Hip Flashcards
Snapping hip syndrome (coxa saltans)
Audible snap or pop that typically occurs with flexion and extension of the hip during exercise. It can also occur during daily activities.
Interal SHS- occurs when the iliopsoas tendon slides over bone structures at the front of your hip joint (anterior aspect of the femoral head or the iliopectineal eminence)
External SHS- occurs when iliotibial band slides over the greater trochanter or the ‘top’ of the thigh bone.
Intra-articular- snapping hip is caused by an actual hip joint issue or injury. Unlike external or internal SHS, intra-articular SFS isn’t caused by a tendon or muscle.
causes:
- commonly an overuse injury
- repetitive extreme hip motions (90% of ballet dancers have it, weight lifting, footballers, runners)
- truma
- surgical procedures
- caused by hip tendon or muscle sliding over bone. As the muscle stretches, it creates tension that results in a snapping sensation when released.
AG:
- late teens early 20’s
RF:
- 5-10% of population is affected by snapping hip, very common, majority experiencing painless snapping
- prevalence slightly higher in women than men
CP:
- pain
- inflammation
- leg muscle weakness when trying to lift your leg sideways or forward
- swelling
- difficulty with regular physical activity such as walking or rising from chair
- feeling your hip is coming out of place
prognosis:
- can increase risk risk of the joint damage
- conservative treatment can successfully alleviate snapping hip syndrome
Iliopectineal bursitis
Largest synovial bursa in the body and is bilateral in 98% of adults.
Located between iliopsoas muscle and the anterior capsule of the hip, this structure is collapsed.
Inflammation of this bursa causes bursitis to occur.
causes:
- inflammation due to excessive friction
- post-traumatic injury
- direct blows and contusions can cause bleeding into the bursa and may result in hepatoma formation
- sports requiring extensive use of the hip flexors
AG:
- females- between the age of 40-60
CP:
- severe, acute, deep groin pain radiating to the anterior hip or thigh.
- the pain may be great enough to disrupt normal gait and cause a limp, is often associated with a snapping sensation. (pain is often related to the iliopsoas tendon snapping over the iliopectineal eminence).
- pain (radiating into the knee, leg and lower back), worse while performing activities and relieved by rest
- stiffness or pain after a rest or in the mornings
prognosis:
- can be treated with physical therapy, pain medications, and reducing activities that make it worse.
- bursitis generally gets better on its own
– conservative measures can be done to make it better, if they don’t work, you might require medication
Ischial/Trochanteric Bursitis
The inflammation of bursa on greater trochanter.
3 constant bursa found around GT area:
- gluteus minimus bursa
- sub gluteus medius bursa
- sub gluteus maximus bursa
Any inflammation or irritation of these bursae can result in symptoms charecteristic of trochanteric bursitis
causes:
- injury to point of hip (falling onto or bumping)
- incorrect posture (scoliosis, arthritis)
- RA, psoriasis, gout, thyroid disease
- previous surgery around hip
- hip bone spurs or calcium deposits in tendons that attach to the GT
- Repetitive microtrauama caused by dynamic use of the muscles that insert on the GT
AG:
- all ages affected
- young female athletes
RF:
- 15% women and 8% men
CP:
- pain to the outside of the hip and thigh or in the buttock
- pain when lying on affected side
- pain when pressing on outside of the hip
- pain gets worse during activities such as getting up from a deep chair or getting out of a car
- pain walking up stairs
- chronic or subacute symptoms of aching pain in the lateral hip localised to the area overlying the GT (pain described as a sharp and intense pain)
- some pt may experience pain in lumbar spine or near the knee as initial symptoms
- localized tenderness to palpation over the tip of the lateral or posterior aspects of the GT
prognosis:
- most cases improve without any treatment over a few weeks
- see medical help if:
– recurring cases of bursitis
– you have a fever or the area affected appears red, swollen or warm (could be sign of infection)
Meralgia Parasthetica
Relatively uncommon condition that is characterised by the symptom complex of pain, numbness, tingling, and parasthesias localised to the anterolateral area of the thigh.
causes:
- compression of lateral femoral cutaneous nerve (sensory nerve to the skin), as it exits the pelvis
- tight clothing, obesity or weight gain, or pregnancy are common causes
- can be due to local trauma, diabetes
- fluid accumulation in the abdomen causing increased abdominal pressure
- scar tissue near the inguinal ligament due to injury or past surgery
RF:
- Extra weight
- Pregnancy- growing belly puts pressure on groin
- diabetes- diabetes-related nerve injury can lead to neuralgia parasthetica
- age
CP:
- people notice a patch of skin that is sensitive to touch and sometimes painful
- symptoms affecting the other part of your thigh:
– tingling and numbness
– burning pain
– decreased sensation
– increases sensitivity and pain to even a light touch
These symptoms commonly occur on one sided of your body and might intensify after walking or standing
prognosis:
- usually good prognosis
- in most cases, will improve with conservative treatment or may even spontaneously resolve
Acquired dislocation of the hip
Displacement of the femur head from the acetabulum. Most of the time this causes damage at the tissue around the hip.
