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COMP ORTHO > Hip > Flashcards

Hip Flashcards

1
Q

what type of joint

A

synovial

ball and socket

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2
Q

Acetabulum faces

A

ant, inf, and lat

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3
Q

Labrum function

A

deepens the acetabulum

increases stability

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4
Q

Angle of inclination

A

through neck of femur, down shaft of femur

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5
Q

Angle of inclination - small

A

coxa vara
greater shear force on the neck of the femur
abduction ROM decreases

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6
Q

Angle of inclination - large

A

coxa valga

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7
Q

Angle of anteversion

A

HOW TO MEASURE
40 in infants
12-14 in adults

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8
Q

Angle of anteversion - small

A

Retroversion

toe out

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9
Q

Angle of anteversion - large

A

Anteversion

toe in

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10
Q

Articular capsule - strong in what way

A

dense and strong ant

thin and loose post

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11
Q

Iliofemoral ligament

A

limts add
excessive ext
ER

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12
Q

Pubofemoral

A

limits abd

ext

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13
Q

Ischiofemoral

A

limits excessive ext
IR
add

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14
Q

Transverse acetabular lig

A

inc stability in inf direction

prevents dislocation with abd

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15
Q

LIgamentum capitis

A

protects blood supply

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16
Q

Osteokinematics - open chain

A

femur on pelvis
convex on concave
OPP

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17
Q

Osteokinematics - closed chain

A

pelvis on femur
concave on convex
SAME

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18
Q

Most congruent/stable position is what

A

ext, abd, IR

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19
Q

Intracapsular pressure

A

less than atmospheric - stabilizes

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20
Q

Area with no trabeculae

A

Wards triangle

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21
Q

Joint reaction force with gait

A

high just after heel strike and during toe off

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22
Q

With knee extended, hip flexion is

A

limited by passive insufficiency of the hamstrings
active insufficiency of the rectus femoris
moment arm of gravity

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23
Q

With knee flexed, hip extension is

A

limited by active insufficiency of the hamstrings, passive insufficiency of the rectus femoris

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24
Q

Trendelenburg SIGN

A

Lean towards side of pain and instability
dec JRF
unload the painful side
Pelvis will drop to other side because of weakness

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25
Q

Flexors are innevated by

A

femoral nerve

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26
Q

Flexors

A 
psoas major
iliacus
TFL
sartorius
rectus femoris
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27
Q

Extensors are innervated by

A

sciatic nerve

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28
Q

Extensors

A 
glut max
glut med
semitendinosus
semimembranosus
biceps femoris
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29
Q

Adductors are innervated by

A

obturator nerve

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30
Q

Adductors

A 
adductor magnus
adductor longus
adductor brevis
gracilis
quadratus femoris
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31
Q

Abductors are innervated by

A

gluteal nerve

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32
Q

ER

A 
glut max
piriformis
obturator internus and externus
gemelli
quad femoris
sartorius
iliopsoas
post glut med and min
biceps femoris
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33
Q

IR

A 
ant glut med and min
TFL
adductor longus
adductor brevis
pectineus
semitendinosus 
semimembranosus
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34
Q

Hip pain can be referral from

A 
lumbar
SI 
viscera
testicle
hernia
lymphadenopathy
ovaries
pelvic inflammatory disease
prostatitis 
UTI
systemic disease
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35
Q

Common path based on age - 0 to 2

A

congenital dysplagia/dislocation

importnatn to catch early

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36
Q

Common path based on age - 2 to 5

A

transient synovitis

infections

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37
Q

Common path based on age - 5 to 10

A

legg calve perthes disease
transient synovitis
slipped femoral epiphysis

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38
Q

Common path based on age - 10 to 20

A

OA from injury
hip fracture from trauma
labral tear

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39
Q

Common path based on age - 20 to 50

A

OA from injury
hip fracture from trauma
labral tear
OP

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40
Q

Common path based on age - over 50

A

OA
hip fracture from fall
OP

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41
Q

barlow maneuver

A

listen for click while mvoing baby hp down

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42
Q

ortolani

A

listen for click rotating hip in/out

43
Q

Tx for congenital hip dislocations

A

neo - hip abd, ER, flex (pavlik)
6m - 6yrs = reduction is needed (LE immobilized)
7-10 yrs = maybe surgery depending
11+ = usually surgery

