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OCS > Hip > Flashcards

Hip Flashcards

1
Q

Closed packed position of hip

A
  • combined extension, IR, and ABD
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2
Q

Open packed position of hip

A
  • 30 degrees hip flexion, 30 degrees of abduction, slight ER
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3
Q

Capsular pattern of hip

A
  • limitation of flexion, IR, and some ABD
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4
Q

3 primary ligaments supporting hip joint

A
  • iliofemoral: limites hyperextension
  • pubofemoral: limits extension and ABD
  • ischiofemoral: spirals around neck of femur and prevents hyperextension
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5
Q

Ligamentum teres

A
  • does not help with tension but helps to guide/protect branch of obturator artery to femoral head. If damaged can lead to avascular necrosis.
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6
Q

anterior muscular support

A
  • pectineus, iliopsoas, rectus femoris
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7
Q

posterior muscular support

A
  • ischiofemoral ligament, obturator internus/externus, piriformis
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8
Q

superior support of the hip

A
  • ischiofemoral ligament, rectus femoris, gluteus minimus
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9
Q

inferior support of the hip

A
  • obturator externus, pectineus
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10
Q

posterior muscles of the hip

A
  • glute max, med, min, and hamstrings
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11
Q

Normal acetabular anteversion

A
  • about 20 degrees, normally greater in women and less than men
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12
Q

Angle of inclination

A
  • angle between neck and shaft of the femur

- begins at 150 degrees in infants and with weight bearing lessens to about 125

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13
Q

Smaller than normal angle of inclination

A
  • coxa vara: can lead to genu valgum
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14
Q

Larger than normal angle of inclination

A
  • coxa valga: can lead to genu varum
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15
Q

Angle of torsion

A
  • angle of femoral head and neck relative to femoral condyles. Normal is 13-15 degrees
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16
Q

Retroversion of hip

A
  • decrease in the angle of torsion (patient will lack IR and seems to have increased ER)
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17
Q

Anteversion of hip

A
  • increase in the angle of torsion (patient will have increased femoral IR)
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18
Q

Femoral neck fractures

A
  • sudden hip pain with increase in activity
  • pain referred to anteromedial thigh, knee, groin
  • fatigue stress fractures
  • ->d/t repetitive and abnormally high forces
  • ->relatively uncommon but should be addressed quickly to prevent serious complications
  • ->5% of these fx’s involve femoral neck and 5% involve femoral head
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19
Q

Insufficiency fractures

A
  • d/t compromised bone density
  • post menopausal women
  • radiation treatments, RA, corticosteroid treatment
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20
Q

Avascular necrosis

A
  • blood supply to femoral head is compromised for a prolonged period of time
  • male more than female
  • patients demonstrate and antalgic gait and present with a capsular pattern of restriction
  • patients complain of sharp intermittent pain and extreme ROMs
  • it is a common complication following hip dislocations, fractures, and chronic synovitis
  • patients may also report dull or aching pain in groin and occasionally lateral hip/buttock pan.
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21
Q

Femoral acetabular impingement

A
  • CAM impingement: non-spherical femoral head, more common in younger males
  • Pincer impingement: increased acetabular coverage around the femoral head. Labrum pinched between acetabulum and anterior femoral head-neck. Middle aged females.
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22
Q

Mixed impingement

A
  • concommitant CAM and Pincer impingement
  • potential for labral compromise
  • most common symptom is pain and catching
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23
Q

Acetabular labral tears

A
  • degenerative, traumatic, or idiopathic

- represents 20% of groin pain in athletes

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24
Q

Type I acetabular lesion

A
  • usually due to a twisting movement
  • detached labrum from articular cartilage surface
  • perpendicular to surface
  • can extend to subchondral bone
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25
Q

Type II acetabular lesion

A
  • history of acetabular dysplasia repeated twisting/pivoting
  • one or more tears within the labrum
  • buckling, pain with forced ADD and IR
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26
Q

