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MSK2 > Hip > Flashcards

Hip Flashcards

1
Q

Prevalence in osteoporosis vs osteopenia

A

both W>M over 50. Especially osteoporosis

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2
Q

Osteoporosis recommendations

A

-Screening for rfs >50
-BMD testing for females >65, males >70 (younger post-menopausal women w/ 1 major or 2 minor rfs)

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3
Q

Hip fx stats, progs

A

-Mostly sustained by people >65
-Survivors have shortened life expectancy
+ prog: sx in 48hrs
- prog: males, >86, >2 comorbs, anemia, mini mental test <6/10

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4
Q

Femur fx prognosis and categories

A

Prog: displaced vs non, comminution, vascular integrity, reduction, fixation.
-high risk thrombosis/embolism
-intertrochanteric: between trochanters
-subtrochanteric: below trochanters
monitor for AVN and non-union
compression fx more stable than tension fx

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5
Q

Hx with hip fx

A

-older adult
-trauma vs spont.

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6
Q

sxs hip fx

where pain is

A

severe groin and anterior thigh pain (more likely than lateral pain)

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7
Q

Hip fx examination

A

-shortening of LE
-limited/painful squat
-painful/limited AROM/PROM all directions
-pain/weakness with strength testing
+fulcrum and PPT

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8
Q

Hip fx surgical procedures

A

arthroplasty
external fixation (rare, temp.)
ORIF- full WB 8-12 wks postop
intramedullary fixation

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9
Q

AVN of the femoral head

basically what it is

A

-Progressive ischemia w/ secondary bone cell death
-Collapsing of bone, leads to degenerative arthropathy
-managed surgically

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10
Q

Hx AVN

A

30-50s
Rfs: trauma, corticosteroid use, alcys, coagulation disorders, HLD, smoking, autoimmune disease, etc

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11
Q

AVN pain location

A

deep groin, buttock, and knee pain

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12
Q

AVN examination

A

-Limited squat
-limited/painful AROM and PROM (IR especially)
-pain/weakness w/ resistive testing

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13
Q

AVN prognostic indicators

A

Extent of lesion
Location
Bone marrow edema presence

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14
Q

Osteoarthopathy stats

A

> 65 w/ hip or knee OA
radiography: joint space loss, osteophytes, sclerosis
-symp. vs asymp.

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15
Q

Osteoarthropathy hx

A

-insidious
-hx of trauma
-family hx
-obesity
-hypermobility
-joint shape abnormality
-physical activity levels
->50yo

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16
Q

Osteoarthropathy sxs

A

-dull and achy most, but sharp buttock, groin, thigh, and knee pain when aggravated
-C-sign
-hip stiffness (sitting/inactivity)
-difficulty donning pants, socks, shoes
-Stair ambulation issues

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17
Q

Osteoarthropathy examination

A

-limited hip AROM/PROM, painful at end range (especially IR, flexion, ABD)
-+Scower
+/- weakness/pain w/ resistive testing (bc we avoid end range with MMT)
joint hypomobility

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18
Q

CPR for hip OA

A
  1. report squatting as an aggravating activity
  2. lateral pain w/ active hip flexion
  3. passive hip IR <=25
  4. pain with active hip ext
  5. +scower w/ ADD
    (having >=4 is best predictor)
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19
Q

Labral tear correlated with

A

degenerative oa
developmental hip dysplasia
aspherical femoral head
slipped capital epiphysis
legg-calve-perthes disease
hip trauma
athletics with repetitive pivoting/flexion
FAI

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20
Q

Most common sxs of labral tear

A

-insidious onset
-groin pain mostly
-activity related pain
-night pain
-locking, pain in walking and pivoting
-limping slight
-requires banister with stairs

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21
Q

FAI 2 types

A

Cam: increased size of femoral head, irregular junction with neck
-leads to anteriosuperior labral and cartilage damage
Pincer: increased protrusion of acetabular rim

most common is a mixture

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22
Q

FAI hx

A

hockey players, golfers, dancers, football and soccer players

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23
Q

FAI sxs

A

sharp, deep anterior pain
pain/limit with deep squat (deep flexion motions)
cutting, lateral movements
hip IR/ ABD motions
-may have painful ER motions with extensive lesions

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24
Q

FAI examination

Cam especially

A

Cam: hip flex/ABD/IR ROM painful/limited (may have bony end feel)
+ FABER and FADDIR
MRA/MRI to measure angle and identify lesions

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25
Q

Loose bodies - what is it? Characteristics?

