Hip Flashcards
common age for transient synovitis and legs-calve perches disease and slipped capital femoral epiphysis
transient synovitis- 2-10
Legg-calve-perthes- 2-8
slipped capital- 10-14
Common age for femoral neck stress fx, snapping hip, AVN, OA
neck fx- 14-30s,65+
Snapping hip- 20-30s
AVN- 20-40
OA- 30s-60
What is the lig ant, inf, and post of hip and what do they limit
ant- Iliofemoral (limits hyperext)
inf- Pubofemoral (limits hyperabduction)
post- Ischiofemoral (limits hyperextension)
When is there a loss of abduction and int rot what does it indicate
hip disease
What are the red flags of the hip
- Rheumatologic conditions
- Inf
- Tumors
- stress fx/ any fx
- AVN, LCP, SCFE
- Congenital dysplasia of hip
- AAA
What % of hips display abnormalities and have labral lesions
70%!
What is the potential series of events that lead to LBP due to reduced hip motion
- reduced hip motion –> +/- capsul stiffness –> altered loading –> tissue stress/sensitizations
What are the mc hip probs associated with cLBP
hip jt pain, morning stiffness, pain w int rot
hip spine syndrome in elderly aspects
limited hip mobility and rom (surgical hip correction can positively influence the LBP)
What type of OA is LBP a poor prognostic factor for
hip oa
but not knee oa
What is the presentation and cause of myositis ossificans
Damage to mm with hematoma due to forceful stretching after injury, deep massage etc
-Direct blow followed by swelling and decreased ability to flex the knee
Hip pointer- onset/cause, treatment, prognosis
Direct trauma/fall on hard surface (disabling contusion of iliac crest)
tx- modalities/rest/ice/rom
prog-3weeks
Avulsion/apophyseal injury- cause, dx, tx
-skeletally immature its, any mm attachment, eccentric force
dx- pain/bruising + x ray
Tx- modalities/rest/ice/rom
presentation of post hip dislocation and complications associated
flex/adducted/int rot
disclocation is med emergency
complications- fx, oa
causes of hip instability and symptoms
causes- repetitive microtrauma from axial loading/ext rot, generalized lig laxity, collagen disorders
symptoms- pain, psoas/ITB snapping/ apprehension/ recurrent instability
What are 3 types of bursitis
Trochanteric
Ischial (direct blow, prolonged sitting)
Iliopectineal (deep to psoas tendon)
Symptoms of Greater trochanteric pain syndrome
- chronic contnous or intermittent pain
- increased pain w activity
- local palpation of GT area recreates pain
- supine resisted hip ext rot
- single leg stance
common demographic for gluteal tendinopathy
mc females 40+
in 35% of those w lbp
tx of bursitis/gtps/gluteal tendinopathy
anti-inflammatory measures (rest/ice/modalities), soft tissues work, corticosteroid inj
Snapping Hip syndrome- presentation, pathology
pres- snapping sensation with fear of dislocation
Pathology- Tendons become inflamed or irritated from rubbing over burs/bony prominances (mc GT)
Adductor strain- cause, tests, risk factor
cause- forceful contraction in stretched pos (prox damage)
tests= direct palp*, fabre, resisted adduction
risk- decrease bilateral him ROM
Hamstring strain- MOI, what type of injury has longer recovery
MOI- forced flexion of hip+ knee extension or excessive contractile force
More prox the injury= longer recovery
moi of piriformis syndrome and features
moi- contracture/spasm, prolonged ext pressure, congenital variations in sciatic n, piriformes hypertrophy/fascia changes
symptoms- buttock pain, pain w sitting, tenderness of sciatic notch, pain in piriformic activity
pathology and presentation of sports hernia
path- bulge or post inguinal wall hernia without presence of true hernia. Abnormalities of RA, partial avulsion of IO, abnormality of EO
Presentation- high performance athletes, inguinal canal pain, dilated superficial inguinal ring, increased pain w coughing/straining/palp
pain increases 6-24hrs after strenuous activity
Assessment of sports hernia
- Squeeze knees together while supine w knees bent
- Squeeze feet together while supine
- Faber, faddir
Ostetis pubis- presentation, assessment, what is diagnositic
-Forced adduction/ pain w activity
assessment- palp, compression via ASIS
dx- >10mm widening at pubis, irregularity and sclerosis of pubic margins
Hip stress fx- presentation, Mechanism, Assessment
pres- Insididous, deep ant pain w weight bearing, night pain
Mech- Osteoclast>Osteoblast
Assess- pain at end of flex/int rot, x ray
Risks of hip fxs
Osteopenia/osteoperosis, malunion, AVN, biomech probs
presentation of hip oa
- middle age/elderly
- moderate ant/lat hip, buttock, groin, knee pain
- morning stiffness <1hr
- Restricted int rot, flex, abduction
Hip Rheumatism- pop, presentation, lab reults
pop- women 25-55, bilateral pain, periarticular swelling
lab- elevated ear, rheumatoid factor
MOI of acetabular labral tears and diagnostic gold standard
MOI- rot + hyperextension or repeated pivoting/twisting
Dx- CT athrography
Symptoms and signs of acetabular labral tears
Symptoms- Ant groin pain, mech hip symtoms (click, lock, catch, instability), C sign (hand around hip= labra tear/fai)
Signs- Coxalgic limp, faddier, scour, log roll etc
FAI- presentation, S/S
mechainical impingement of femoral head or neck on acetabulum
-pain in ant aspect of hip, motion/pos related
S/S- Faddier, foot progression angle walking, max squat test
How to differentiate developmental dysplasia/dislocation (test)
Dysplasia- hips w pos Ortolani sign
Dislocation-hips w negative ortolan sign
MOI of developmental dysplasia/dislocation
Breech delivery
females
first born infants
pos fam history of DHD
Transient synovitis presentation
- child <10 years old with gradual pain in inguinal areas and difficulty bearing weight
- Insidious limp
- Pt. holds hip in ext rot/abd/flex
Slipped capital femoral epiphysis pop, pres, diagnosis
Occurs in rapidly growing/overweight children 8-17
- hx of minor trauma
- may present as knee pain alone
Xray dx
Legg calve perthes disease- pres (age), how can it present, s/s
males 5-7 mc
- bilateral 10%
- May present as knee pain
- Decreased hip abduction, int rot
x ray signs of LCP
present sign, fragmentation, collapse etc
Meralgia parenthetic- pres, moi
- Numbness/tingling of lat thigh due to compression of lat fem cutaneous nerve
moi- prolonged sitting, overweight/obese, tight belt, symptoms worse 1 inch inf to asis w pressure
