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OCS Exam > Hip > Flashcards

Hip Flashcards

1
Q

What are 5 potential causes of intraarticular hip pain?

A

-OA
-Labral Pathology
-Avascular Necrosis
-Legg-Calve-Perthes
-Slipped Capital Femoral Epiphysis

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2
Q

What are 6 potential causes of extra-articular hip pain?

A

-Iliopsoas Bursitis
-Femoral Neck Stress Fracture
-Osteitis Pubis
-Obturator nerve entrapment
-Iliolinguinal nerve entrapment
-SIJ referral

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3
Q

What are 4 potential non-musculoskeletal causes of hip pain?

A

-Retrocecal appendicitis
-Hernia
-Renal referral
-Ureteral referral

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4
Q

Signs of hip OA?

A

-Older patient >60 y/o
-Groin, posterior, or lateral hip pain
-Commonly refers pain to the knee
-High frequency of associated L-spine DJD

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5
Q

What is the hip osteoarthritis cluster?

A

-Hip pain
-IR >= 15 degrees
-Pain with IR
-Morning Stiffness <60 minutes
-Ages 50 or older

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6
Q

Is the Hip OA cluster better for ruling in or ruling out?

A

Ruling out.

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7
Q

What are common symptoms of acetabular labral tears?

A

-Pain
-Clicking
-Locking
-Catching
-Instability
-Giving way
-Stiffness

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8
Q

What are differential diagnoses of hip labral tears?

A

-Snapping hip syndrome
-Lumbar/SIJ referred pain
-Stress Fracture

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9
Q

When does avascular necrosis of the hip typically show up?

A

-4th decade of life

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10
Q

Predisposing factors to consider when thinking about avascular necrosis?

A

-Steroid usage
-Renal Disease
-Alcoholism
-Sickle Cell Disease
-Radiation
-Gout
-Previous trauma esp. femoral neck fracture and hip dislocation

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11
Q

What are signs of hip avascular necrosis?

A

-Nonspecific groin/hip pain
-Hip AROM WNL (unless progressed)
-Predisposing factors present

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12
Q

What ages typically have Legg-Calve-Perthes?

A

<15 years old

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13
Q

What are signs of Legg-Calve-Perthes?

A

-Pain in hip, knee, and groin
-Hip Flexion Contracture
-Limited IR
-Positive FADIR

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14
Q

What ages are typically impacted with slipped capital femoral epiphysis?

A

9-17

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15
Q

What are signs of a slipped capital femoral epiphysis?

A

-Antalgic Gait: hip held in ER
-Pain poorly localized from going to medial knee
-**Decreased hip IR with increased hip flexion

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16
Q

What are signs of iliopsoas bursitis?

A

-Presenting in hip flexion and ER for relief
-Pain with passive hip extension
-Pain with resisted hip flexion
-Bursa tender to palpation
-Positive snapping hip maneuver
-Positive supine heel raise

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17
Q

What is the snapping hip maneuver?

A

pt is supine, PT hand on the inguinal crease as the hip is brought into flexion, then abduction and ER back to neutral feeling for a painful snap

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18
Q

What is the supine heel raise?

A

Pt is supine with hip flexed to 15, PT places hand on the psoas below the lateral half of the inguinal crease and resists hip flexion; positive with pain under the fingers

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19
Q

What are signs of a femoral neck stress fracture?

A

-Pain at extreme ROM most consistent finding
-Pain with weight bearing
-Positive hop test
-Positive heel tap
-Postive FABER/scour/quadrant
-Positive fulcrum
-Overall, tests that add torsion/bending stresses are most diagnostic

20
Q

What is the fulcrum test?

A

Test for femoral neck fracture:
-PT arm under the seated patient’s thigh with downward pressure applied over the anterior aspect of the distal end of the femur; positive with sharp thigh pain and apprehension also

21
Q

What is the best test for femoral neck fracture detection?

A

Bone Scan

22
Q

What are signs of osteitis pubis?

A

-Tenderness along the pubis
-PROM hip adductors limited with pain
-Hip adductors weak w/pain

23
Q

Who are more likely to have osteitis pubis?

A

-Long distance runners
-Weightlifters
-Fencers
-Soccer players
-Football players

24
Q

What are signs of obturator nerve entrapment?