Physical exam for acetabular lesion

A
  • pain at extremes of ROM, especially with flexion, ADD, and IR
  • normal radiographs
  • pain with ASLR
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27
Q

Ruptured ligamentum teres

A
  • traumatic injury (repetitive microtrauma, particularly with laxity)
  • iatrogenic injury
  • micro-instability: CAM lesions, ehlers-danlos syndrome, those with increased flexibility
  • reduced and painful movement in extension or combined flexion/IR
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28
Q

Snapping hip syndrome internal, external, and intra-articular

A
  • internal: iliopsoas snapping over lesser trochanter produces snapping in groin. Stenosing synovitis of the iliopsoas
  • external: generally seen in women with wider pelvises who run on banked surfaces. ITB or gluteus maximus snapping over the greater trochanter
  • intra-articular: synovial chondromatosis, loose bodies, labral tears
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29
Q

Snapping hip syndrome symptoms

A
  • c/o snapping and popping with ambulation with complaints of pain with laying on involved side, especially if ITB is involved.
  • if iliopsoas is involved pain is usually felt in the groin when the hip is moving from flexion to extension
  • palpate ITB subluxation
  • (+) ober/thomas test, patient usually responds well to conservative management
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30
Q

Trochanteric bursitis

A
  • 2nd leading cause of lateral hip pain
  • lateral thigh, groin, and gluteal pain
  • pain with palpation, active or resisted ABD
  • often associated with length deficits in abductors, potential leg length discrepancies
31
Q

Iliopsoas/iliopectineal

A
  • anterior hip or groin pain increased with extension
  • pain with end range passive hip flexion/ADD
  • palpable tenderness of involved bursa
32
Q

Ischial bursitis

A
  • results from chronic compression or direct trauma
  • pain with sitting in a firm chair
  • females>males
33
Q

Gluteal bursitis

A
  • located above and behind greater trochanter
  • individuals aged 40-50
  • pain in gluteal, trochanteric area and may spread to posterior thigh
  • pain increases with walking and going upstairs
  • pain with passive IR and ABD, resisted ER
34
Q

Screening for colon cancer

A
  • > 50 y/o
  • bowel disturbances
  • unexplained weight loss (10% of total weight in 1 month)
  • colon CA in first degree relative
  • pain unchanged by positions or movement
35
Q

Screening for pathological fracture

A
  • > 70 y/o females
  • fall history
  • pain worse with movement
  • shortened and externally rotated LE
36
Q

ROM required for walking

A

flexion: 40-60
extension: 15-20
ABD: 7
ADD: 5
ER: 9
IR: 4

37
Q

Accessory movements/direction of femoral head for…

A
  • flexion: dorsal glide
  • extension: ventral glide
  • ABDuction: caudal glide
  • ADDuction: lateral glide
  • IR: dorsal and lateral glide
  • ER: ventral glide
38
Q

Skeletal modeling in children occurs through adaptation

A
  • wolf’s law
  • gravity
  • genetics
  • alignment
  • weight distribution
  • muscle recruitment
  • motor control
39
Q

Normal acetabular anteversion

A
  • 18.5 males

- 21.5 females

40
Q

Yellow flags for hip

A
  • avoidance of activity
  • poor social interaction
  • emotional lability
  • poor engagement in treatment
  • unrealistic parental expectations
41
Q

Osteomyelitis

A
  • birth-5 y/o
  • 1 in 5,000 children
  • recent infection, trauma, or spontaneous occurence
  • sudden onset, localized bone tenderness, swelling, and pain
42
Q

Septic arthritis

A
  • birth-5 y/o
  • 75% of cases occur before age 3
  • rapid inflammatory response
  • permanent joint destruction
  • irritability, fever, anorexia, painful WB, (+) FABER
43
Q

Transient synovitis

A
  • Children <10 y/o
  • males>females
  • may be preceded by upper respiratory infection or illness
44
Q

Juvenile idiopathic arthritis

A
  • autoimmune disorder which is activated by an external trigger in a genetically predisposed individual
  • age and gender vary by disease and sub-type
  • acute or chronic iridocyclitis, most common in oligoarticular
45
Q

