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Musculoskeletal 2 > Hip > Flashcards

Hip Flashcards

1
Q

primary osteoarthritis

A
  • increasing age
  • obesity
  • “wear and tear”
  • fam hx of OA
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2
Q

secondary OA

A
  • AVN
  • infection
  • trauma
  • pediatric hip dz (congenital dysplasia, SCFE, Legg-Calve Perthes)
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3
Q

sx of a OA

A
  • groin pain or anterior thigh pain
  • stiffness in hip joint
  • decreasing ROM
  • locking or grinding (crepitus) w/ movement
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4
Q

PE of hip w/ OA

A
  • leg length discrepancy (LLD)
  • gait: antalgic, trendelenburg, toe-in, toe out
  • progression of dz leads to decreased flexion, extension, abduction
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5
Q

what is the first motion to lose in hip OA?

A

internal rotation

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6
Q

XR for OA

A
  • AP and lateral views
  • joint space narrowing
  • osteophytes
  • cyst formation
  • sclerosis
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7
Q

conservative tx for OA

A
  • activity modification (weight loss/low impact exercise)
  • correct LLD w/ shoe lift
  • NSAIDs
  • corticosteroid injection
  • assistive devices like can (opposite hand)
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8
Q

surgery for OA

A
  • total hip arthroplasty

- hip resurfacing (not really done any more)

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9
Q

osteonecrosis aka AVN

A
  • hip is MC site of AVN
  • b/l in 50%
  • occurs when blood supply to femoral head is disrupted and the bone in head of femur dies and gradually collapses
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10
Q

possible causes of AVN

A
  • trauma/injury
  • long term steroid use
  • alcoholism
  • sickle cell
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11
Q

common population of AVN

A
  • M>F

- MC b/w ages of 40-65

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12
Q

legg-calve-perthes

A
  • AVN in pediatric hip

- congenital

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13
Q

sx of AVN

A
  • groin pain and/or buttock pain
  • decrease in ROM losing IR and abd first
  • pain is usually gradulat but can be acute onset if collapse occurs
  • develops in stage and progression can be from several months to over a year
  • stages I-IV
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14
Q

PE for AVN

A
  • LLD
  • loss of motion in all directions
  • antalgic gait
  • pain localized to groin w/ ROM testing
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15
Q

imaging for AVN

A

-XR:
-opacity in femoral head
-collapse of femoral head
MRI: used for staging AVN

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16
Q

conservative tx of AVN

A
  • meds to relieve pain but most successful tx are surgical

- if diagnosed in the early stage then these pts are good candidates for hip preserving procedures

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17
Q

surgery for AVN

A
  • core decompression
  • drill holes into femoral head to relieve pressure in the bone and create channels for new blood vessels
  • for early stages to prevent collapse of femoral head
  • often combine w/ bone grafting to regenerate healthy bone
  • usually NWB for 3 mos
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18
Q

trochanteric bursitis

A
  • inflammation of greater trochanteric bursa
  • F>M
  • can be hard to distinguish from tendinosis of gluteus medius and minimus
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19
Q

causes of trochanteric bursitis

A
  • repetitive stress (overuse)
  • previous surgery (THA)
  • injury/falling on hip
  • LLD
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20
Q

sx of trochanteric bursitis

A
  • pain localized to the greater trochanter that can radiate to lateral thigh
  • pain w/ increased activity
  • pain at night w/ sleeping on affected side
  • pain after prolonged sitting and then standing
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21
Q

PE of trochanteric bursitis

A
  • point TTP over greater trochanter
  • pain w/ adduction and IR localized to greater trochanter
  • XR nl
  • pain exacerbated w/ active hip abduction
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22
Q

tx of trochanteric bursitis

A
  • activity modications
  • NSAIDS (oral and topical)
  • steroid injection: 2cc celestone/3cc 1% lidocaine using spinal needle (1 per mo. x 3 mos)
  • PT
  • surg. is rare
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23
Q

iliopsoas bursitis

A
  • located on inside (groin side) of hip
  • pain localized to groin
  • not as common as trochanteric bursitis but tx is similar
  • <30 yo
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24
Q

causes of iliopsoas bursitis

A
  • repetitive stress
  • leg length discrepancy
  • RA
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25
Q

