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OCS Prep > Hip > Flashcards

Hip Flashcards

1
Q

hip disorders 0-2 yo

A
  • developmental dysplasia of the hip
  • septic arthritis
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2
Q

hip disorders 2-12 yo

A
  • acute transient synovitis
  • leg- calve-perthes
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3
Q

hip disorders 8-17 yo

A

SCFE

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4
Q

hip disorders 5-30 yo

A

osteoid osteoma (femoral neck)

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5
Q

normal torsion

A
  • 8-15
  • 40 degrees at birth
  • normal at 16 years old
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6
Q

anteversion

A

torsion >15
in-toeing, excessive IR

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7
Q

retroversion

A

torsion <8
toe out, excessive ER

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8
Q

craigs test

A
  • tests verison of hip
  • prone, knee in 90 flex
  • rotation hip IR and ER, find greater troch at parallel to table, measure ankle of leg
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9
Q

developmental dysplasia

A
  • 1/100 births
  • 6:1 girls:boys
  • 80% unilateral, 20% bilateral
  • mechanical: position in the womb
  • physiological: estrogen and relaxin in utero
  • environmental: cultural positioning of infants
  • limited and asymmetric abduction
  • asymmetric thigh folds
  • positive galeazzi sign (unequal knee height in supine hips to 90)
  • positive ortolani sign(relocating dislocated hip)
  • telescoping
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10
Q

developmental dysplasia treatment

A

birth to 9 months
- abduction diapers
- pavlik harness

9 months or older
- abduction orthosis (double diaper)
- surgical intervention

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11
Q

septic arthritis

A
  • acute, rapidly progressing infection
  • <2 years old
  • pyogenic bacteria
  • irritability
  • hip held in open packed position
  • fever, sweating, chills, tachycardia
  • loss of appetite

treatment
- aspiration, IV antibiotics

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12
Q

acute transient synovitis

A
  • inflammation of synovial lining
  • self limiting
  • often preceded by upper respiratory infection
  • up to 5% later develop AVN
  • unknown cause

Features:
- hip pain, limp, refuse to walk
- decreased hip ROM >IR
- fever possible (<101)
- radiographs will be normal

Management
- relative rest
- PWB crutches
- radiographs

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13
Q

Legg-calve Perthes

A
  • AVN of femoral head
  • 3-12 most common (9-12)
  • males >females
  • whites > blacks
  • 95% unilateral
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14
Q

legg-calve perthes presention

A
  • hip and knee pain at night
  • ROM decreased abduction and ER; flexion contracture common
  • abnormal growth patterns: forearm and hands short, feet short
  • psoatic limp: worse late in day
  • often very active
  • correlated with ADD
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15
Q

legg- calve perthes treatment

A
  • reduce hip irritability
  • restore and maintain hip mobility
  • regain a spherical femoral head
  • prevent ball from extruding or collapsing
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16
Q

SCFE

A
  • posterior and inferior displacement of femoral head
  • 2:1 boys:girls
  • 10-16 yo most common
  • 50% are bilateral
  • obese
  • black > white
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17
Q

SCFE presentation

A
  • gradual hip pain and limp
  • medial sided knee pain
  • hip extension and IR limited
  • passive flexion presents with abd/ER
  • 3-12 months before diagnosis

treatment is ORIF

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18
Q

OA subjectively

A
  • older patient >60
  • groin pain, postero/lateral hip, anterior thigh pain
  • commonly refers pain to the knee
  • high frequency associated with Lspine DJD
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19
Q

two clusters of OA
(SN of 8%, SP 75%)

A
  • hip pain
  • IR <15
  • pain with IR
  • morning stiffness >60 min
  • age over 50
  • IR<15
  • flexion <115
  • stiffness >60 min
  • pain in hip
20
Q

labral tears

A
  • complaint of pain, clicking, locking, catching, instability, or giving away
  • anterior groin pain in 96-100%
  • MOI: hip external rotation +extension

EXAM
- FABER SN .88
- femroal acetabular impingement test
- imaging gold standard is arthroscopy

21
Q

AVN

A
  • 4th decade of life
  • nonspecific leg pain
  • steroid usage, renal disease, alcoholism, sickle cell disease, gout, previous trauma

EXAM
- hip AROM WNL
- radiographs findings do not occur until 3 months
- MRI highly specific/sensitive

22
Q

iliopsoas bursitis

A

Subjective
- anterior hip pain
- worse with hip extension
- overuse
- may complain of snapping

Exam
- present in hip flexion and ER for relief
- pain with passive hip extension
- pain with resisted hip flexion
- bursa tender to palpation
- (+) snapping hip maneuver
- (+) supine heel raise

23
Q

femoral neck stress fracture

A

Subjective
- stress fx: 10% of all injuries seen in sports
- femur is 4th most common site of fracture
- overuse vs insufficiency
- females > males
- groin, thigh, or knee pain
- often occurs after change in activity
- risk factors: female, amenorrhea >6months, family history of OP, smoker, eating disorder

EXAM
- pain at extreme ROM
- pain with weight bearing
- positive hop test (70% accurate)
- positive heel tap
- positive FABER, scour, quadrant
- positive fulcrum
- bone scan 100% sensitive

24
Q

osteitis pubis

A
  • gradual onset of pain in pubic region
  • following bladder or prostate surgery
  • long distance runners, weightlifters, fencers, soccer players, football players