Legg-Calve-Perthes disease

A
  • ischemic necrosis of the femoral head
  • occasionally follows episodic transient synovitis
  • males>females, ages 4-8 y/o
46
Q

Growing pains

A
  • occurs during periods of rapid growth and joint hypermobility
  • most common cause of musculoskeletal pain
  • > 30% of children 4-6 years
  • pain is non articular and always bilateral
  • self limiting, no signs of inflammation
  • more serious conditions must be ruled out
47
Q

Slipped capital femoral epiphysis (SCFE)

A
  • acute, acute on chronic, or chronic
  • 2-10 per 100,000
  • 3.94 times higher in African-American children
  • 2.53 times higher in hispanic children
  • males>females, 60% bilateral
  • ->males: 9-15 y/o
  • ->females: 10-16 y/o
  • obesity may be a factor
  • patient will demo an antalgic gait, growing pain, anteromedial thigh pain, and/or knee pain. May only present with knee pain
48
Q

Legg Calve Perthes disease

A
  • children may be small for their age
  • antalgic gait (shortened stance phase on affected side, hip ABD, weakness leading to trendelenburg or ABDuctor lurch)
  • limited hip ABD and IR
  • pain complaints related to activity
  • pain referred to anteromedial thigh/knee
49
Q

Initial stage of legg-calve-perthes disease (1 of 4)

A
  • lateralization of femoral head, widening of medical joint space.
  • later signs include subchondral fracture and physeal irregularity
50
Q

Second stage of legg-calve-perthes disease (2 of 4)

A
  • Fragmentation stage: epiphysis is fragmented and acetabulum contour is more irregular
51
Q

Third stage of legg-calve-perthes disease (3 of 4)

A
  • re-ossification (healing) stage, new bone formation on femoral head
52
Q

Fourth stage of legg-calve-perthes disease (4 of 4)

A
  • residual stage, femoral head fully re-ossified
53
Q

Treatment of oegg-calve-perthes disease

A
  • prevent deformation and maintain ROM
  • ABDuction orthosis
  • conservative management vs surgical containment
54
Q

Slipped capital femoral epiphysis symptoms

A
  • pain in groin with referred pain to thigh or knee
  • antalgic gait, limitation in IR
  • affected limb positioned in ER and shortened position
  • with flexion, thigh rotates into ER and flexion is limited
  • acute: sudden onset, severe pain following a minor fall or twisting
55
Q

Imaging for slipped capital epiphysis symptoms

A
  • plain film radiography with AP, lateral views: AP shows widening of growth plate, lateral any slipping will disrupt the alignment
  • CT: confirm closure of physis
  • MRI: aide early diagnosis
  • severity graded on amount of displacement
56
Q

Treatment for slipped capital epiphysis

A
  • keep displacement to a minimum, maintain ROM
  • delay or prevent degenerative changes
  • acute patients may be stable or unstable
  • if suspected, limit weight bearing until further evaluation can be performed
  • post-op rehab can lead to increased strength and progressive weight bearing
57
Q

Osteonecrosis

A
  • vascular injury associated with displacement
  • frequently associated with acute/unstable joint
  • antalgic gait, capsular pattern
  • intermittent sharp pain in extreme ends of range
  • can be a complication of SCFE
  • treatment: maintain ROM, prevent collapse with decreased weightbearing until healing occurs
58
Q

Chondrolysis

A
  • disolution of articular cartilage
  • often found after surgical fixations, specifically if the pain penetrates the femoral head or if there is manipulation or reduction
  • rapid, progressive joint stiffness and pain
  • ABDuction contracture
  • treatment: activity modification, protective WB with crutches, gentle ROM and anti-inflammatories
59
Q

Transient synovitis and septic arthritis

A
  • atraumatic, acutely irritable hip
  • antalgic gait or difficulty with weight bearing
  • limited motion, joint effusion
  • abnormalities in blood and joint fluid
  • treatment: transient synovitis will resolve with conservative management. Activity modification, protected WB. Septic arthritis=>antibiotic therapy
60
Q