PE of iliopsoas bursitis

A
  • present in hip flexion
  • pain w/: passive hip extension, resisted hip flexion
  • bursa TTP
  • psoas sign
  • obturator sign
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26
Q

psoas sign

A

Place patient in L lateral

decubitus and extend R leg at the hip. If there is pain with this movement, then the sign is positive

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27
Q

obturator sign

A

Passively flex the R hip and knee and internally rotate the hip. If there is
increased pain then the sign is positive

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28
Q

tx of iliopsoas bursitis

A
  • activity modification
  • NSAIDs
  • PT: massage, ice, heat, US
  • steroid injection vs oral steroid
  • surgery is rare
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29
Q

snapping hip

A
  • snapping or popping sensation of the hip usually caused by tendons sliding over bony prominences
  • can lead to trochanteric bursitis
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30
Q

MC site of snapping is where?

A

IT band moving over the greater trochanter

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31
Q

sx of snapping hip

A
  • pt will describe it as hip is dislocating
  • common when climbing stairs or rising from seated position
  • if mild usually resolves w/ time
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32
Q

MC to see snapping hip in . . .

A
  • adolescents
  • dancers
  • gymnasts
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33
Q

PE snapping hip

A
  • normal ROM and gain
  • some pts can reproduce the snapping while standing w/ leg adducted and rotating the hip
  • can sometimes visualize the IT band subluxing over the greater trochanter
  • nl XR
  • positive ober test
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34
Q

tx of snapping hip

A
  • pt education and observation
  • NSAIDs
  • stretching exercises of IT band
  • activity modification
  • surgery is rare
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35
Q

lateral femoral cutaneous nerve impingement aka meralgia paresthetica

A

pain and/or tingling and numbness radiating to the lateral part of thigh

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36
Q

causes of meralgia paresthetica

A
  • obesity
  • direct compression from tight clothing or straps around waist
  • scar tissue from previous surg
  • injury to nerve from anterior approach THA
  • pregnancy
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37
Q

PS of meralgia paresthetica

A
  • decreased sensation along distribuation of the nerve
  • positive tinel sign medial to ASIS
  • normal ROM and gail
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38
Q

diagnostic studies for meralgia paresthetica

A
  • XRs are nl

- EMG or NCS to help diagnose nerve damage

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39
Q

tx of meralgia paresthetica

A
  • avoidance of clothes or activity that compresses the n.
  • weight loss for obese pts
  • local anesthetic injection or nerve block which can also confirm diagnosis
  • oral steroids
  • neurontin or lyrica sometimes
  • surgical decompression only indicated for persistent or severe sx
  • NSAIDs
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40
Q

possible causes of labral tear

A
  • trauma (injury or dislocation of the hip) such as contact sports
  • structural abnormalities can accelerate wear and tear of the joint causing a labral tear
  • repetitive motions including sudden twisting or pivoting motions
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41
Q

sx of labral tear

A
  • locking, clicking, or catching in hip joint
  • groin pain or “C” sign
  • stiffness and decreased ROM secondary to pain
42
Q

PE of labral tear

A

pain or reproducible click w/ ROM most commonly when taking the hip of IR to extension

43
Q

imaging for labral tear

A
  • XRs are normal

- MR arthogram is best study to determine labral tear **have to use dye or it won’t get picked up!

44
Q

conservative tx of labral tear

A
  • NSAIDs

- injection of corticosteroid into hip joint

45
Q

surgical tx of labral tear

A
  • hip arthroscopy will determine debridement vs repair of labrum
  • repair rehab: restore ROM w/i the restrictions
46
Q

femoroacetabular impingement

A
  • condition where extra bone grows along one or both of the bones that form the hip joint - giving the bones an irregular shape
  • over time this friction can damage the joint resulting in tears of the labrum and OA
47
Q

types of FAI

A
  • pincer
  • cam
  • combined
48
Q

pincer type FAI

A

-occurs because extra bone extends out over the normal rim of the acetabulum
-The labrum can be crushed under the prominent rim of
the acetabulum
-clinically is probably more common

49
Q

cam type FAI

A

-the femoral head is not round and cannot rotate
smoothly inside the acetabulum
-A bump forms on the edge of the femoral head that grinds the cartilage inside the acetabulum
-more painful

50
Q

combine FAI

A

-both princer and cam are present

51
Q

causes of FAI

A
  • occurs b/c hip bones don’t form normally during childhood growing years
  • little that can be done to prevent it
  • some never develop sx
52
Q

what does symptomatic FAI indicate?

