Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Clin Med > hip > Flashcards

hip Flashcards

1
Q

who do we commonly see hip osteoarthritis (DJD) in?

A

with the aging process or trauma
common in > 60 y/o, women > men

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what is the patient presentation for early DJD?

A

pain in lateral hip, groin or along L3 dermatome alone anterior thigh and knee- deep, aching pain
stiffness in AM, better with movement
pain on WB during gait or @end of day after activity (also with sitting, crossing legs and putting on socks/shoes)
antalgic gait (trendelenberg gait)
ADLs become difficult- sleep also decreased
commonly accompanied by a limitation in back extension
positive findings confirmed with plain radiograph
bilateral stance- less than 1/2 body weight on each hip
unilateral stance- 3x body weight due to muscular contraction- pain with stair climbing > walking on flat surfaces
cane use decreases compressive forces- contralateral side
osteonecrosis possible due to: excessive steroid use, alcohol abuse, excessive radiation or trauma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what is trendelenberg sign?

A

when the patient walks and the hip drops on the leg in the air

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what do we see in end-stage DJD?

A

unrelating pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what is the clinical criteria for hip OA?

A

hip internal rotation <15º
morning stiffness for ≤ 60 min
hip flexion < 115º
pain with hip internal rotation
age > 50 y/o

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what is the reference standard for hip OA?

A

radiographic findings include: joint space narrowing, osteophytes, sclerosis, cyst, protrusion, and femoral head remodeling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what is the physical exam or special tests for hip OA?

A

dec flex/IR ROM
trandelenberg sign
scour test
faber test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what is the treatment of hip OA to decrease effects of stiffness?

A

stress importance of daily movement
ROM- exercises-stationary bike

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what is the treatment of hip OA to decrease pain?

A

decrease mechanical strain by using AD (cane or crutch on contralateral side of walker prn)
grade 1 or 2 oscillations
stretching to correct muscle-length imbalances (slow, sustained pain free, after warm up, 60 seconds, 3-5 reps)- hip flexors/hip abd

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what is the treatment of hip OA to increase ROM/strength?

A

joint mobs (grade 3 or 4)
PNF stretching techniques to tight muscles (hip flexors/hip abd)
self-stretching
increase strength in supporting muscles- hip abd, hip ext, quads

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what is the treatment of hip OA to increase endurance?

A

stationary bike
swimming
walking (outdoors or treadmill with arms)- walking may hurt if gait pattern not fixed
stair master machine
goal is 150 mins/week

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what do we want for stretching and strengthening exercises for hip OA?

A

should be pain free, without increased symptoms lasting > 1-2 hours more than 2 pts on the NPRS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what are some radiographic evaluations at the pelvis and hip?

A

antero-posterior pelvis
antero-posterior hip
lateral frog leg hip

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what does an AP projection radiograph allow for?

A

enhanced detail
improves profile greater tuberosity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what does a lateral frog leg projection radiograph allow for?

A

allows profile of lesser tuberosity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what are we looking for on a hip xray?

A

asymmetrical joint space narrowing, osteophytes, subchondral cysts, and subchondral sclerosis considered a definitive radiographic diagnosis?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

how many grades are there for kellgren/lawrence radiographic?

A

grades OA on scale 1-4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what is a kellgren/lawrence radiographic grade 1?

A

doubtful narrowing of joint space and possible osteophyte formation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what is a kellgren/lawrence radiographic grade 2?

A

definite osteophyte, definite narrowing of joint space

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what is a kellgren/lawrence radiographic grade 3?

A

moderate multiple osteophytes, definite narrowing of joints space, some sclerosis and possible deformity of bone contour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what is a kellgren/lawrence radiographic grade 4?

A

large osteophytes, marked narrowing of joint space

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what is the point of kellgren/lawrence radiographic grade?

A

baseline grade is an important predictive factor for having a THA
grade 2 or greater= strong predictor of hip OA progression
grade 3//4= 4-5x higher odds ratio that pt would have a THA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what are symptoms of a labral tear?

A

pain is experienced in the groin and hip
locking or clicking of the hip joint
stiffness is experienced in the hip
limited range of motion of the hip
sudden appearance of symptoms after an incident is noticeable
gradual development of symptoms with progressive degeneration

24
Q

what is the incidence for labral tears?

A

asymptomatic- 40-54% (increase with age)
symptomatic- 70% (median age 38 for males and 40 for females, male patients had a higher incidence of acute injury than females)

25
Q

what are risk factors for labral tears?

A

trauma, increased ROM, anatomic abnormalities

26
Q

what can we do in the physical exam or special tests for labral tears?

A

FABER test, scour test, anterior labral tear test (aka FADDIR test)

27
Q

how are labral tears diagnosed?

A

MRI arthrogram

28
Q

what is a femoral acetabular impingement?

A

decreased joint clearance between the femur and acetabulum

29
Q

what does femoral acetabular impingement cause?