44
Q

Leg calve perthes is what

A

osteochondritis of the femoral capital epiphysis
ossification center necrosis
cause is unknown
eipphyseal plate breaks down and become necrotic

45
Q

Leg calve perthes - more common in

A

males (5x)
ages 2 to 12
caucasians

46
Q

Leg calve perthes s/s

A

pain with ambulation

gradual insidious onset of pain, aching in hip, thigh, knee and tender hip casule

47
Q

Slipped capital femoral epiphysis

A

displacement of the femoral head on the femoral neck
painless and weak
Idiopathic

48
Q

Slipped capital femoral epiphysis s/s

A

minimal vague pain
referred pain to the knee
Dec hip IR, abd, flex
antalgic gait - but not painful

49
Q

Transient synovitis

A

idiopathic, inflammation of synovial membrane
quick onset
very severe pain
immediate flare up

50
Q

Transient synovitis - who does it happen to

A

males before puberty

51
Q

Transient synovitis - presentation

A

limping, hip pain, possible low grade

52
Q

Inflammatory synovitis

A

history of RA
ankylosing spondylitis
systemic lupus erythematosus

53
Q

Avascular necrosis

A

lack of blood circulation to the head of the femur
usually is secondary to something else
asymptomatic at first and then deep throbbing pain in hip/groin/thigh
loss of ROM
mm spasm

54
Q

Septic arthritis

A

infection of the joint
acute pain
extremely painful
if not caught early can destory the joint

55
Q

Degenerative joint disease (OA)

A

groin/throchanteric pain
morning sitffness, dec ROM
mm spasm, crepitus, pain with ambulation

56
Q

OA - pos exam findings

A 
Scour
FABER
tight iliopsoas and rectus
weak hip abd 
antalgic gait
radiographs
57
Q

OA - tx - acute

A

decrease inflammation
increase ROM
unload joint (aquatic)

58
Q

OA - tx - subacute

A

inc ROM
exercise mm to slow disease process
HEP wthopen chain exercises

59
Q

OA - tx - chronic

A

close chain gentle ex

functional

60
Q

HIp arthroscopy

A

remove loose bodies and treat acetabular labral lesions

61
Q

Hip arthrodesis

A

fusion
indicated for youn (less than 30-35)
active pt with unilateral disease
gets rid of pain

62
Q

Hanging hip

A

soft tissue procedure
mm release for OA
dec pain and inc function

63
Q

Hip osteotomies

A

make larger area to absorb pressure
femoral (less than 50)
pelvic/acetabular - stringent pt population

64
Q

Hemiarthroplasty

A

take femoral head off femur,step down shaft, replace with new metal head

65
Q

Hip resurfacing

A

bone preserving alternative to THA for young pt

66
Q

Labral tears - usual MOA

A

twisting/turning

will hear a click or other noises

67
Q

Labral tears - clinical presentation

A

pain, clicking, locking, giving way

68
Q

Snapping hip syndrome

A

hear a pop every time the pt moves a certain way

can be benign

69
Q

Snapping hip syndrome - external

A

glut max tendon or ITB moving over the greater troch

70
Q

Snapping hip syndrome - internal

A

iliopsoas tendon over lesser trochanter or anterior acetabulum
Iliofemoral lig over femoral head

71
Q

Snapping hip syndrome - clinical presentation

A

dull, aching pain, associated with certain movements but no discrete area of tenderness
audible or palpable snap
normal imaging

72
Q

Greater trochanteric bursitis

A

overuse injury
forceful adduction is a contributor
quicker onset nd more difuse than tendonitis

