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MSK > hip > Flashcards

hip Flashcards

1
Q

what is the pelvic girdle comprised of?

A

2 sets of hip bones, connected in my middle by sacrum and coccyx

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2
Q

where do the sacral nerves pass through?

A

holes in the lateral sacrum, formed by fusing of the transverse processes

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3
Q

what is each hip bone made of?
(also called innominate bone)

A

ilium: has iliac crest and the ala (wing like area), forms superior acetabulum
pubis: forms anteromedial acetabulum
ischium: forms inferior acetabulum

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4
Q

what are the components of the ischium?

A

ramus: fuses with the pubic ramus to form posterior border of obturator foramen
tuberosity: sit bones, when hamstrings attach
spine: process that separates greater and lesser sciatic notches

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5
Q

what is the lunate surface of the acetabulum?

A

horseshoe shaped articular surface on peripheral edges, made of articular cartilage

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6
Q

what is the acetabular fossa?

A

non-articular surface, filled with fat

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7
Q

what is the femoral head covered in?

A

articular cartilage
articulates with the lunate surface of the acetabulum

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8
Q

what is the greater trochanter the attachment site for?

A

gluteus medius and minimus, obturator internus and piriformis

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9
Q

what is the lesser trochanter the attachment site for?

A

iliopsoas muscle

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10
Q

where is the greater trochanteric bursa?

A

deep to the gluteus maximus, in between the minimus and medius on the greater trochanter

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11
Q

where is the iliopsoas bursa?

A

between the iliopsoas and anterior joint capsule
(closer to acetabulum)

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12
Q

where is the anterior hip recess?
where does the anterior hip capsule extend to?

A

superficial and inferior to femoral head, superficial to femoral neck

extends inferiorly to the intertrochanteric line

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13
Q

what should the measurement for the anterior hip capsule be?

A

<7mm

evaluate for fluid build up

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14
Q

where does the iliopsoas tendon insert and what is the function?

A

inserts medially on the lesser trochanter, flexes the hip joint

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15
Q

where does the rectus femoris muscle originate and insert, and what is the function?

A

origin on anterior/inferior iliac crest, inserts on the tibia
extends the hip joint

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16
Q

what does NAVEL stand for?

A

nerve, artery, vein, empty space, lymphatic

for the femoral neurovascular bundle medial to the iliopsoas tendon

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17
Q

what are the 3 adductor muscles/tendons of the medial hip?

A

adductor longus: only one assessed with ultrasound
adductor brevis
adductor magnus

(all originate on pubic ramus)

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18
Q

where do the gluteus medius and minimus insert? what is their function?

A

minimus: anterior facet of greater trochanter
medius: lateral facet of greater trochanter

medially rotate and abduct the hip

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19
Q

what 3 muscles make up the hamstrings?

A

biceps femoris
semitendinosus
semimembranosus

extend the thigh and flex the knee

20
Q

what is the largest nerve in the body?
where does it divide?

A

sciatic nerve
divides just above the pop fossa

21
Q

what does the sciatic nerve innervate?

A

hamstring muscles and short head of the biceps femoris

22
Q

what is the most common pediatric presentation in orthopedic practices?

A

irritable hip

23
Q

what is the most common cause of irritable hip? what is the presentation?

A

transient synovitis

happens typically between 5-8 years old with painful hip and unable to bear weight

24
Q

what measurement is considered joint effusion in a pediatric hip?

A

> 5mm in the anterior joint space

> 2mm difference from the contralateral hip is abn

25
Q

what are the most common causes of joint effusion in peds?

A

transient synovitis***, septic arthritis or Perthe’s disease

larger effusions are more commonly associated with synovitis

26
Q

what is transient synovitis defined by?
(what is it? what causes it)

A

inflammation of the synovial joint capsule from an upper resp infection moving to the hip

27
Q

when is transient synovitis more common, girls or boys?

A

boys

28
Q

what is the clinical presentation for transient synovitis?

A

1-7 days of pain and limping with refusal to bear weight, resolution in 2 weeks

29
Q

what should be considered if the transient synovitis does not resolve on its own?

A

Perthe’s disease

30
Q

what is septic arthritis?

A

bacterial infection of the hip, can lead to rapid cartilage and tendon deterioration and bone damage

31
Q

how does septic arthritis appear?

A

thickened anterior capsule and complex joint effusion due to presence of pus
very similar to transient tenosynovitis

32
Q

what is Perthe’s disease?

A

blood supply to the femoral head is interrupted and bone cells begin to necrosis, causing a flattened head

33
Q

how does Perthe’s disease appear?

A

effusion, thickening of the femoral head articular cartilage, fragmentation of the epiphysis

difference of 3mm to the contralateral side is abn

34
Q

is Perthe’s disease a chronic or temporary disease?

A

temporary, blood supply returns and bone grows back

35
Q

what is the measurement for adult hip effusion?

A

anterior joint capsule >5mm

36
Q

What is synovial chondromatosis?

A

synovial villi develop ossified bodies, may break off and become loose in the joint

37
Q

what is pigmented villonodular synovitis? (PVNS)

A

overgrowth and thickening of the synovium, is a type of giant cell tumor

most common in 40-60yo’s, can present as a large synovial mass in the hip joint

38
Q

what is the most common finding of trochanteric bursitis?

A

thin portion of thickened synovium, difficult to differentiate
compare with contralateral side, large effusions here are uncommon

39
Q

what is DDH?

A

developmental dysplasia of the hip
caused by shallow acetabulum where the femoral head can slip out of the socket

40
Q

what is the window of opportunity to treat DDH?
what happens when left untreated?

A

within first 6 months of life

can develop into inability to walk when child is 1yo
- or limp/abn gait in childhood and a lifetime of limited ROM

41
Q

what are the risk factors of DDH?

A

F: female
F: first born
F: family hx
B: breech
O: oligohydramnios

42
Q

what is Graf’s method?

A

focuses on measuring the shape and size of the acetabulum, measurements taken when coronal image is taken
measurements are the base line, roof line, and labrum line

43
Q

for Graf’s method:
what is the alpha angle?
beta angle?

A

alpha: between roof and base line, >60 is normal
beta: between labrum and base line, >55 is normal

44
Q

what is Morin’s method?

A

using same image as Graf’s method, 2 lines are drawn 90* to the base line

1st line: from baseline to bottom of femoral head
2nd: from top to bottom of femoral head

45
Q

what is the normal % for Morin’s method?

A

52% and above is considered normal

46
Q

how often are hip ultrasounds done on a neonate once DDH is diagnosed?

A

every 2 weeks to see if it resolves on its own

47
Q

if the DDH hip remains unstable, what is the treatment?

A

splint therapy

if severe or diagnosed late, sx reduction of the femoral head into acetabulum is considered

MSK (9 decks)

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