EXAM
- tenderness along pubis
- PROM hip adductors limited w pain
- RROM hip adductors weak with pain

25
Q

obturator nerve entrapment

A
  • activity induced entrapment
  • can be due to pelvic fx, hematoma, retroperitoneal masses, intrapelvic tumors
  • presents as medial thigh pain with exercise
  • pain continues with activity, recedes with rest

EXAM
- paresthesias medial thigh
- adductor muscle weakness (no pain)
- pain may be reproduced with weightbearing hip ER and adduction
- EMG diagnostic

26
Q

ilioinguinal nerve entrapment

A
  • supplies cutaneous innervation to groin, scrotum, or labia
  • c/o pain in from inguinal region to genitals
  • risk factors: abdominal muscle hypertrophy, pregnancy, prior iliac crest bone graft harvesting, overtraining athletes
  • reproduction of symptoms with hip hyperextension
27
Q

signs of buttock

A
  • limited straight leg raise
  • limited hip flexion to the same extent as SLR
  • limited trunk flexion to the same extent as hip flexion
  • painful weakness of hip extension
  • noncapsular pattern of restriction at the hip
  • swollen buttock
28
Q

hip outcome measures recommendation

A

Level A: hip outcome score, copenhagen hip and groin outcome score, interneational hip outcome tool

29
Q

labral debridement protocol

A
  • early PROM
  • CPM use (6-12 hours/day for 3-4 weeks)
  • overcoming inhibition of posterior hip musculature is an important key to progression
  • AD should be continued until gait is normal
  • aquatic walking or deweighing treadmill
  • avoid normal treadmill to prevent forced extension
  • avoid excessive early flexion and abd to prevent inflammation
30
Q

labral repair (anterior/superior) protocol considerations

A
  • limit PROM to 90 flexion for 10 days and 25 degrees abduction, gentle external rotation and extension for 3 weeks
  • PWB for 10-28 days\
  • avoid excessive early flexion and abd to prevent inflammation
31
Q

osteoplasty rehab considerations

A
  • limited impact activities for 8 weeks
  • flexion limited to 90 for 10 days,
  • foot flat weightbearing for 4 weeks
  • slightly slower progression
  • avoid excessive early flexion and abd to prevent inflammation
32
Q

microfracture rehab considerations

A
  • flexion is limited to 90 deg for 10 days
  • size and location of lesion affects WB adn tolerance
  • slower progression, 6-7 weeks of limited weight bearing
  • avoid excessive early flexion and abd to prevent inflammation
33
Q

sports hernia

A
  • insidious onset
  • gradually worsening
  • diffuse
  • unilateral groin pain that may radiate to perineum and upper medial thigh
  • mainly males mid 20’s
34
Q

main causes of chronic groin pain

A
  • adductor longus dysfunction
  • osteitis pubis
  • sport hernia
  • pathological condition of the hip joint
35
Q

sports hernia rehab

A
  • avoid sharp movements
  • focus on core and leg inflexibility, weakness, , endurance
  • jogging at 3-4 weeks
  • 6-8 weeks for full return
36
Q

sports hernia rehab

A
  • avoid sharp movements
  • focus on core and leg inflexibility, weakness, , endurance
  • jogging at 3-4 weeks
  • 6-8 weeks for full return
37
Q

hamstring reinjury risks

A
  • persistent weakness in injured muscle
  • reduced extensibility of the musculotendon unit due to residual scar tissue
  • adaptive changes in the biomechanics and motor patterns of sporting movements
38
Q

rehab for hamstring strains overall

A
  • eccentric strength training
  • neuromuscular control of lumbopelvic musculature
  • progressive agility and trunk stabilization has better outcomes versus stretching and strengthening
  • early mobilization
39
Q

phase 1 hamstring rehab

A
  • protection
  • ice
  • NSAIDs
  • lumbopelvic musculature, SLB, short stride frontal plane stepping (grapevine), avoid isolated resistance training

Progression criteria
- normal walking stride without pain
- very low speed jogging without pain
- pain- free isometric contraction against submax resistance during prone knee flexion

40
Q

phase 2 hamstring rehab

A
  • avoid end range HS lengthening if weakness persists
  • ice
  • neuromuscular control, agility, trunk stabilization

Progression criteria
- full strength without pain during 1 rep max
- forward and backward jogging at 50% max speed without pain

41
Q

phase 3 hamstring rehab

A
  • ice if needed
  • sport specific drills
  • progress hamstring strength to end range motion

Return to sport
- all strength and mobility be preformed without pain
- less than 5% difference

42
Q

cam impingement

A
  • when the femoral head has an abnormally large radius with loss of the normal spherical junction between the femoral head and neck
  • usually in anterosuperior labral and chondral lesion
  • young athletic males
43
Q

pincer impingement

A
  • abnormal acetabulum with increased overcoverage
  • leads to posteroinferior chondrol lesions
  • more common in middle-aged women in athletics
44
Q

where to labral tears commonly happen and refer

A
  • anterior or anterosuperior
  • anterior groin
45
Q

tests for intra-articular hip pain

A
  • Faber, scour, patrick, resisted straight leg raise
  • Faber is sensitive in ruling out labral
46
Q

hip precautions with THA posterior

A
  • avoid hip flexion past 90, adduction past midline
  • cemented THA is not limited in weightbearing

OCS Prep (11 decks)

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