73
Q

GT bursitis clinical presentation

A

achy diffuse tenderness at GT
pain with WB over surfaces in sidelying
pain with resisted abd, passive flex, passive add
pos obers

74
Q

Iliopsoas/iliopectineal bursitis clinical presentation

A

localized pain/snapping with resisted hip flex or passive hip ext
tough to lift leg straight up, pain in lower abdomen
pt often thinks it is a hernia

75
Q

Piriformis syndrome

A

compression of the sciatic nerve as it moves through piriformis

76
Q

Piriformis syndrome - clinical presentation

A

pain with palpation, radiates down leg
dull/achy pain in buttock and point tenderness in buttock
sitting and walking inc pain, going upstairs is painful
paresthesias and weakness

77
Q

Ischial bursitis

A

often happens in sprinters using hamstrings to push off
overuse injury
can also be from prolonged sitting

78
Q

Classification for hip mm strain/tear

A

grade I - little tissue damage, mild inflammation, pain with normal strength
grade II - dec strength, ROM, significant pain, disruption of fibers
grade III - complete rupture, loss of strength, limited pain, palpable defect

79
Q

Adductor mm strain - caused by

A

forceful stretch of mm
most commonly gracillis or adductor longus
acute proximal pain over medial thigh, might radiate into rectus abdominis

80
Q

Adductor mm strain - pain with

A

active and passive ROM, palpation

81
Q

Hamstring mm strain

A

most commonly strained mm
usually at origin
Inc risk with excessive hip flex and knee ext
eccentric force injury is common

82
Q

Quad mm strain

A

often rectus femoris

often from rapid deceleration

83
Q

Osteitis pubis

A

inflammation of pubic symphesis from repetitive stress

pain in groing, mm spasm

84
Q

Iliac crest contusion (hip pointer)

A

contusion of iliac crest, ASIS, or both
pain and tenerness
if tender at insertion - need xray to rule out avulsion

85
Q

Avulsion fractures are most common in who

A

adolescents

86
Q

Femoral neck fracture - clinical pres

A

acute onset of pain
unable to WB
shortened and ER LE

87
Q

Femoral neck fracture - classes

A 
class I - incomplete
class II - complete, non displaced
class III - complete, partial displacement
class IV - complete, total displacement
88
Q

Intertrochanteric fracture- description

A

between trochanters

89
Q

Intertrochanteric fracture - types

A

I - a line
II - displaced a little bit
III - spiral
IV - total displacement

90
Q

Subtrochanteric fracture - description

A

righ tbelow the trochanters

classified by degree of displacement and number of fragments

91
Q

Hip dislocations - anterior from what movement

A

forced into abd, ER, ext

less common

92
Q

Hip dislocation - posterior from what

A

forced into add and flex

more common

93
Q

Meralgia paresthetica

A

abnodmal distribution of lateral femoral cutaneous nerve on sensory exam
lateral tight goes numb

94
Q

Capsular pattern

A

IR then flex then abd then ext

95
Q

If strong and painless

A

normal or isolated minor pathology

96
Q

If strong and painnful

A

minor/mod pathology of mm, tendon, or burssa

97
Q

If weak and painful

A

more acute or major path of mm tendon or burs

could also be fracture

98
Q

If weak and painless

A

serious pathology
nervous system
tumor

99
Q

Trendelenberg sign

A

weakness of glut med
pt standing and asked to lift leg
(+) if ipsilateral hip drops

100
Q

90/90 hamstring test - pos if what

A

knee is unable to reach 10 degrees from neutral (lacking 10 or more of extension)

101
Q

Craigs test

A

abnormal femoral anteversion angle
pt pron with knee flexed to 90
palpate GT and slowly move hip through IR/ER
when GT feels most lateral stop and measure the angle - normal is 8-15 of IR
less than 8 = retroversion
greater than 15 = anteversion

102
Q

Resting hip position (loose packed)

A

30 flex
30 abd
Slight ER

103
Q

CLose packed hip

A

max ext, IR, and Abd

COMP ORTHO (11 decks)

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