Juvenile idiopathic arthritis

A
  • not a single disease but encompasses all arthritis that occur prior to the age of 16, persists >6 weeks and are of unknown origin
  • joint pain, swelling, and limited mobility
  • morning stiffness
  • gait deviations
  • hip affected in 30-50% of children
  • early signs: leg length discrepancy, pain in groin, buttock, medial thigh, or knee
61
Q

Acute juvenile idiopathic arthritis

A
  • joint inflammation, effusion, ligamentous laxity
  • muscular spasm and hypertonicity
  • management: maintain and preserve joint function
62
Q

Sub-acute-chronic juvenile idiopathic arthritis

A
  • synovial hypertrophy
  • loss of joint integrity
  • muscle atrophy and weakness
  • disease onset early in life may negatively affect muscle development
  • management: restoration and compensation of function. Education and support to child and family
63
Q

Long term effects of atypical musculoskeletal development

A
  • idiopathic conditions characterized by disorder of endochondral ossification (limp during walking)
  • critical ROM values for stability (at least 30 degrees of ABDuction, avoid hip flexion contracture of 20-25 degrees or more)
64
Q

Developmental dysplasia

A
  • 1 per 100 for dysplasia
  • 1 per 1000 fore dislocation in newborns
  • origin is multifactorial
  • clinical exam must include hip flexion/ABD ROM
  • most infants have 75-90 degrees of ABD
  • limitation or asymmetry of 5-10 degrees
  • asymmetrical thigh folds
  • apparent femoral shortening with uneven knee heights
  • barlow or otolani signs
65
Q

Barlow maneuver

A
  • dislocation of the femoral head over the posterior acetabular rim
  • hip is flexed, abducted, and gradually adducted with pressure posteriorly. A positive otolani sign indicates a more unstable hip than a positive barlow sign
66
Q

ortolani test

A
  • the hip is dislocated in a position of flexion, abduction, and slight traction to reduce
67
Q

Developmental dysplasia intervention

A
  • panlikk harness used birth-9 months: position child in flexion and ABDuction and restricts hip extension and ADDuction
  • 9+ months: ABDuction orthosis(>9 months), closed reduction (6-18 months), open reduction (>2 years)
68
Q

Apophysitis and avulsion fractures

A
  • hip and pelvis ossification patterns
  • fuse later in childhood
  • muscular contraction or excessive stretching
69
Q

Iliac apophysitis

A
  • affects adolescents in T and F or XC or dancers
  • D/t repeated contraction of the TFL, rectus femoris, sartorius, gluteus medius, and oblique abdominal muscles
  • treatment: rest, normalize 2-joint muscle flexibility, increase strength
70
Q

Avulsion injuries

A
  • occurs in ASIS (sartorius), ischium (hamstring), lesser trochanter (iliopsoas), AIIS (rectus femoris), iliac crest (abdominals)
  • treatment: rest. gradual increase in ROM, PRE, reintegration to play
71
Q

Stress fractures

A
  • due to repetitive microtrauma
  • junction of the ischium and pubic ramus, femoral neck and shaft are often affected
  • persistant pain and groin tenderness
  • limited mobility and activity related increases in pain.
  • treatment: relative rest, protected WB’ing, restriction from percussive activities)
72
Q

Sutlive CPG for hip OA

A
  • squat is aggravating activity
  • hip flexion causes pain laterally
  • active hip extension causes pain
  • passive hip IR <25 degrees
  • (+) scour test
73
Q

6 minutes walk test

A
  • walk 30 m laps as many times as possible in 6 minutes
  • relative contraindications: HR >120, BP >180/100
  • absolute contraindications: unstable angina, MI in previous month are absolute contraindications
74
Q

TUG

A
  • > 12 seconds=increased fall risk

- in those with hip OA >10 seconds correlated with up to 3x higher risk of being a near faller

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