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MSK > Hip > Flashcards

Hip Flashcards

1
Q

What is femoroacetabular impingement syndrome (FAI)?

A

Altered morphology of femoral neck or acetabulum, causing pain during movement

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2
Q

What are the three hip movements most commonly affected in FAI

A

FADIR
- Flexion
- Adduction
- Internal rotation

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3
Q

Compare CAM type and Pincer type impingement in FAI

A

CAM - femoral neck deformity, usually young, athletics males
Pincer - acetabular deformity, usually females

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4
Q

What condition is commonly related to a CAM type FAI?

A

Previous SUFE

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5
Q

What are the effects of FAI

A
  • Damage to labrum & cartilage
  • Increased risk OA in future
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6
Q

FAI clinical presentation

A
  • Activity related pain in the groin
  • Difficulty sitting
  • C sign positive
  • FADIR provocation test positive
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7
Q

FAI Investigations

A
  • XRay or CT
  • MRI to visualise damage to labrum & cartilage
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8
Q

FAI management

A
  • Asymptomatic ⇒ Observation
  • CAM type? ⇒ Surgical removal +/- labral tear debridement
  • Pincer type? ⇒ Osteotomy +/- labral tear debridement
  • Secondary OA ⇒ Arthroplasty
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9
Q

AVN hip Risk factors/ Aetiology

A
  • Alcohol, steroids
  • Haematological disease, hyper-coagulable states
  • Trauma, decompression disease

OR Idiopathic

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10
Q

AVN can be caused by trauma & injury of femoral head blood supply. Which artery supplies the femoral head?

A

Medial femoral circumflex

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11
Q

AVN hip Clinical presentation

A
  • Insidious onset of groin pain
  • Pain exacerbated by stairs or impact
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12
Q

Describe the examination findings of an individual with AVN of the hip

A

Examination usually normal (unless advanced to collapse/ OA)

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13
Q

AVN hip Investigations

A

MRI - Most sensitive & specific, will show changes in any stage of disease

X-ray - Often normal in early disease

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14
Q

Describe the X-ray findings of AVN hip in lateral stage disease (where visible on XRay)

A
  • Patchy slecorsis of femoral head weight bearing area
  • Lytic zone underneath
  • ‘hanging rope sign’
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15
Q

In what two hip conditions will an X-ray show a ‘hanging rope sign’

A
  • AVN of hip
  • Perthes disease
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16
Q

What distinguishes reversible to irreversible AVN

A
  • Reversible - articular surface not collapsed
  • Irreversible - articular surface has collapsed
17
Q

Reversible AVN hip management options

A
  • Bisphosphonates (non-surgical)
  • Core decompression +/- bone graft (most common surgical)
  • OR curettage and bone grafting
  • OR vascularised fibular bone graft
18
Q

Irreversible AVN hip management options

A
  • Total hip replacement (most common surgical)
  • OR (if <15% femoral head damaged) rotational osteotomy
19
Q

Idiopathic transient osteonecrosis of the hip (ITOH) pathophysiology

A
  • Local hyperaemia & impaired venous return
  • bone marrow oedema & increased intramedullary pressure
  • osteonecrosis & temporary bone loss
  • progressive groin pain & difficulty weight bearing
20
Q

Who are the two groups of people more commonly affected by ITOH?

A
  • Middle aged men
  • Pregnant women, third trimester
21
Q

ITOH clinical presentation

A
  • Progressive groin pain (over several weeks)
  • difficulty weight bearing & walking
22
Q

ITOH investigations (first line & gold standard)

A

First line
- Bloods - Raised inflammatory markers
- X-ray - osteopenia, thin cortices, preserved joint space

Gold standard
- MRI

Other
- Bone scan

23
Q

ITOH XRay findings

A
  • Osteopenia of femoral head & neck
  • Thinning of cortices
  • preserved joint space
24
Q

ITOH management

A
  • Self limiting, resolved over 6-9 months
  • Analgesia & e.g. crutches (prevent stress fractures)
25
Q

AVN of hip vs ITOH

A

Similarities
- progressive groin pain
- osteonecrosis

AVN
- much more common
- usually bilateral
- normal X-ray or hanging rope sign
- surgical repair

ITOH
- rare
- usually unilateral
- difficulty weight bearing
- osteopenia, thin cortices
- self limiting

26
Q

Trochanteric bursitis aetiology

A

Repetitive trauma caused by iliotibial band tracking over trochnateric bursa

27
Q

Trochanteric bursitis risk factors

A
  • female
  • young runners
  • older patients
28
Q

Trochanteric bursitis clinical presentation

A

Pain on lateral hip
Pain on palpation of greater trochanter & lying on side
Pain on weight bearing, walking, stairs, single leg standing
Pain on passive adduction & active abduction (PAD & AB’s)

29
Q

Trochanteric bursitis investigations

A
  • Clinical diagnosis
30
Q

Trochanteric bursitis management

A

Analgesia, physio, steroids
No surgery!!

31
Q

Trochanteric bursitis falls under the umbrella term of ‘Greater trochanteric pain syndrome’/‘Gluteal cuff syndrome’. Name another condition that falls under this umbrella.

A

Gluteal tendinopathy (mainly gluteal medius muscle)

MSK (20 decks)

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