Dislocation occurs in conjunction with a high-trauma.
Commonly classified according to the direction of dislocation of the femoral head, either anterior or posterior, and are treated with specific techniques for reduction.
Anatomy:
- ligaments stabilising- iliofemoral lig (anterior), ischiofemoral lig (posterior).
- anterior ligaments are stronger than posterior (so 90% of dislocations are posterior)
- displacement of femoral head can interrupt blood supply, leading to avascular necrosis (AVN)
- medial femoral circumflex artery is the major. blood supplier to the femoral head
causes:
- can be congenital or acquired:
– congenital- result from the physiologic position of the foetus in utero pressed against the abdominal wall of the mother.
– acquired- either native dislocations or dislocations after total hip replacement
- majority of native hip dislocations result from motor vehicle collisions
- most common acquired dislocation is hip dislocation that occurs within the first 3 months following total hip replacement
AG:
- older age- decreased muscle mass reduces stress on the hip prosthesis and decreases the natural protection against hip dislocation.
RF:
- females more common than men
- alcohol abuse causes an increased likelihood (falling and knocking)
- various pre-operative disorders
- traumatic hip dislocations
CP:
- severe pain
- swelling.
- leg length discrepancy and deformity
- hip immobility
- clear deformity
Protrusio Acetabuli
Where the socket of the hip is too deep and bulges into the cavity of the pelvis.
causes:
- primary form shows a slight familial tendency
- develops soon after puberty (usually no symptoms at this time even though movements are limited)
AG:
- females more than men
- may occur later in life (secondary to ‘bone softening’ conditions, like osteomalacia or pages disease and long standing RA)
CP:
- limiting range of motion (earliest sign)
- can be symptomless
- may be slight pain
Prognosis:
- can progress until the femoral neck impinges against the pelvis
- treatment indicated only if pain is severe or movements are markedly restricted (this calls for total joint replacement).
Coxa Vara
Deformity of the femoral neck. It is defined as the angle between the neck and shaft of the femur being less than >125 degrees.
congenital coxa vara- present at birth and is caused by an embryonic limb bud abnormality.
developmental coxa vara- occurs as an isolated deformity of the proximal femur. Tends to go unnoticed until walking age is reached, when the deformity results in leg length difference or abnormal gait pattern.
acquired coxa vara- caused by an underlying condition such as fibrous dysplasia, rickets, or traumatic proximal femoral epiphyseal plate closure.
causes:
- can be present at birth, or developmental problem which becomes apparent as the child grows older and bigger.
AG:
- during development of bones in the body
- affects 1 in 25000 children, with either hip
- boys and girls affected equally
CP:
- limb length discrepancy
- prominent GT
- limitation of abduction and internal rotation of the hip
- abnormal but painless gait pattern
- trendelenberg limp is sometimes associated with coxa vara and a waddling gait is often seen when bilateral coxa vara is present
- may also cause femoral retroversion or decreased anteversion.
Femoral Anteversion (in-toe gait)
Inward twisting of the thigh bone
Femoral neck points forward
Causes knees to point inwards and toes to point inwards too (in-toe gait)
10% of children
causes:
- can be present at birth
- Development of the body. No specific cause other than development of a Childs body.
AG:
- children
- present at birth
- signs usually become noticeable between 2-4. Most obvious around 5-6
RF:
- more common in girls than boys somewhat
- often affects both legs, but not always
CP:
- knees pointing towards each other
- can cause child to trip and fall over, have trouble walking
- abnormal gait
- inability to walk with their feet close together and legs straight
prognosis:
- condition usually resolves on its own
- severe form of the condition requires surgery, outlook of surgery is excellent
- typically does not lead to arthritis or any other health problems
Perthes’ disease
Rare childhood condition affecting the hip
Where the femoral head part of the hip joint dies due to a lack of blood flow.
The main blood supplier to the hip is the medial femoral circumflex artery.
causes:
- genetics may play a role (some evidence to show this)
AG:
- usually affected children between 4-8
- can extend between 2-12
RF:
- 1 in 10000 children (rare)
- both hips affected in 15% of cases
- 5x boys than girls
- affects very active children, even athletic children
- more common in asians, eskimos and caucasians
CP:
- children tend to be smaller than average for their size
- first symptom- usually limp or a change in the way the child walks or runs
- pain in hip area, groin, thigh, or even the knee may occur
- irritation and inflammation in the hip area may result in muscle spasms
- pain with activity- relief with rest
- pain may be ‘on and off’. Pain occurs without an injury associated
prognosis:
- can respond well to treatment
- in most cases, after 2-5 years of treatment/observation, many children can return to their normal activities without limitations
- if perches’ disease has been developed at 6 years or younger, have an excellent prognosis
Slipped Upper Femoral Epiphysis (SUFE)
Hip condition that occurs in teens and pre-teens who are still growing.
The ball at the head of the femur, slips off the neck of the bone in a backward direction.
Usually develops gradually over time.
SUFE most common hip disorder in adolescents.