A

-Medial thigh pain with exercise
-Pain continues with activity and recedes with rest
-Medial thigh paresthesias
-Adductor muscle weakness w/o pain
-Pain reproduced with weight bearing hip ER and ADD

25
Q

What is the diagnotic tool for obturator nerve entrapment?

A

EMG
MRI & Xray of little value

26
Q

What is the hallmark sign of neuropathy?

A

Muscle weakness without pain

27
Q

What is the mechanism of obturator nerve entrapment?

A

Entrapment due to the course of the obturator nerve diving under the pubic ramus and commonly entrapped between the adductor brevis and longus

28
Q

What does the ilionguinal nerve supply cutaneous innervation to?

A

Groin, scrotum, labia

29
Q

What are signs and predisposing factors for ilioinguinal nerve entrapment?

A

-Pain wtih hip hyper extension from inguinal region to genitals

Predisposing factors:
-Abdominal muscle hypertrophy
-Pregnancy
-Prior iliac crest bone graft harvesting
-Overtaining in athletes

30
Q

What is the referral pattern of the SIJ?

A

Anterior groin and from sacrum down the back of the leg; similar to sciatic

31
Q

What are signs of retrocecal appendicitis?

A

-Pain at McBurney’s point, medial inquinal region, and right scrotum
-Pain typically preceded by nausea
-Low grade fever >1.5 degrees; often with chills/sweats
-Pain with resisted hip flexion MMT
-Pain with obturator test (Hip IR and ER while flexed to 90)

32
Q

What are symptoms of a hernia?

A

-intermittent or persistent bulge and pain
-localized and sharp pain
-increased pain with changes in position, physical exertion, bowel movements, and valsalva

33
Q

What is the difference between a direct/indirect hernia and a femoral hernia?

A

The femoral hernia is more rare (4%) and goes down into the leg

34
Q

What are signs and symptoms of renal referral?

A

Unilateral low back and front abdominal area pain unrelieved by position; possibly nausea/vomiting

35
Q

How to test for kidney pain reproduction?

A

With the pt in prone, place one hand over the costovertebral angle on the back and thump the hand with the other fist; pain is positive test

36
Q

What are signs of ureteral pain?

A

Pain from costovertebral angle and radiating to the front by the inguinal canal and into the groin area
Unrelieve by changing position

37
Q

What percentage of hip fractures are associated with a fall?

A

90%

38
Q

When are women 10x more likely to have had a fracture with a fall?

A

Over 80

compared to those 60-69

39
Q

What are exam findings that might clue you into a hip fracture?

A

-Leg ER and abducted when in supine
-Leg appears shortened
-Pos Log Roll Test
-Pos axial load to the LE
-Unable to perform SLR

40
Q

What is the log roll test?

A

Passive hip IR/ER with the LE in neutral while in supine

41
Q

When might a hip fracture not be treated with surgery/ORIF?

A

Those that are severely debilitated, unstable, uncorrectable disease, end stage of terminal illness, non-ambulatory

42
Q

What type of hip fracture heals better?

A

Extracapsular

43
Q

What are risks associated with intracapsular ORIF of the hip?

A

Avascular Necrosis
Impact Failure
Non Union
Mal Union
Degenerative Changes of the hip joint

44
Q

What are signs or risk factors for hip stress fracture?

A

Increased training volume
Deep, aching pain in hip/groin region
Worse with activity, better with rest
Difficulty weightbearing
“sign of the buttock”
Decreased ROM
Empty End Feel
Non-capsular pattern
Pattellar-pubic percussion test pos

45
Q

What is the difference between a fatigue stress fracture and an insufficiency stress fracture?

A

Fatigue generally due to an increase in activity but healthy otherwise
Insufficiency in older adults, post menopausal, RA, Renal dysfunction, after radiation, coxa vara, metabolic disorder, paget’s disease

46
Q

What is the “sign of the bottock?”

A

A potential indicator of femoral head/neck fracture noted by:
-Limited SLR similar to hip flexion
-Trunk flexion limited to the extent of hip flexion
-painful weakness of hip extension
-Swollen Bittock
-Non capsular pattern

OCS Exam (12 decks)

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