A

if sx present = already damage to cartilage or labrum

53
Q

sx of FAI

A
  • pain (groin)
  • stiffness
  • limping
  • worse w/ turning, twisting, and squatting and may cause sharp, stabbing pain
54
Q

PE of FAI

A
  • impingement test: bring knee towards chest and then rate it inward towards opposite shoulder (pain = positive)
  • imaging: XR, CT, MRI
55
Q

tx of FAI

A
  • activity modification
  • NSAIDs
  • PT
  • surgical: hip arthroscopy
56
Q

90% of hip dislocations are what type?

A

posterior

57
Q

associated injuries w/ hip dislocations

A

-acetabular or femoral head fractures

58
Q

causes of posterior hip dislocations

A
  • high energy impact on the knee while pt is sitting w/ hip flexed and adducted
  • ex: MVA when person is not wearing seatbelt and knees hit dashboard
59
Q

causes of anterior hip dislocation

A
  • common in sporting events

- forceful abduction and ER

60
Q

PE of posterior hip dislocation

A
  • leg presents w/ hip in flexion, adduction and IR/shortening of limb
  • knee and foot will appear rotated toward the middle of body
61
Q

PE of anterior hip dislocation

A
  • leg presents in abduction and ER
  • leg rotated out and away from body
  • check NV status
62
Q

tx of hip dislocation

A
  • prompt reduction to prevent osteonecrosis of femoral head
  • closed reduction (recommended to use sedation or general anesthesia)
  • palpable clunk
  • get post reduction XR
  • get CT to assess for associated injuries
  • protected WB and activity modification (2-3 mos)
63
Q

what is used to classify acetabular fxs?

A

Judet-Letournel Classification

-10 fx patterns based on degree of columnar damage

64
Q

PE of acetabular fxs

A
  • d/t high impact falls of MVA

- need to assess sciatic, femoral and obturator nerve function

65
Q

imaging for acetabular fxs

A
  • AP and Judet views

- CT scan

66
Q

conservative vs. surgical tx for acetabular fxs

A
  • conservative: only if < 2-5 mm of displacement in the dome and femoral head maintains position
  • surgical: displaced > 2-3 mm and can’t maintain congruent joint
67
Q

common causes of femoral head fx

A
  • secondary to MVA (MC)
  • axial load impact proximally through the femur
  • high energy trauma
  • can be associated w/ hip dislocation
68
Q

sx of femoral head fx

A

groin pain esp. w/ WB

69
Q

PE of femoral head fx

A
  • check NV status

- severe groin pain

70
Q

imaging for femoral head fx

A
  • XR: AP and Judet view

- CT to evaluate for associated acetabular fxs

71
Q

tx for femoral head fx

A
  • closed tx for stable fxs and adequate reduction

- ORIF for inadequate reduction or unstable fxs

72
Q

femoral neck fx

A
  • 50% of hip fxs are this type
  • 80% occur in women
  • average age is 77 for women and 72 for men
73
Q

causes of femoral neck fx

A
  • for older pts: fall onto greater trochanter (valgus impaction)
  • younger pts: high energy trauma
  • stress fxs seen in athletes, military recruits, ballet dancers
  • osteoporosis/osteopenia
74
Q

