Hip Flashcards
What nerve supplies both of the hip joints?
Obturator nerve
What is the cause of a positive Trendelenburg test?
Weakness in the hip abductor muscles
What conditions can cause shortening of the lower limb?
Osteoarthritis (severe cases)
Perthe’s disease
SUFE
Avascular necrosis (AVN)
All hip replacements eventually fail, how long do they tend to last for?
15 - 20 years
What are conservative measures for managing OA before total hip replacement?
Analgesia, physiotherapy, weight loss. exercise and a walking stick where possible.
The hip is one of the most common sites for avascular necrosis (AVN) to occur. True/false
True
What features are apparent in AVN?
Usually presents with groin pain
On x-ray, there is a ‘‘Hanging rope’’ sign.
In some cases, the femoral head may collapse leading to seconadary osteoarthritis.
What is trochanteric bursitis?
Trochanteric bursitis also known as gluteal cuff syndrome arises as a result of considerable strain placed upon the broad tendinous insertion of the abductor muscles (mainly gluteus medius). Result is tendonitis and degeneration leading to tendon tears. The trochanteric bursa becomes inflamed.
What is treatment of trochanteric bursitis?
Mostly conservative treatments: analgesics, anti-inflammatories, steroids and physiotherapy.
Surgery does not provide useful treatment.
Posterior hip dislocations are more common than anterior hip dislocations. True/false
True, this is because the anterior ligaments are stronger. Posterior hip dislocations take up 90% of these cases.
In the case of infection. Trochanteric bursitis can be treated with antibiotics. True/false
True, if there is infection present it can present with erythema, swelling and warmth.
What is transient synovitis?
AKA irritable hip. It is caused by temporary irritation and inflammation of the synovial membrane within the joint (synovitis).
How does transient synovitis present and what age group does it occur in?
Occurs in children aged 3-10
Presents with:
Limp
Refusal to weight bear
Groin or hip pain
Mild low grade temperature
This usually happens a few weeks after a viral infection.
How is transient synovitis treated?
Usually based on symptoms. Child given analgesics if in pain.
Important that septic arthritis is excluded as a cause.
Safety netting is important. Child should return if they develop fever or if symptoms worsen.
What is avascular necrosis (AVN)?
When the blood supply to a part of bone is disrupted, resulting in death of bone tissue. Causing the bone to breakdown and joint to collapse.
What x-ray sign is associated with AVN?
“Hanging rope sign” - a late stage of perthes disease.
What age group of children does perthes disease most affect?
Children aged 4-12 (mainly boys 5-8 years old).
Clinical presentation of perthes disease?
Pain in hip or groin
Limp
Reduced hip movements
May be referred pain to the knee.
There will be NO history of trauma. If there is, think SUFE.
Conservative management of perthes disease?
Reduce risk of damage and deformity to the femoral head with:
- Bed rest
- Analgesia
- Crutches
- Traction
What type of children is slipped upper femoral epiphyses (SUFE) most common in?
Obese pre-pubertal (around 11 years old) boys
Usually undergoing growth spurt.
Perthes disease can be triggered by minor trauma. True/false
False, if there is minor trauma in patient history, think SUFE.
Initial investigations of choice for perthes disease and SUFE?
X-ray
Management of SUFE
Surgery to relocate femoral head back to the correct position to prevent it from slipping further.
What movement is restricted in children with SUFE?
Restricted internal rotation of the hip, so when examining the patient, they will prefer to keep their hip in external rotation.
What does the leg look like with a displaced femoral fracture?
Shortened and externally rotated
What does the leg look like with a femoral head dislocation?
Shortened and internally rotated
