Hip Flashcards
Slipped Capital Femoral Epiphysis
It involves separation of the proximal femoral epiphysis through the growth plate during the adolescent rapid growth spurt (10-15 years). The head of the femur usually displaced medially and posteriorly in relation to the femoral neck.
More common in:
Children who are above the 90th percentile for height or are obese
Males (peak age 13) than female(peak age 12)
Blacks than whites
The left hip
Bilateral in 20-30% of cases with the 2nd slip usually within a year
Etiology ( unknown but thought to be a confluence of factors)
Age related weakness, trauma, overweight, coxa vara, congenital abnormalities, an autoimmune process, inflammation and hormonal imbalance.
Legg-Calve-Perthes
This condition is a relatively common hip and / or knee pain presentation in childhood, with a reported incidence of approximately 1 in 1500, with a male to female ration of 6:1. Over half of cases are in children aged between 5 to 7 years; however it has been seen in children as young as 3 and as old as 12 years. This condition is bilateral in 20% of affected children.
Aetiology unknown, however;
Increased incidence in children who have previously suffered from transient synovitis within the last month (therefore monitor)
Some research suggests a very low birth weight and maternal smoking.
Clinical presentation;
Characteristic presentation involves a limp which may or may not be associated with pain. If painful it is usually lateral hip, anterior thigh or sometimes in the suprapatellar space
Kocher Criteria (Septic Arthritis)
Includes:
Non-weight-bearing on affect side
ESR greater than 40 mm/hr
fever
WBC count of >12,000;
When 4/4 criteria are met, 99% chance that the child has septic arthritis; when 3/4 criteria are met, a 93%, when 2/4 criteria are met, a 40% chance, when 1/4 criteria are met, there is a 3% chance of septic arthritis.
Transient synovitis
Nominated in the literature as the most common cause of limping and pain in a childhood. Common between the ages of 3 to 10 years and more common in boys
A self-limiting acute inflammatory reaction that commonly follows an upper respiratory infection. Has also been associated with history of minor trauma and overuse.
Clinical presentation;
Painful limp is the cardinal sign with referred pain into groin and thigh
Restriction in extension and internal rotation
Temperature seldom exceeds 38.3C (temps above think osteomyelitis)
-Self-limiting condition (3-6 weeks)
-protected weight bearing (possible bed rest until pain begins to resolve usually a few days
Osteoarthritis/ Degenerative Joint Disease of the Hip
Primary OA develops in previously healthy joints. Most cases develop in people over 50. By the age of 65, at
least half of people have some OA in some joint(s). It is mild in many cases, but about 1 in 10 people over 65
have a major disability due to OA of one or both hips or knees)
Secondary OA develops in joints previously abnormal for a variety of reasons. For example, congenital hip
deformities, FAI, trauma, AVN, femoral head remodelling, long leg syndrome
Obesity. Knee and hip OA are more likely to develop, or be more severe, in obese people due to increased load on the joints.
Age. OA becomes more common with increasing age
Sex. Women are more likely to develop OA than men.
Obesity. Knee and hip OA are more likely to develop, or be more severe, in obese people due to increased load on the joints
Clinical prrsentation
- Pain in the groin and or knee aggravated by weight bearing activities
- Joint stiffness worse in the morning, reduced by gentle activity
-Loss of active and passive ROM in a capsular pattern internal rotation and flexion first.
ROM
Trendelenburg`s Test
Hip Abduction Test
Step Down Test
Prone SLR
Septic Arhtritis
Developmental dysplasia of the hip (congenital dysplasia of the hip)
Malformation of the hip joint – It describes a spectrum of congenital abnormalities that can range from barely detectable deviations in the norm to an irreducible dislocation.
Abnormal findings in the neonatal period may disappear after the first few weeks of life, while other signs, which may be readily apparent when the child begins walking, may have been undetectable during infancy. In some cases it may present later in life with premature degenerative changes.
Causes
Ligamentous laxity - inherited or hormonally induced
Inherited osseous structural defect
Breech position
clinical presentation
Moderate severe cases
Non-traumatic subluxation or dislocation in infant may not be apparent until 3 months of age
Delayed walking and unilateral limping Mild cases
Premature DJD bilateral or unilateral
Physical findings
May be associated with coxa valga and anteversion
infant - Positive Barlow and Ortolani tests
Femoroacetabular Impingement
FAI is a condition in which the femoral head, acetabulum, or both are shaped somewhat abnormally. Simply, the ball and
socket do not fit perfectly, causing friction during hip movements, resulting in damage within the hip joint. The damage can occur to the articular or labral cartilage and is associated with degenerative joint disease.
Cam impingement
More common in young men, average age of 32 years
Mostly located at the antero-superior aspect of the femoral head-neck junction
Pincer impingement
More common in middle-aged women, average age of 40 years, and can occur with various disorders
- Pincer impingement is caused by an acetabular abnormality, usually anterior, resulting in overcoverage of the femoral head.
Symptoms-
People with FAI usually have pain in the groin area, although the pain sometimes may be more toward the outside of the hip. Sharp stabbing pain may occur with turning, twisting, and squatting, but sometimes, it is just a dull ache.
- FAI commonly goes unrecognized for years, since it is rarely painful in its early stages.
- Diagnosed by noting both certain limits in hip motion and related signs on x-rays and other imaging tests.
Spontaneous Osteonecrosis of the Femoral Head
Most individuals present between ages of 30 to 70 years, with a 4:1 male predominance. Bilateral but asymmetrical hip involvement may be present in up to 50% of cases.
Clinical presentation
symptoms initially may be vague and non-specific and can occur over several years
pain in buttock, groin, thigh or knee
usually there is a gradual increase in intensity of pain
with a reduction in motion (rotation and abduction)
this precipitating a limping gait and associated muscle atrophy
Pathogenesis and clinical presentation
Subchondral osteolysis > ache, stiffness and feel weak > referred pain and limping
Fragmentation > capsular dysfunctional pattern and painful limp, weakened abductors and spastic adductors
Repairing > decrease S&S and disuse atrophy
Remodeling > flattened mushroom femoral head > premature DJ
Osteomyelitis
Approximately 85% of all osteomyelitis occur in children under the age of 16 years
It results from heamatogenous spread in all but a few cases that can arise from an open wound or an adjacent infected focus.
In infants: Fever and sings of systemic toxicity are usually absent the
most common clinical signs being: irritability, poor feed, localised limb
oedema and pseudo-paralysis (muscle guarding and unwillingness to
move the affected limb)
Capsulitis of the Hip
Similar in presentation and aetiology to adhesive capsulitis of the glenohumeral joint
The condition may preferentially affect women between the ages of 35 and 50
Clinical presentation
Rapid onset of pain and stiffness
Early stage > stiffness and capsular pattern
Later stage > less pain and increased ROM
Hip Fracture
Femoral Neck Fracture
Elderly patients commonly fracture the hip in a fall, often as a result of visual impairment, Parkinson‟s disease, a previous stroke, or lower limb dysfunction.
8:1 female to male fracture ratio
intertrochanteric fractures occur more often than femoral neck fractures
Clinical presentation
Pain or tenderness over trochanteric area, groin and thigh
Unable to bear weigh
Exam findings
If displacement occurs > shortening of limb and external rotation
Tuning fork test and x-ray findings
Positive Anvil test
