Hip

Question 1

Picked up on newborn exam
POSITIVE ortalini and barlow
Unequal skin folds

Answer 1

Hip dysplasia

Question 2

Viral infection -> hip pain 2-10yrs

Answer 2

Transient synovitis

Question 3

Degen -> AVN fem head 
Progressive hip pain + Limp
Stiffness + RedROM
widening of the right hip joint space 
with flattening of the femoral head

Answer 3

Perthes dx

Question 4

Kid = Joint pain, swelling >3m
Knees, ankles, elbows
Limp, ANA+, Ant Uveitis

Answer 4

JIA – PauciArticular most common

Question 5

Pyrexia + acute hip pain

Answer 5

Septic arthritis

Question 6

Obese and boys
Knee/Distal thigh pain
Can’t int. rotate in flexion

Answer 6

Slipped upper femoral epiphysis

Insitu pinning

Question 7

Hx of alcohol XS, LT csted use,
Hip pain, red ROM of hip
x-ray shows a subchondral fracture, segmental flattening of the femoral head and osteopaenia.

Answer 7

Avascular necrosis

Question 8

Right hip pain.
lie prone facedown -> Extend hip joint with straight leg then bend the knee
Stretch the femoral nerve and will cause pain if it is trapped

Answer 8

Referred lumbar spine pain

Question 9

worse on the ‘outside’ of hip
Bad @ night when lies on right side.

On exam = full ROM in the hip including int. and ext. rotation.
Deep palpation of the lateral aspect of the right hip joint recreates the pain.

Due to repeated movement of the fibroelastic iliotibial band

Answer 9

Greater trochanteric pain syndrome

AKA Trochanteric bursitis.

Question 10

Sometimes @ T3 of pregnancy
Groin pain + limited ROM in the hip
NWB
ESR inc

Answer 10

Transient idiopathic osteoporosis

Question 11

Common in pregnancy
Ligament laxity increases in response to hormonal changes of pregnancy

Pain @ pubic symphysis + radiation to the groin and medial thighs.
A waddling gait may be seen

Answer 11

Pubic symphysis dysfunction

Question 12

Shortened, Int. rotated, Flexed, Adducted

Sciatic nerve injury

Answer 12

Posterior hip dislocation

Question 13

Shortened, Ext. rotated,
AVN risk (fem circumflex + lig teres artery)
Low-energy impacts in elderly patients

Answer 13

NOF #

Question 14

Abducted, Ext. rotated, palpable bulge of the femoral head

Answer 14

Anterior hip dislocation

Question 15

Shortened
Swelling, Deformity
Soft tissue injury and bleeding = Given the force of impact required to fracture a femur

Answer 15

Femoral shaft frac

Question 16

Pain @ walking or palpation,
Instability,
Neurovascular deficits
Signs of damage to pelvic organs e.g. haematuria or PR bleeding.

Answer 16

Pelvic fractures

Question 17

Knee EXT weak
Patellar reflex loss
Thigh numb

Answer 17

Femoral nerve

Question 18

Ankle DORSIflex

Calf and foot numb

Answer 18

Lumbosacral trunk

Question 19

Knee FLEXION weak
Foot movements weak

Gluteal -> ankle = pain and numbness

Answer 19

Sciatic nerve

Question 20

Weak hip ABduction

Medial thigh NUMB

Answer 20

Obturator

Question 21

small segments of articular cartilage and bone come loose into the joint due to reduced blood supply. It tends to present in OLDER children with a more insidious onset.

Answer 21

Osteochondritis dissecans occurs when small segments of articular cartilage and bone come loose into the joint due to reduced blood supply. It tends to present in older children with a more insidious onset.

Question 22

Chronic pain + tingling of BUM
-worsened by sitting on toilet/chair for aaaages

O/E: elicit pain @INT rotation

Answer 22

Piriformis Sydrome

-sciatic come out of foramen BELOW piriformis -> liable to comp

Question 23

Test integrity of structures?
ACL - ?
PCL - ?
Meniscal tear - ?
Thomas - ?
Trendelenburg - ?

Answer 23

ACL - Lachman
PCL - Post drawer
Meniscal tear - McMurray
Thomas - FFD hip
Trendelenburg - hip abduction