Hip Flashcards
Acetabular labral tear
Clinical presentation
Anterior hip pain with clicking, locking, catching, instability, giving away, and/or stiffness
Coxa valga as predisposing factor
MOI: hip extension + external rotation
Acetabular labral tear diagnosis
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
Avascular necrosis
predisposing factors
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)
Avascular necrosis diagnosis
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
Legg-calve-perthes
Clinical presentation
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
Slipped capital femoral epiphysis
Etiology
Most common hip disorder in adolescents
Ages 9-17
Males > females
More common in obese kids, or tall kids following growth spurt
Slipped capital femoral epiphysis
Clinical presentation
*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
Iliopsoas bursitis
Pain with passive hip extension
Pain with resisted hip flexion
Bursa is tender to palpation
(+) Snapping hip manuever
(+) Supine heel raise
Femoral neck stress, fracture
risk factors
Female
amenorrhea > 6 months
family history of osteoporosis
smoker
eating disorder
Femoral neck stress fracture
Clinical presentation
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
Femoral neck stress fracture
Diagnosis imaging
Radiograph will not detect fracture at 3-4 weeks, if at all
Bone scan (Sn= 100, Sp = 76-100)
Obturator nerve entrapment
Clinical presentation
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
SIJ referral
SIJ provocation tests more sensitive than specific:
Gaenslen
Thigh thrust
Distraction
Compression
Sacral thrust
Sn = 94%, Sp = 78%
Cam impingement
Form of hip impingement due to asphericity of the femoral head
Twice as prevalent in males than females
Pincer impingement
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
Mixed hip impingement
Combination of cam and pincer impingements
Coxa valga
Femoral neck-shaft angle > 140 degrees
Can be linked to structural instability and subsequently, development of labral tear
Risk factors for hip osteoarthritis
Previous history of developmental disorders.
Slipped capital femoral epithesis
Legg calve perthes disease.
Congenital hip dislocations
Developmental dysplasia
Normal hip joint space on radiograph
3-5mm space is normal
< 2.5mm remaining indicates moderate OA
< 1.5mm remaining indicates severe OA
Sutlive clinical prediction rule for hip OA
Painful squatting
Painful hip flexion
Scour test that produces grain pain.
Painful hip extension,
Internal rotation < 25°
Kellgren-lawrence scale
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
Hip cluster OA
Cluster #1
Sn = 86, Sp = 75
Hip pain
IR >= 15 degrees
Pain with IR
Morning stiffness < 60 minutes
Age > 50
Hip cluster OA
cluster 2
Sn = 86, Sp =75
Hip IR < 15deg
Hip flexion =< 115
Stiffness < 60min
Pain in hip
Hip OA
Highest specificity clinical feature
Limited hip IR
Most sensitive clinical feature of intraarticular hip pain
FABER test
