trauma
total jt
chronic jt replacement
diabetes
immunosuppression
infectious disease
substance abuse
sickle cell disease
renal failure
what is the pathology of septic arthritis
microorganism invasion
weakened and compromised jt
bacteria activates clotting factors lead to thrombosis
massive inflammation
what are S&S of septic arthritis
infection
painful and asymmetrical gait
infection S&S
what are the review components of septic arthritis
refusal to move- pain, limited ROM, weakness in multiple directions
possible sign of buttock
palpation- TTP, lymph nodes, heat, swelling
what is the referral for septic arthritis
emergency to avoid permanent jt and bone damage
