Hip Flashcards
3 ducks pec the grass
3 adductors (longus, brevis, magnus) pectineus, gracillis
sally gets food often
sciatic, gluteal, femoral, obturator (nerves)
abduct & medial rotation saying
tensor fascia lata, glute med and min
all abduct the leg and rotate in
coxa varum
angle of inclination < 125°
coxa valgum
angle of inclination >130°
femoral anteversion
angle of anteversion >15°
femoral retroversion
angle of antversion <15°
fractures dislocation
- uncommon in sport
- serious road traffic accidents or falls in elderly
- often neck of femur
- pelvic rarer
- women>men
- total hip replacement, hemiarthroplasty or dynamic hip screw
muscle problems
locomotor function
* weakness eg. trendelenburg
* spasticity eg. cerebral palsy
* tightness e.g piriformis syndrome- compresses sciatic nerve
* combinations e.g pelvic crossed syndrome
septic arthiritis
definition, risk factors, symptoms
- an infection in the joint (synovial) fluid and joint tissues
- The infection usually reaches the joints through the bloodstream. In some cases, joints may become infected due to an injection, surgery, or injury.
Risk factors
- A systemic blood-borne infection
- IV drug use
- Osteoarthritis
- Past history of septic arthritis
- Rheumatoid arthritis
Other factors that may increase the risk for septic arthritis include:
* Alcoholism
* Diabetes
* HIV
* Lung or liver disorders
* Old age
* Suppressed immune system
Symptoms
* Fever
* Joint pain
Joint swelling
osteomyelitis
causes, pop, treatment
- Osteomyelitis is inflammation or swelling that occurs in the bone usually a result of infection
Causes
* It can result from an infection somewhere else in the body that has spread to the bone, or it can start in the bone — often as a result of an injury.
Population
* Osteomyelitis is more common in younger children (five and under) but can happen at any age.
* Boys are usually more affected than girls.
Treatment
* Antibiotics are often prescribed to treat osteomyelitis. Surgery may also be recommended in certain cases.
meralgia paraesthestica
symptoms, definition, population
Meralgia Paraesthestica -
- tingling, numbness, and burning pain in the outer side of the thigh. The disorder occurs when the lateral femoral cutaneous nerve is compressed or squeezed as it exits the pelvis.
- The condition results from compression (pressure on or squeezing) of your lateral femoral cutaneous nerve (LFCN). This large nerve supplies sensation to the front and side of your thigh.
Symptoms
Symptoms of meralgia paresthetica only occur on one side of your body in the front of your upper thigh. They include:
* Pain, which may extend down to the outer side of your knee.
* Burning, aching, tingling or numbness in your thigh.
* Increased pain sensitivity (for example, gently touching your thigh may cause pain).
* Worse pain after walking or standing for long periods.
Meralgia paresthetica doesn’t directly cause issues with your muscles or movement.
Population
* injury or surgery in your hip area.
* Medical conditions like obesity, pregnancy and diabetes.
* Wearing clothing that’s too tight or belts around your waist.
* A tumor near your LFCN.
trochanteric bursitis
- pain and inflammation of tissues that are situated around the outer part of the hip or upper thigh.
- The greater trochanter is a large, bony point that you can feel on the outside of the upper thigh.
- It serves as a useful attachment point for muscles that help stabilise your pelvis.
- The bursa is a type of thick tissue that helps to reduce friction between the bone (greater trochanter) and the tendons (gluteal tendon).
- In some cases, irritation of these bursae tissues can lead to pain and inflammation. This is how the term “trochanteric bursitis” originated
Symptoms
- Pain that is located around the lateral of the upper thigh/hip and may radiate further down the outer thigh.
- Commonly there is tenderness over the lateral hip.
- struggle to sleep on the affected side.
- pain is worse with tasks that involve standing on one leg such as walking, running, dressing and climbing the stairs.
- The pain can be worse for the first few steps after sitting when sitting crossed legged, sitting in a low chair or lying on the non-painful side and the affected leg drops down. This is because all these positions increase the compression of the tendon and bursa
Population
- Women are more prone to GTPS because of pelvic biomechanics, different activity levels in the population and hormonal effects.