A

-free floating body (cartilage/bone) within joint

-vary in size
-secondary to degen. changes in hip
- may cause muscle inhibition (weak, discoordination)

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26
Q

Hx loose bodies

A

-chronic hip pain
-advances OA
-prior traumatic hip dislocation
-Prior AVN

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27
Q

Loose bodies sxs

A

-anterior hip/groin pain
-catching, locking, clicking, giving way LE (mechanical issue)
-sudden pain w/ WB activities

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28
Q

Loose bodies examination

A

limited AROM/PROM with catching/grinding
springey end-feel w/PROM

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29
Q

Loose Bodies implications

A

identify, refer, managed with arthroscopy

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30
Q

Snapping hip 3 categories

A

Intra-articular
Internal
External

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31
Q

Intra-articular SHS

A

synovial chondramatosis (tumor)
loose bodies
labral tears
long head biceps over ischium and iliofemoral lig over femoral head

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32
Q

Internal SHS

A

iliopsoas over femoral head, lesser trochanter, pectineus, iliopectineal eminence
fibrosis/tenosynovitis of iliopsoas tendon
snapping/ painful anterior hip (especially extending from flexed position)
pain/snap with movement from FABER position to ext, ADD, IR

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33
Q

External SHS

A

ITB/glut max over GT
lateral hip pain/snapping
aggravated by running on slanting surfaces, directional change on planted LE
-observed at:
hip: increased compression on soft tissue structures btw GT and ITB
knee: btw lateral femoral condyle and ITB

ITB contracture vs weak glut med and hip ERs
Painful Ober test
lead to GT bursitis

34
Q

Tendon acute injury Phase 1

A

inflammatory
first 3 days

35
Q

tendon healing phase 2

A

reparative/collagen
within first week
increased fibroblasts through week 4
collagen fibers initially disorganized and random
they become more aligned and perpendicular to long axis over time

36
Q

tendon healing P3

A

remodeling
collagen/cell re-alignment typically complete by ~2 months

37
Q

Why do we want controlled tensile loading for healing?

A

parallel organization associated w/ improved tissue strength
motion can aid in preventing cross-linkage between tendon tissue and sheath tissue

37
Q

tendinopathy- involved structures

A

rectus femoris
iliopsoas
gluts

38
Q

tendinopathy hx

A

internal SHS

39
Q

Tendinopathy sxs

A

anterior thigh/groin pain

40
Q

Tendinopathy examination

A

painful/weak resisted hip flex
painful/limited hip ext and IR ROM (guarded/empty end feel)

41
Q

Muscle tissue injury- strain degrees

A

-DOMS possibly
-Contusion (bruise)
-Strain:
1st: min. structural damage
2nd: partial tear
3rd: rupture

42
Q

Muscle strain healing

A

excellent regenerative capacity
outcome and time affected by type, severity, extent

43
Q

Muscle strain phases

A

Destruction: gap forms with disrupted fibers
-tissue necrosis and development of local hematoma /edema
Repair: hematoma forms, primary matrix forms/ fibroblasts synth. proteins, collagens produced
Remodeling: tissue matures and contracts

44
Q

Muscle strain examination

A

tender to palp. muscle bellies with palpable defect
antalgic gait
ecchymosis/edema several days
pain/weak RT, limited/pain AROM w/ concentric contraction
pain/limited A/PROM placing stretch on musculotendinous unit (90-90, SLR test)

45
Q

Strain: Hamstrings

what muscle is difficult
rfs
RTS criteria

A

Biceps femoris: greater recovery time and risk for recurrence
Rfs: prior hx, hammy weakness, older athletes
RTS criteria: jogging 70% baseline, RTS at 90-95% baseline

46
Q

Hamstring strain hx

A

distinct injury/audible pop
MOI: sprint w/ trunk flex and fast running

47
Q

Strain: ADDS

rfs, MOI, sx

A

rfs: prior hx, decreased ROM hip ABD
soccer,hockey
MOI: directional change when running
sx: groin pain (worse quick stops/starts)

48
Q

Strain: Iliopsoas

MOI
sxs

A

MOI: forced hip ext during active hip flex
sx: anterior hip/groin pain, painful high stepping

49
Q

Strain: Quads

most difficult muscle
rfs
MOI

A

Rectus femoris worse prognosis- longer recovery
rfs: older athletes, dry playing field, shorter, dom. LE strength/flex
MOI: kicking while running, sprinting (accel/decel)

50
Q

Strain: glut med/min hx

A

fall, increased duration/frequency of loading, sport-related injury
middle-aged women

51
Q

Strain: glut med/min sxs

A

buttock/lateral hip/ groin pain

51
Q

Bursitis- Trochanteric

A

greater risk: 40-60y/o
W>M
lateral hip pain, tender GT,
+FABER, pain rotation, ABD/ADD, radiating pain down lateral thigh
pain hip ABD against resistance

52
Q

Bursitis- Iliopasos/Iliopectineal

A

frequently un-recognized
anterior hip pain
pain/limited hip flex ROM
pain/limited hip ext and ER
tender to palp/ between anterior joint and iliopsoas