Stable SUFE- patient able to weight bear
Unstable SUFE- patient unable to weight bear
causes:
- develops during periods of rapid growth, shortly after puberty occurs.
- more likely to occur during a growth spurt
- can occur suddenly after a minor fall or trauma
AG:
- teens and pre-teens who are still growing
- 12-16 B
- 10-14 G
RF:
- boys more common (could be due to boys having more intense growth spurts or more growth spurts in general)
- excessive weight or obesity
- family history of SUFE
- an endocrine or metabolic disorder
CP:
- pain (in groin, knee or thigh)
- stiffness
- instability
- may walk or run with a limp after a period of activity
- may hold the affected side in a position of increased external rotation resulting in an out-toed gait.
Pyogenic arthritis (septic arthritis)
Painful infection in a joint
Can come from germs that travel through your bloodstream from another part of your body
Causes:
- germs travelling through blood stream from another part of body
- penetrating injury, such as an animal bite or trauma, delivers germs directly into the joint
AG:
- infants and older adults are most likely to develop septic arthritis
RF:
- existing joint problems- chronic diseases and conditions that affects your joints- such as OA, gout, RA or lupus
- having an artificial joint- bacteria can be introduced during joint replacement surgery, or having an artificial joint may become infected if germs travel to the joint from a different area of the body through the bloodstream.
- skin fragility
- joint trauma
- medications for RA
- weakened immune system
CP:
- Extreme discomfort and difficulty using the affected joint
- swollen joint- red and warm
- pt may suffer with a fever and won’t be well
prognosis:
- if treatment delayed, septic arthritis can lead to joint degeneration and permanent damage
- if treated properly and early enough, a full recovery can be made
Tuberculosis
Bacterial blood bourne infection that travels to the joint via the blood stream.
Can be caught by inhaling droplets from people who have TB.
causes:
- infectious disease that can be caught
- caused from pulmonary TB, can travel through blood to joint causing TB of that joint
AG:
- no age is immune, but usually starts during the first 3 decades of life
CP:
- early presentations- pain around the hip
- pain in hip, limb
- restriction of movement in almost all cases
- depending on extent, can be deformity due to destructive changes by TB
- abscess formation can occur
- swelling, pathological dislocations and sinuses
The irritable hip (transient synovitis)
Hip pain in children, more often caused by a condition called irritable hip, which usually gets better on its own.
Should always be checked as it could be a sign of something more serious.
causes:
- cause unknown.
- where hip joint becomes sore and inflamed
- septic arthritis may cause it
- a problem with the hip bones and blood supply to the hip joint (Perthes’ disease)
These are less common but more serious
AG:
- Children 10 years or younger
- ages 3-10
RF:
- boys more than girls
CP:
- pain and a limp
- pain ranges from mild to severe and tends to starts suddenly
- occurs on one side of the hip, but it can affect the hip, groin, thigh and knee on the affected side.
- babies may crawl in an unusual way because of the pain
- slight fever sometimes occurs (septic arthritis), but this is less common. Temperature above 101 degrees Fahrenheit then most likely a different health problem.
prognosis:
- not usually serious and often gets better by itself
- mild condition that usually lasts up to 2 weeks
Rheumatoid Arthritis
Autoimmune disease.
Chronic inflammatory arthritis that can affect joint symmetrically.
Immune system of body mistakenly attacks its own body tissues.
4 stages of presentation:
- preclinical- raised ESR rate (erythrocyte sedimentation rate)
- synovitis- inflamed synovial membrane of the joint
- destruction- due to inflammation of the joint, destructive changes can occur to bone, cartilage and other tissues within the joint
- deformity- due to constant destruction from inflammation, deformity of the joint starts to show after break down of cartilage and maybe bone.
cause:
- unknown cause
- immune system attacks own body tissues
- may include:
– genetics
– environmental factors
– hormones
AG:
- RA can occur at any age, most likely between 30-50
- if it starts 60-65, called late-onset RA
CP:
- fever
- deformity may occur
- pain and stiffness
- swelling
- morning stiffness lasting longer than 30 minutes
- pain and stiffness lessens with activity
prognosis:
- no cure for RA, but can be managed
- regular exercise important
- exercise strengthens the muscles that supports the joint
Osteoarthritis
Degenerative joint disease. Leading cause of impaired mobility in older pt.
Degeneration of articular cartilage within a joint over time.
Causes:
- wear and tear over time causing degeneration
- can lead to the formation of marginal osteophytes within the joint.
RF:
- older age
- obesity
- sex- women more than men
- repeated stress on joint- job
- genetics
- bone deformities
- metabolic disease- diabetes
CP:
- joint pain and stiffness
- not uncommon to complain of pain at rest and at night
- walking long distances, or putting shoes and socks on can produce significant pain
- morning pain, and stiffness lasting less than 30 minutes as its not inflammatory. Stiffness tends to go as pt starts to mobilise joint
- pt may complain of locking, clicking or giving way sometimes
prognosis:
- OA will progressively get worse, however can be managed.
- staying active, maintaining a healthy weight our losing weight if overweight can help.
- mobilising treatments can help pain and joint function.