- Females have a smaller insertion of the Glute med tendon, resulting in: smaller area across which tensile load could be dissipated
- Female: male 4:1 40-60 years old.
- It can affect people who are both active and sedentary.
You are more likely to suffer from it if you already have low back pain, hip osteoarthritis or you are overweight
Illiotibial band syndrome
- Iliotibial band syndrome (ITBS) is a common knee injury that usually presents with pain and/or tenderness on palpation of the lateral aspect of the knee, superior to the joint line and inferior to the lateral femoral epicondyle.
- The iliotibial tract is a thick band of fascia that runs on the lateral side of the thigh from the iliac crest and inserts at the knee. It is composed of dense fibrous connective tissue that appears from the m. tensor fasciae latae and m. gluteus maximus. It descends along the lateral aspect of the thigh, between the layers of the superficial fascia, and inserts onto the lateral tibial plateau at Gerdy’s tubercle
- non-traumatic overuse injury
- often concomitant with underlying weakness of hip abductor muscles
- this condition is likely to be caused by compression of the innervated local adipose tissue
- ‘impingement zone’ occurring at, or slightly below, 30° of knee flexion during foot strike and the early stance phase of running. During this impingement period in the running cycle, eccentric contraction of the tensor fascia latae muscle and of the gluteus maximus causes the leg to decelerate, generating tension (compression) in the iliotibial band.
Symptoms
- sharp pain on the outer aspect of the knee, particularly when the heel strikes the floor, that can radiate into the outer thigh or calf
- worse when running or coming down stairs
- audible snapping sensation the knee bends due to the band flicks over the bony tubercle.
- There may also be some swelling on the outer side of the knee.
Population
- Runners
sports involving repeated knee flexion and extension, such as cyclists and runners
Avascular necrosis
- a painful bone condition that gets worse over time and can affect your mobility. It occurs when something cuts off blood flow to one of your bones.
- when something blocks the flow of blood to your bone tissue
- Without blood flow, your skeletal system can’t make new bone tissue fast enough. The dying bone begins to crumble and eventually collapses.
Aetiology
- Traumatic avascular necrosis: This can happen after you break a bone or dislocate a joint.
- Nontraumatic avascular necrosis: This happens if you have an illness or medical condition that keeps blood from flowing to your bone tissue. Nontraumatic avascular necrosis often affects the same bones on both sides of the body. For example, if you have avascular necrosis in your right shoulder, you’re likely to have it in your left shoulder.
- interruption of blood supply to the bone. Femoral head ischaemia causes bone marrow and osteocytic death, leading to collapse of the necrotic segment of the head of femur.
Stages
1. Initial/necrosis:blood supply gets disrupted, and necrosis begins
2. Fragmentation: the body resorbs the necrotic bone and replaces it with woven bone that is weak and vulnerable to breaking and collapse
3. Reossification: stronger bone develops
4. Healed/Remodeling: bone regrowth is complete, and final shape present (depending on damage may be normal or abnormal)
Symptoms
- Minimal early joint pain
- Increased joint pain as bone and joint begin to collapse
- Limited range of motion due to pain
- Pain in the groin
- Painful rom especially in internal rotation
Risk factors
- Genetic predilection
- Corticosteroid intake
- Alcohol
- Smoking
- Chronic diseases- sickle cell disease, human immunodeficiency, autoimmune disorders
Diagnosis
- Radiographs in mid/late disease
Mri in early
labral tear
Pathology (structures involved)
* crescent-shaped cartilage structure lines the rim of the acetabulum, which is located in the pelvic bone.
* labrum runs along the rim of the socket to provide a suction seal and stability to the hip joint, absorbing shock and distributing pressure during hip motion.