53
Q

GTPS

where tender
may involve what
correlations

A

TTP GT with pt side-lying
may involve glut max/med/min bursae, muscle attachments, other soft tissues
correlations: hip/lumbar/knee OA, tendinopathy, ER strain
prevalence with mechanical LBP, and knee OA

54
Q

GTPS hx

A

females
obesity
LBP/ chronic arthropathy of hip/knee
middle age/older

55
Q

GTPS sxs

A

pain greater at night
aggravated w/ standing >15min
radiating sxs (paresthesia/pain)
limits/pain w/ donning and doffing socks/shoes
sxs radiate to knee or below knee

56
Q

GTPS examination

A

excess ABD vs ADD during gait
TTP lateral hip
ITB tight
+FABER, resisted external derotation
pain/limit hip ADD ROM (possibly IR too)
Pain/weak hip ABD and ER RT and AROM

57
Q

Nerve entrapments -how to find

A

-remember pathways
-start prox, work dist
-is structure sensory, motor or both
-potential mechanisms for compression

58
Q

3 categories PN injuries

A

-compression (low and high pressure)
-interruption of axonal continuity
-stretching (tensile)

59
Q

Low pressure compression injury

A

-impaired circulation in epineural for prolonged time
-depletion of O2 in endothelial cells of capillaries-increased vascular permeability
-leaking of fluids/protein into endoneural space (edema)
-Increased EFP -occludes vessels that penetrate perineurium
-endoneural edema and O2 depletion

60
Q

Sciatic N vs Obtuator N- potential areas of compression

A

S: piriformis, ischial tuberosity/GT, long head BF
O: overlying fascia

61
Q

S vs O -motor distribution

A

S: hammys, fibular and tibial distributions
O: ADDs/IR

62
Q

S vs O -sensory distribution

A

S: lower leg tibial and fibular dist.
O: medial thigh and knee joint

63
Q

S vs O -clinical indicators

A

S: Achilles and hamstring DTRs diminished
O: hx pelvis fx, THA, pelvic sx, prolonged labor

64
Q

Femoral N vs Lateral femoral Cutaneous N. -areas of compression

A

F: inguinal canal
LFC: inguinal canal

65
Q

F vs LFC -motor dist.

A

F: knee extensors
LFC: N/A

66
Q

F vs LFC -sensory dist.

A

F: anterior thigh/lower leg
LFC: anterio-lateral thigh

67
Q

F vs LFC -clinical implications

A

F: diminished patellar reflex, aggravated hip ext, EMG good prog for recovery in year
LFC: latrogenic, compression from belts, obesity, pregnancy, improves with hip flex/sitting, worsens standing/walking

68
Q

Avulsion fxs characteristics

who gets them
involving?

A

M>W
2nd decade (young athletes, growth plates)
mimics apophysitis
involving: ischial tub., AIIS, ASIS, pubic symphysis, iliac crest, LT/GT

69
Q

Avulsion fxs hx

A

vigorous activities

70
Q

Avulsion fxs sxs

A

known trauma
local pain (worse w/ activity, better w. rest)

71
Q

Avulsion fxs examination

A

TTP
antalgic gait/limp
hematoma
crepitus
muscle guarding
limit/pain hip ROM (stretching contractile unit)
pain/weak RT (of action unit does)

72
Q

Stress fx pathophys

A

repetitive microtrauma
osteoblastic activity lags compares to osteoclastic activity
may progress to cortical disruption (clear fx line) then complete fx

73
Q

Fatigue fx vs insufficiency fx

A

F: normal bone, abnormal stress
I: abnormal bone, normal stress

74
Q

Low risk stress fxs

A

compressive
managed w/ activity
-pain free activity 4-8wks
location: femoral shaft, medial tibia, ribs, ulna shaft, mets 1-4

75
Q

High risk stress fxs

A

prog worsens with time required for dx
prolonged NWB
locations: femoral neck, patella, anterior tibial diaphysis, medial malleolus, talus, navicular, prox 5th met, 1st MTP seasmoids

76
Q

Stress fx hx

why it happens
what’s affected
rfs

A

insidious, progressive
ADLs affected with progression
continual pain w/ pathologic progression
increased training intensity
rfs: females, amenorrhea, smoking, steroid use

77
Q

Stress fx sxs

A

focal pain
exercise-induced pain
night pain

78
Q

stress fx examination

what pt will present like

A

local tenderness
limited ROM at joint area (guarded or painful end feel)
palpable guarding
possible local swelling
MRI, bone scan

79
Q

Stress fx HIP sxs

A

5% of all stress fxs (that’s high)
exercise-induced pain
hip,groin, thigh, or referred to knee pain
night pain
WB activity aggravates

80
Q

Stress fx hip examination

specifically pain and dx

A

diffuse groin/hip pain
+PPPT, fulcrum
MRI, bone scan findings

MSK2 (7 decks)

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