Hip Flashcards by Robert Kerby

who is most likely to get a cam impingement

20-30yom

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what does the iliofemoral ligament do?

it limits extension, adduction, and ER

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describe coxa valga (3)

angle >135
less shock absorption
accelerated degeneration

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what is synovial chondromatosis?

multiple bone or cartilage loose bodies that shows up as “popcorn” on imaging

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what are the six non arthritic sources of hip joint pain?

FAI
structural instability
acetabular labral tears
osteochondral lesions
loose bodies
ligamentum teres injury

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what is the general definition of FAI

abnormal contact between the femur and acetabulum resulting in labral and chondral damage

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what type of cartilage is on the head of the femur?

hyaline

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what is the neural supply to the anterior hip joint and where does the pain refer?

femoral nerve L2-L4 lends to groin and anterior medial thigh pain

obturator nerve L3-L4 lends to medial thigh pain (no groin)

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describe OA pain

deep aching poorly localized and presents gradually over years; severe has episodes of sharp pain

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what is grade A evidence for flexibility and strength training?

1-5x/wk for 6-12 wks for mild-mod hip OA

hip flexors and ER stretching

hip extensor, abductor, and ER strength

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what 3 things cause OA

abnormal anatomy
excessive load
combination of both

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describe coxa vara (3)

angle <120
less arthrosis
high risk of stress fracture

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what is the grade C weak evidence to dx FAI?

anterior hip/groin pain or lateral hip/trochanter pain
aching or sharp pain
agg by sitting
pain reproduced by hip flexion adduction, and IR (FADIR)
hip IR <20 with hip flexed to 90

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is the femur anteverted or retroverted?

normal physiologic anteversion

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how does excessive anteversion present? (3) who is impacted?

in toeing
patellar squint
excessive IR, decreased ER

boys 2:1

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what are the treatment grades for hip problems and why is it important

manual - F
education - F
stretching - F
strengthening - F
cardiopulm endurance - F
NMR - F

treat. what. you. find.

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how does excessive femoral retroversion present? (2)

excessive ER, decreased IR

2. out toeing

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what vascular supply is compromised in hip neck fracture?

branches of the lateral circumflex

what is important about the ligamentum teres

it is a conduit for the foveal artery (not present in everyone)

is radiography useful in dx hip OA?

it is the gold standard, but can only identify joint space narrowing, sclerosis, and osteophytes in severe hip OA

although there is no cure for OA, what three things amend to intervention

addressing ROM
strength
functional limitations

how long is conservative hip management prior to surgery?

8-12 weeks

what is the neural supply to the posterior hip joint and where does the pain refer?

sacral plexus L4-S4 lends to buttock pain

what is grade A evidence for measuring OA for pain and function?

WOMAC and VAS for pain

WOMAC LEFS and HOOS

6MWT, 30second STS, TUG, timed SLS, 4square

what vascular supply is compromised in hip dislocation?

artery to the head of the femur

what is grade C weak evidence for dx of intraarticular injuries excluding FAI

1. anterior groin pain or generalized hip pain 2. FAID or FABER + 3. popping, locking, snapping 4. instability

what is cam FAI

femoral head asphericity related to slipped capital femoral epiphysis

what are three examples of hip anatomical abnormalities

1. CHD 2. FAI 3. LCP

which category of FAI is most common

combo

what are the 3 categories of FAI

cam, pincer, and combo

what is grade A evidence of hip OA? 5

1. age >50 --- ***#1 RF!!!*** 2. moderate ant/lat hip pain during WB 3. morning stiffness 30-60min 4. hip IR <24 5. hip flexion discrepancy of >=15

what is LCP

permanent deformity of the femoral head due to blood flow disruption in children 4-8yrs. good prognosis if dx before 6yo

where would you use STM on an OA pt? (5)

1. iliacus 2. hip ERs 3. post glute med 4. QF 5. glute max

what does the ischiofemoral ligament do

it limits extension, abduction, and IR

what are the two artery branches from the femoral artery that supply the hip?

femoral head artery and lateral circumflex branches

what is the MOI for a labral tear?

forceful rotation with hip in hyperextension, but typically not assoc with any specific event

what is slipped capital femoral epiphysis - who does it effect

growth plate fracture resulting in femur epiphysis slippage - common in obese male adolescents

what is pincer FAI

acetabular abnormalities

who is most like to get a pincer FAI?

women in 30s-40s notice after yoga and aerobics

what five features characterize a hip OA

1. focal articular degradation 2. thickened subchondral bone 3. osteophytes 4. mild/mod synovial inflammation 5. thickened capsule

what is the close pack position of the hip?

trick question, there is a bony and a ligamentous close pack position ligamentous: max extension, IR, abduction bony: 90 deg flexion, moderate abduction, and ER (faber position)

why is the center edge angle/angle of wiberg relevant??

if this vertical angle is <25, there is a higher risk of dysplasia, dislocation, and arthritis

what is the loose pack position of the hip?

30 deg flexion, abduction, and slight ER

what does the pubofemoral ligament do?

it limits extension, abduction, and ER