A

abnormal contact between the femur and acetabulum, particularly when hip flexion is combined with adduction, and internal rotation. can also cause labral tears and bring about progressive degenerative process leading to OA

30
Q

what are the 4 types of femoral acetabular impingement?

A

normal
cam
pincer
mixed

31
Q

what are cam impingements a result of?

A

an abnormal morphology of the proximal femur, usually at the femoral head-neck junction

32
Q

what are pincer impingements a result of?

A

an abnormal morphology or orientation of the acetabulum

33
Q

what are the principles for labral tears and FAI for treatment?

A

relieve symptoms
maintain function
management strategies: control inflammation/pain, joint mobs, ROM, maintain muscle length and muscle strength. limiting activities in frontal and sagittal planes. lumbopelvic strengthening and stabilization. surgery if recalcitrant to conservative measures

34
Q

what is greater trochanter bursitis also known as?

A

greater trochanteric pain syndrome

35
Q

who do we commonly see greater trochanteric bursitis in?

A

women > men
middle aged women most commonly affected
active or sedentary patients

36
Q

what is the etiology for greater trochanteric bursitis?

A

repetitive microtrauma, blunt trauma, or idiopathic

37
Q

what is the typical patient presentation for greater trochanteric bursitis?

A

pain usually in region of greater trochanter and possibly along lateral aspect of thigh (along ITB)
usually worse with weightbearing, sitting with crossed legs or with direct pressure
End of day usually worse
difficulty sleeping on painful side

38
Q

what are some contributing factors to greater trochanteric bursitis?

A

leg length discrepancy, hip history of lateral hip surgery and sports participation that involves running or contact
if running on crowned roads, legs closet to the curb most susceptible

39
Q

how is a greater trochanteric bursitis diagnosed?

A

imagining usually not needed but radiographs may be done to rule out other disorders
rule out hip OA as a contributing factor as well as lumbar pathology
unless direct trauma, swelling and ecchymosis/erythema usually not seen

40
Q

what do we do in our physical exam or special tests for greater trochanteric bursitis?

A

ER ROM more painful than IR
ADD more painful than ABD (Ober test)
pain and weakness with hip ABD (trandelenberg)
FABER
palpation

41
Q

what is the treatment for greater trochanteric bursitis?

A

decrease inflammation via ice, estim, ionto, anti-inflammatories, and relative rest
TFL/ITB stretching (+ ober test)
hip flexor stretching (especially in older individuals)
hip strengthening emphasizing gluteus medius
check for muscle imbalances or possible biomechanical causes
lumbar impairments (mobility and core strength)
pt education (takes weeks to make difference)
if lack of response to PT- cortisone injections and rarely surgery

42
Q

what muscle are commonly seen in hip muscle strains?

A

adductor longus, gluteus medius, proximal hamstring or psoas

43
Q

what do patients with a hip muscle strain experience?

A

pain after sudden onset with incident

44
Q

what are some risk factors for hip muscle strains?

A

prior injury in the same area
muscle tightness
failure to warm up properly before exercising
attempting to do too much too quickly when you exercise

45
Q

are radiographs needed for hip muscle strains?

A

they may be needed to rule out avulsion fracture if pain is noted with palpation at bony insertion site

46
Q

what do we notice with patients with a hip muscle strain?

A

may not an antalgic/altered gait
may be ecchymosis in site of injury
local tenderness to palpation at the site of injury
pain with resisted movements of affected muscle
pain with passive movements opposite of muscle action

47
Q

what is the treatment for acute hip muscle strains?

A

modalities to promote healing and decrease pain and inflammation, such as massage, submaximal isometric exercises, passive ROM exercises, and lumbopelvic stabilizing exercises

48
Q

what is the treatment for subacute hip muscle strains?

A

concentric exercises, including functional closed-chain and weight-bearing exercises, lumbopelvic stabilization activities, general flexibility exercises, and progressive balance and stability exercises

49
Q

what is the treatment for chronic/remodeling phase of hip muscle strains?

A

eccentric exercises and sport-specific training

50
Q

in what patients are slipped capital femoral epiphysis most common in?

A

its the most common during the adolescent years, usually 10-17 y/o for boys and and 8-15 y/o for girls
boys 2x more likely than girls
BMI is a risk factor

51
Q

what is common for symptoms with slipped capital femoral epiphysis?

A

symptoms worsening- min vague pain early
cause unknown may present as knee pain

52
Q

what is commonly seen with the physical exam for patients with slipped capital femoral epiphysis?

A

antalgic gait and limitation in hip ROM/strength- non capsular pattern for ROM loss

53
Q

when is prognosis good for slipped capital femoral epiphysis?

A

if caught early

54
Q

what is the treatment for slipped capital femoral epiphysis?

A

treatment of choice often surgery

55
Q

what do we do post op slipped capital femoral epiphysis?

A

ROM, strengthening, maximize function

56
Q

what do we educate patients on post op slipped capital femoral epiphysis?

A

weight control (dietician), sport participation based on MDs recommendation

Clin Med (17 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions