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Orthopedics and Rheumatology > Hip and Thigh > Flashcards

Hip and Thigh Flashcards

1
Q

Hip ROM

A

Flexion Extension Abduction Adduction Internal rotation External rotation

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2
Q

Hip abductors

A

Gluteus medius and minimus, piriformis Weakness = Trendelenburg’s sign

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3
Q

Which is stronger, internal or external rotation?

A

External rotation Therefore, when testing strength of hip, just check to see that internal rotators are intact.

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4
Q

X ray Views of the Hip

A

Bare minimum: AP pelvis

  • compares two sides
  • can serve as baseline view for future visits

Consider Later view of affected hip

  • can be cross table or frog legged

Trauma: Judet and Inlet/Outlet views

  • judet: examination of acetabulum
  • I/O: examination of pelvic ring
    *
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5
Q

Hip Dislocation

  • anterior vs. posterior dislocation
  • MOI
  • Sxs
  • Rad
  • Treatment
  • Complications
A

Anterior Dislocation

  • will appear flexed, abducted with external rotaiton
  • +/- femoral nerve injury

Posterior Dislocation (MC)

  • flexed, adducted, with internal rotation
  • leg length loss
  • +/- distal pulses
  • sciatic/femoral nerve dysfunction

All:

MOI - requires high energy force

Sxs

  • severe pain
  • decreased or no ROM
  • usually associated with other injuries (knee, acetabular fx, etc)

Radiology

  • AP pelvis
    • Posterior dislocation: affected head smaller
    • Anterior: affected head larger
  • AP/lat femur to knee
  • CT

Treatment

  • EMERGENT REDUCTION
  • ensure no FB or other fxs first
  • post reduction xray/CT
  • crutch assisted walking, wt bearing as tolerated
  • exercises
  • close f/u

Complications

  • osteonecrosis
  • arthritis
  • nerve dysfunction
  • chronic pain
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6
Q

Hip Fractures

  • types of fx with respective MOI
  • risk factors
  • symptoms
  • PE
  • rad
  • treatment
  • complications
A

Types of fxs

  • femoral neck
    • twisting injury
    • impacted vs. displaced
    • at risk for AVN of femoral head
  • intertrochanteric
    • fx line b/w greater and lesser trochanter
    • usually due to fall directly on hip

Risk Factors

  • inc’d age
  • white females
  • sedentary lifestyle
  • tobacco
  • EtOH
  • dementia
  • medications (e.g. prednisone)

Symptoms

  • recent fall
  • non wt bearing
  • groin pain (buttock)

PE

  • Displaced fx: externally rotated, abducted, shortened limb
  • Non-displaced: no obvious deformity
  • No straight leg raise
  • Pain with ROM

Rad

  • AP pelvis, lat hip
  • MRI

Treatment

  • surgical
  • DVT ppx
  • DEXA

Complications

  • medical complications (pneumo, DVT) –> mortality
  • ambulation/independence loss
  • non-union
  • osteonecrosis
  • arthritis
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7
Q

Femoral Shaft Fracture

  • MOI
  • Sxs
  • Rad
  • Tx
  • Complications
A

MOI - high energy trauma

Sxs

  • thigh pain
  • deformity
  • loss of ROM/ambulation

Rad

  • Films: femur, knee, hip, pelvis
  • Arterial studies

Treatment

  • traction
  • surgery
  • +/- ATLS

Complications

  • fat embolism
  • ARDS
  • organ failure
  • death
  • infection
  • non/malunion
  • chronic pain, limp
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8
Q

Pelvic Fractures

  • types
  • sxs
  • evaluation (low vs. high energy vs. acetabular)
  • rad
  • treatment
  • complications
A

Types

  • stable
  • unstable
  • acetabular

Symptoms

  • Groin pain, non-weight bearing

Evaluation

  • Low energy
    • analgic gait
    • pain with ROM
    • pain with straight leg raise
    • evaluate C-spine (esp with fragility fracture)
  • High energy
    • ATLS
    • look for open fx
    • eval for GU injury (blue scrotum with blood coming from meatus)
  • VIews: AP pelvis, oblique, inlet/outlet views; CT, AP chest, C-spine
  • Acetabular fx
    • typically higher energy
    • need judet (oblique) views +/- to appreciate fx
    • many can be treated conservatively (except large posterior fxs

Treatment

  • analgesics
  • protected weight bearing
  • DVT ppx
  • DEXA
  • If unstable fx: heme resuscitation, compression/traction, surgery

Complications

  • leg length change
  • mal/non-union
  • CMS injury
  • GU injury
  • DVT
  • chronic pain
  • DJD
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9
Q

Osteoarthritis of hip

  • patho
  • sxs
  • PE
  • rad
A

Patho

  • sclerosis of bone, formation of fibrous cysts
  • loss of joint space
  • osteophyte formation

Sxs

  • gradual onset of pain with plateaus
  • pain with wt bearing in buttock, groin, thigh, knee
  • night pain
  • loss of hip extension with flexion contracture (feels better in flexion)
  • acute pain after years of mild discomfort usually because of subchondral cyst rupture

PE

  • trendelenberg sign
  • hyperlordosis/flexion contracture
  • loss of ROM
  • affected limb shortening

Rad

  • loss of joint space
  • sclerotic, cystic bony changes; osteophytes
  • standing films
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10
Q

Avascular Necrosis of Femoral Head

  • Definition
  • Causes (5)
  • Sxs
  • Rad
  • Tx
  • Complications
A

Disruption of blood supply –> bone deformity

Causes:

  • Trauma
    • fx of femoral neck
    • slipped capital femoral epiphysis
    • hip dislocation
  • Corticosteroids
    • transplant pts (exogenous)
    • Cushing’s dz (endogenous)
  • EtOH/Pancreatitis
    • 90% of cases attributable to alcohol and corticosteroids
  • Chronic Disease
    • diabetes
    • sickle cell anemia
    • gout
      • SLE
  • Other
    • local irradiation
    • tumors
    • pregnancy

Sxs

  • dull ache/throb
  • decreased ROM
  • limp

Signs

  • pain with SLR
  • pain with ROM
  • +/- decreased ROM
  • antalgic gait
  • trendelenburg gait

Rad

  • AP, frog - leg hip
  • MRI

Treatment

  • controversial - fibular graft?

Complications

  • minimal/none

OA

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11
Q

Lateral Femoral Cutaneous Nerve Syndrome

  • definition
  • sxs
  • PE
  • rad
  • tx
A

compression or entrapment of lateral femoral cutaneous nerve

Sxs

  • abnl sensation lateral/ant. lateral thigh+/- radiation to knee
  • no motor dysfunction

Risk Factors

  • obesity
  • pregnancy
  • trauma
  • scar tissue
  • iatrogenic

PE

  • tender to palpation
  • sensation findings
  • neur normal

Rad

  • AP pelvis
  • CT/MRI

Treatment

  • Remove compression
  • wt loss
  • steroid injection
  • surgical release (rarely - usually not that bothersome)
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12
Q

Iliotibial Band Syndrome

  • Sxs
  • Signs
  • Rad
  • Tx
A

Subluxation

Sxs

  • Snapping/popping
  • Pain

Signs

  • feel snap over greater trochanter when standing, adduct, then rotate

Rad

  • AP pelvis, lat hip
  • CT arthrogram to r/o other things
  • MRI

Treatment

  • Nothing
  • stretching, strengthening
  • NSAIDs, injection
  • surgery
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13
Q

Trochanteric Bursitis

  • Risk factors
  • Sxs
  • PE
  • Rad
  • Tx
  • Complications
A

Risks

  • Spine dz
  • hip pathology
  • limb length discrepency
  • RA
  • surgery

Sxs

  • pain over GT, may radiate to knee
  • worse when first rising, long walking
  • relieved after a few steps

PE

  • redness, warmth (may look like septic joint)
  • pain to palpation over GT
    pain with active abduction

Rad

  • AP, lateral views
  • bone scan/MRI (r/o)

Treatment

  • NSAIDs
  • activity modificaitons
  • cane use
  • injections are very helpful

Complications

  • chronic pain
  • limp
  • sleep disturbance
  • NSAID complications
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14
Q

Osteomyelitis

  • cause
  • sxs
  • tests
  • tx
  • complications
A

Cause

  • heme vs. soft tissue vs. penetration
  • inflammation –> abscess –> bone destruction

Symptoms

  • +/- injury
  • pain (out of proportion)
  • fever/malaise

Signs

  • immobile limb (infants)
  • gentle ROM possible
  • **Focal bone tenderness **
  • +/- soft tissue changes

Tests

  • WBC, ESR< CRP
  • X-rays (negative early, late mottled/moth eaten)
  • blood, aspirate cultures (before abx treatment)
  • Bone scan/MRI

Treatment

  • early and aggressive
  • IV abx
  • surgical decompression, I&D

Complications

  • death
  • pathologic fracture
  • soft tissue destruction
  • bone growth/ftn
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Orthopedics and Rheumatology (8 decks)

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