hip Flashcards
trochanteric bursitis
inflammation of a bursa over the greater trochanter on the outer hip between hip abductors and IT band
presentation
pain localised at the outer hip, referred to as greater trochanteric pain syndrome
pain lying on side
worse on walking
may have scars from previous surgery
may have muscle wasting
tenderness
worst pain in active abduction and passive adduction
causes trochanteric bursitis
repetitive movements, runners
trauma
inflammatory conditions
infection
scoliosis
muscle wasting post surgery
OA
hip replacment
investigations trochanteric bursitis
x ray may be normal
MRI shows soft tissues and fluid
US can be therapeutic and diagnostic
treatment trochanteric bursitis
NSAIDs
relative rest
physio
injection corticosteroids if rest fails
shock lithotripsy sometimes
bursectomy- rarely, painful scars
avascular necrosis of hip
males more than females
death of bone due to lacj of blood supply
pften 1 side symptomatic at a time
but 80% bilateral
causes of avascular necrosis
radiation
fracture
dislocation
iatrogenic
steroids
haematological issues
alcoholism - commonest rf
presentation avascular necrosis
insidious onset of groin pain
pain with stairs and walking uphill
limp intermittent
normal exam findings
disproportionate pain
may replicate early arthritis
reduced range of motion
investigations
MRI best identifies earliest changes
xray only if necrosis went to bone collapse stage
treatment avascular necrosis
find cause
reduce weight bearing
nsaids
bisphosphonates- controversial
anticoagulants
physio
surgical if bad. restore blood supply core decompression, rotational osteotomy, total hip replacement
femoroacetabular impingement
2 surfaces hitting together
hip pathology in younger patient
can be cause of secondary osteoarthritis
anatomical phenomenon
2 types- cam lesion or pincer
pincer
young females
active
abnormal acetabulum
extra prominence in edge of acetabulum
cam lesion
young athletic males
rowers
femoral based
decreased head neck ratio, aspherical head
presentation of FAI
groin pain
worse with flexion
block to movement
pain getting out of chair, squatting, lunging
reduced flexion and internal rotation
FADIR test replicates pain
investigations FAI
xray
MRI for associated conditions
