Hip

Question 1

Acetabular labral tear
Clinical presentation

Answer 1

Anterior hip pain with clicking, locking, catching, instability, giving away, and/or stiffness
Coxa valga as predisposing factor

MOI: hip extension + external rotation

Question 2

Acetabular labral tear diagnosis

Answer 2

FABER (Sn = 0.88)
Clicking in hip +LR=6.67
Femoral acetabular impingement test

Hip arthroscopy as gold standard
MRA also has high sensitivity and Sp

Question 3

Avascular necrosis
predisposing factors

Answer 3

Present in 80% of cases, thus key to diagnosis

Steroid use
Renal disease
Alcoholism
Sickle cell disease
Radiation
Gout
Previous trauma (especially femoral head fracture and hip dislocation)

Question 4

Avascular necrosis diagnosis

Answer 4

MRI is highly specific and sensitive
Radiograph typically do not show findings until > 3 months
Predisposing factors are present in 80% of cases, key to diagnosis

Question 5

Legg-calve-perthes
Clinical presentation

Answer 5

Most common age 4-9. Male> female

Intermittent deep hip pain

Pain in hip, knee, or groin
Hip flexion contracture
Limited hip IR, dec hip ROM, limp
(+) Flexion-adduction test
Radiograph usually diagnostic

Typical age 4-10 years old

Question 6

Slipped capital femoral epiphysis
Etiology

Answer 6

Most common hip disorder in adolescents
Ages 9-17
Males > females

More common in obese kids, or tall kids following growth spurt

Question 7

Slipped capital femoral epiphysis
Clinical presentation

Answer 7

*decreased hip internal rotation with increased hip flexion
pain poorly located from groin to medial knee

Acute:
Hip presents in extension, ER, adduction
A/PROM cause pain

Chronic:
Limited hip flexion
Typically no pain with motion test

Question 8

Iliopsoas bursitis

Answer 8

Pain with passive hip extension
Pain with resisted hip flexion
Bursa is tender to palpation
(+) Snapping hip manuever
(+) Supine heel raise

Question 9

Femoral neck stress, fracture
risk factors

Answer 9

Female
amenorrhea > 6 months
family history of osteoporosis
smoker
eating disorder

Question 10

Femoral neck stress fracture
Clinical presentation

Answer 10

Pain with extreme range of motion.
Pain with weight bearing
Positive hop test.
Positive FABER, scour, quadrant tests
Positive fulcrum test
Sign of the buttock

Question 11

Femoral neck stress fracture
Diagnosis imaging

Answer 11

Radiograph will not detect fracture at 3-4 weeks, if at all
Bone scan (Sn= 100, Sp = 76-100)

Question 12

Obturator nerve entrapment
Clinical presentation

Answer 12

EMG is diagnostic.
MRI and x-ray of limited value.

Paresthesia at medial thigh
adductor weakness
pain reproduced with weight bearing external rotation and adduction

Question 13

SIJ referral

Answer 13

SIJ provocation tests more sensitive than specific:
Gaenslen
Thigh thrust
Distraction
Compression
Sacral thrust

Sn = 94%, Sp = 78%

Question 14

Cam impingement

Answer 14

Form of hip impingement due to asphericity of the femoral head

Twice as prevalent in males than females

Question 15

Pincer impingement

Answer 15

Hip impingement that results from bony abnormality on acetabulum

Excessive acetabular coverage anteriorly may result in premature abutment of femoral neck on acetabular rim

More common in middle-aged active women

Question 16

Mixed hip impingement

Answer 16

Combination of cam and pincer impingements

Question 17

Coxa valga

Answer 17

Femoral neck-shaft angle > 140 degrees
Can be linked to structural instability and subsequently, development of labral tear

Question 18

Risk factors for hip osteoarthritis

Answer 18

Previous history of developmental disorders.
Slipped capital femoral epithesis
Legg calve perthes disease.
Congenital hip dislocations
Developmental dysplasia

Question 19

Normal hip joint space on radiograph

Answer 19

3-5mm space is normal
< 2.5mm remaining indicates moderate OA
< 1.5mm remaining indicates severe OA

Question 20

Sutlive clinical prediction rule for hip OA

Answer 20

Painful squatting
Painful hip flexion
Scour test that produces grain pain.
Painful hip extension,
Internal rotation < 25°

Question 21

Kellgren-lawrence scale

Answer 21

Grades of OA
gr1 not visible on radiograph
Gr 2 small possible osteophytes but doubtful narrowing of joint space
GR3 moderate narrowing of joint space and moderate osteophytes and joint
GR4 severe joint space narrowing, deformation of bone contour, subcondral sclerosis, large osteophytes

Question 22

Hip cluster OA
Cluster #1

Answer 22

Sn = 86, Sp = 75
Hip pain
IR >= 15 degrees
Pain with IR
Morning stiffness < 60 minutes
Age > 50

Question 23

Hip cluster OA
cluster 2

Answer 23

Sn = 86, Sp =75
Hip IR < 15deg
Hip flexion =< 115
Stiffness < 60min
Pain in hip

Question 24

Hip OA
Highest specificity clinical feature

Answer 24

Limited hip IR

Question 25

Most sensitive clinical feature of intraarticular hip pain

Answer 25

FABER test