Aetiology (mechanism, causes)
* Repetitive motions- wear & tear
* Traumatic injury especially in athletes performing repeated hip flexion
* Hip impingements/dysplasia
* Osteoarthritis
Clinical signs (special tests)
* Deep groin or buttocks pain, clicking when hip Is in motion, pain when rotating hip
* Hip stiffness limited rom
* Pain especially as you walk, run and sometimes at night
* FABER test
Epidemiology (population group/sport it is common in)
* Sports with a lot of rotating and twisting on leg
* Golfers rotating on hip when swinging
* Ice Hockey goal keepers
* Ballet dancers
Inguinal lymphadenopathy
Inguinal lymphadenopathy
* Lymph nodes are small, rounded structures (glands) that are part of your immune system.
* Swollen lymph nodes
Causes
- Fungal infection
- Jock itch
- STI’s
- Skin infections
- Automimmune disorders
○ Amyloidosis
○ Arthiritis
○ Lupus
- Inflamation
○ Lyphedema
- Cancer
Medications
Inguinal hernia
Inguinal hernia
- occurs above the inguinal ligament and through the inguinal canal. They are a subset of abdominal wall hernias.
Classification: broadly divided into two types:
1. Direct hernia: occurs when a portion of the intestine protrudes directly outward through a weak point in the abdominal wall eg may be caused by a deficiency in the number of transversus abdominus aponeurotic fibers.
2. Indirect hernia: occurs when a portion of the intestine pushes downward through the deep inguinal ring into the inguinal canal where the testes descend into the scrotum before birth (males) or to the labia (females)
Symptoms
* Intermittent or persistent bulge in the groin
* Pain or discomfort in the groin, especially when lifting, coughing, or bending
* Weakness or pressure in the groin
* Men can experience pain and swelling in the scrotum
* Inguinal hernias tend to be more noticeable following a heavy meal or after standing for a prolonged period of time.
* The pain associated with an inguinal hernia is usually sharp and localized.
femoral artery aneurysm
Femoral artery aneurysm
- A femoral artery aneurysm is a part of an artery in your thigh that stretches out or bulges to about twice its normal size. When this happens, all the layers of your artery wall stretch out too much. This weakens the artery wall, making it likely to tear. If it tears, you can lose a lot of blood from this major artery.
Types
- Type I femoral aneurysm: Your aneurysm stops before the part of your common femoral artery that splits or branches off into two smaller arteries (profunda and superficial femoral).
- Type II femoral aneurysm: Your aneurysm includes the branching point and your profunda artery.
- Type III femoral aneurysm: Your aneurysm involves only the superficial femoral artery (one of the branches of the common femoral artery).
- Type IV femoral aneurysm: Your aneurysm includes only the deep or profunda femoral artery.
Causes
- Atherosclerosis
- High bp
- Trauma
- Diseases affecting connective tissue health - Ehlers Danlos syndrome, marfan syndrome, adventitial cystic disease
Population
- Older than 70
- High blood pressure
- High cholestrol
- Connective tissue damage
- Atherosclerosis
Symptoms
- A lump in your groin that may be pulsating.
- Swelling in your lower leg.
- Pressure or pain in your groin or leg.
- Blood clots.
- Rupture of the aneurysm (not common).
- However, up to 40% of people with a femoral aneurysm don’t have any symptoms.
Lypoma
Lypoma
- soft, fatty lumps that grow under your skin. They’re harmless and do not usually need any treatment, but it’s important to get any lumps checked by a GP.
* feel soft and squishy
* can be anything from the size of a pea to a few centimetres across
* may move slightly under your skin if you press them
* are not usually painful
* grow slowly
* can appear anywhere on your body
Sebaceous cytsts
Sebaceous cytsts
* Sebaceous cysts are typically harmless, slow-growing bumps under the skin. They often appear on the scalp, face, ears, trunk, back, or groin area. They are sometimes called epidermal inclusion cysts. But it’s more accurate to call them sebaceous cysts.
Causes
* A ruptured follicle linked to acne
* A sebaceous duct that doesn’t grow correctly
* Injury to the area
Sometimes they happen for no clear reason. The cysts usually contain keratin, lipid, and other skin particles.
Cysts can remain stable or they may steadily grow. Sometimes they will become inflamed or suddenly break open (rupture). This poses a risk for infection.
