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MSK II > Hip and Groin > Flashcards

Hip and Groin Flashcards

1
Q

Describe the pubic clock and the groin triangle

A 
Pubic clock:
12 - inguinal canal/rectus abdominus
9 - inguinal ligament
6 - adductor longus
3 - pubic symphysis
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2
Q

What are risk factors for groin pain?

A
  1. Sudden increase in training load
  2. Deconditioned on RTS
  3. Mm imbalance
  4. Reduced hip mobility
  5. Past hx of groin injury
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3
Q

What are groin pain causes NOT TO BE MISSED?

A 
SCFE
Perthes
Tumor
AVN
Arthropathy
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4
Q

What causes hip OA?

A
  1. Intraarticular pathology
  2. changes in alignment/contact forces (FAI)
  3. AVN
  4. CHD
  5. Genetics!
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5
Q

In THR - what is the Birmingham Implant?

A

A surgery done to preserve the femoral head and neck; these are shaved off just enough to cap off with a prosthesis
- good for young physically active patients

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6
Q

Describe THR

A
  • posterolateral (more common) or anterolateral approach
  • very painful procedure!
  • femoral head+neck is replaced
  • STAY AWAY FROM ADD+FLEXION > 90º (+ IR) - DISLOCATION risk
  • last 15-25 yrs
  • each prosthesis talilored for the individual to prevent risk of disloc + LLD
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7
Q

THR - post surgical - describe what happens/priorities

A
  • NO add/flexion/IR - dislocation risk (no crossing legs, sleep with pillow in legs)
  • WBAT - ASAP
  • usually sent to rehab after 2 days acute care
  • usually discharged 5/7 post surgery
  • think about CP interventions as well, glute strengthening, ankle pumps
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8
Q

What might a NOF # present with

A

ER + shortened on affected side

If dislocation - IR + lengthened

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9
Q

What are the different classifications of femoral #’s and which is most common?

A

NOF - most common
Intertrochanteric
Subtrochanteric

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10
Q

What is the typical management of hip fractures?

A
  1. ORIF
  2. Dynamic Hip Screw (another type of fixation)
  3. Proximal femoral nail
  4. WBAT - Asap
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11
Q

Subtrochanteric fractures

A
  • always require ORIF + intramedullary nail
  • higher rate of malunion
  • may be in combo with shaft/intertrochanteric fractures
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12
Q

What is physio management of post op hip #?

A
  • address CP - chest/breathing post op
  • circulation (foot pumps)
  • strengthening for quads/glutes
  • flexion, abd exercises on board
  • weight bearing within 24-48 hrs
  • multidisciplinary!(falls prevention, delerium, comorbidities etc)
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13
Q

Briefly describe AVN

A
  • loss of blood supply to the femoral head
  • softening, damage and collapse
  • deformity and seperation of overlying cartilage
  • early OA
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14
Q

What is OA?

A
  • articular cartilage covers the contact regions in the bones that form a joint; smooth - hard - lubricated with synovial fluid
  • wear and tear or injury can cause cartilage loss + exposed bone
  • exposed subchondral bone = pain sensitive
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15
Q

What are precautions for imaging?

A
  • avoid in genital region
  • avoid in young
  • ## don’t use only for exploratory reasons
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16
Q

How to determine whether OA is treated surgically or not (hip)?

A
  • age (31% are <65)
  • disability
  • degree of joint destruction
17
Q

What are principles of treating groin pain?

A
  1. Relative rest/reduce load
  2. Technique analysis
  3. Graded RTS/asymptomatic loading
18
Q

Describe the femoral neck fractures (Garden classifications)

*Marnee spent NO time on this but know it anyway

A 
Garden 1: incomplete/non displaced
Garden 1: valgus impaction
Garden 2: complete, undisplaced
Garden 3: complete, partially displaced
Garden 4: complete, completely displaced
  • completeness refers to whether fracture is through the entire NOF or just partially (incomplete)
  • displaced = whether there’s seperation of NOF from HOF
19
Q

Epidemiology of hip fractures?

A

22,000/yr and $1.2B in cost
<50% return to pre injury living conditions
5% die in hospital
1 in 10 die in 30 days

after injury - other injuries/comorbidities develop

20
Q

What is the function of the acetabular labrum?

A
  1. Deepens the joint
  2. Increases contact area - so reduced stress
  3. Maintain IAP
  4. Only outer 1/3 vascularized - so tear into inner 1/3 won’t heal
21
Q

What are the 2 types of acetabular labral tears?

A

Type 1 tears - detachment of labrum from articular hyaline cartilage at acetabular rim

Type 2 tears - cleavage tears within the substance of the labrum

(Brukner+Khan)

22
Q

What are the symptoms of labral tears hip?

A
  • diffuse ant hip/groin pain/posterior buttock?
  • clicking
  • sensation that joint is giving way/instability
  • +ve quadrant test (FADIR+FABER good to rule out - high sens; thomas test also)
23
Q

What are the most common causes of labral tears?

A
  1. Twisting
  2. DJD
  3. FAI
  4. Hip dysplasia
  5. Laxity
24
Q

What are exercise treatment strategies for labral tears?

A

Focus on PROGRESSION

  • significant reduction in pain
  • significant reduction in use of assistive device
  • 3x10 reps of hip exercises - flexion/extension/adduction/abd
  • functional ex - squat/lunge/single leg squat/balance ex
  • mobs - Grade 1-4 depending on irritability

MSK II (7 decks)

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