PE of femoral neck fx

A
  • athletes describe insidious onset of pain over 2-3 weeks localized to groin that can radiate to the knee
  • displaced fxs will be nonambulatory w/ shortening and ER of lower extremity
  • TTP to groin and pain w/ ROM
75
Q

imaging of femoral neck fx

A
  • AP and IR view on XR

- MRI to rule out suspected stress fx

76
Q

Garden Classification of femoral neck fxs

A
  • Type I: incomplete fx
  • Type II: complete fx w/ no displacement
  • Type III: complete fx w/ partial displacement
  • Type IV: complete fx w/ complete displacement
77
Q

treatment for stress fx of femoral neck

A
  • NWB on crutches until asymptomatic

- follow XRs closely since the risk for displacement is high

78
Q

tx for nondisplaced fx of femoral neck

A

-ORIF w/ 3 cancellous screws

79
Q

tx for displaced fx of femoral neck

A
  • bipolar/hemiarthroplasy reserved for need for faster full WB, poor health, pathologic fx, poor ambulatory status before surgery (NOT for young active pt)
  • THA for active young or eldery person if preexisting DJD
80
Q

intertrochanteric fx

A
  • b/w the greater and lesser trochanter of proximal femur

- MC > 60 y/o

81
Q

what attaches to the greater trochanter?

A

-gluteus medius
-gluteus minimus
(hip extensors and abductors)

82
Q

what attaches to the lesser trochanter?

A

-iliopsoas

hip flexor

83
Q

causes of intertrochanteric fx

A
  • most result from direct impact to greater trochanteric area from a simple fall
  • younger pts = high energy
84
Q

PE of intertrochanteric fx

A
  • nondisplaced: may be ambulatory w/ minimal pain
  • displaced fxs: nonambulatory w/ lower extremity shortened and ER
  • ROM is painful
85
Q

tx of intertrochanteric fx

A
  • ORIF indicated unless extreme medical risk for surgery
  • sliding hip screw vs. gamma nail
  • to THA unless hardware failure
86
Q

causes of greater trochanteric fx

A
  • rare
  • from direct blow from fall in elderly
  • may occur following THA
87
Q

PE of greater trochanteric fx

A
  • lateral hip pain

- pain w/ abduction

88
Q

imaging in greater trochanteric fx

A

-MRI recommended

b/c up to 95% may have an associated fx such as an intertrochanteric fx

89
Q

tx of greater trochanteric fx

A
  • usually nonoperative
  • partial WB until callus visible on XR (4-6 weeks)
  • gradually progress to WBAT
  • ORIF only if pt is young and active w/ widely displaced greater trochanter
90
Q

lesser trochanteric fx causes

A
  • rare as isolated fx
  • MC: adolescent males 13-17 y/o typically secondary to forceful iliopsoas contracture
  • if in elderly: should be concern for pathologic fx
91
Q

lesser trochanteric fx is usually a component of what?

A

IT fx

92
Q

PE of lesser trochanteric fx

A
  • pain in inguinal area

- pain w/ passive ROM in all directions w/ max pain in extension and relief when seated

93
Q

tx of lesser trochanteric fx

A

-nonsurgical tx w/ limb resting in flexion obtains excellent functional results

94
Q

subtrochanteric fx

A
  • b/w lesser trochanter and a point 5cm distal to the lesser trochanter
  • high rates of malunion and nonunion
  • usually associated w/ other injuries
95
Q

causes of subtrochanteric fx

A
  • elderly: low energy falls
  • young: high energy falls from height or MVA or gunshot wound
  • frequent site for pathological fx
96
Q

PE of subtrochanteric fx

A
  • unable to ambulate
  • gross deformity usually present
  • painful hip ROM and TTP and swelling of the proximal thigh
  • NV exam needed
  • susceptible to compartment syndrome d/t hemorrhage into the thigh
97
Q

tx of subtrochanteric fx

A
  • operative tx indicated
  • ORIF of femur
  • TTWB 4-8 weeks and FWB at 8-12 weeks
98
Q

Ddx of subtrochanteric fx

A
  • gilmore’s groin (sports hernia)
  • sacroilitis
  • piriformis syndrome
99
Q

how do you know on imaging that the injury to a forearm is high energy

A

there is a fx of the tibia and fibula at the same level

100
Q

two very important things to present to an orthopod when presenting a case

A
  • age of pt

- date of injury

101
Q

what type of injury should you keep in mind when a pt has pain w/ weight bearing?

A

think bone

102
Q

approximately when do you lose the ability to remodel bone?

A

age 10

Musculoskeletal 2 (14 decks)

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