Hip Clinical Presentations Flashcards
List common clinical presentations at the hip
- Osteoporosis
- Fractures
- Avulsion
- Stress
- AVN
- Osteoarthropathy
- Labral Tear
- FAI
- Loose Bodies
- Snapping Hip Syndrome
- Tendinopathy
- Muscle Strain
- Bursitis
- Greater Trochanteric Pain Syndrome (GTPS)
- Nerve Entrapments
Fractures of the Hip and mortality and prognostic indicators
- >/= 90% of hip fractures are sustained by individuals >65 y/o
- 1 year mortality rate 14-36%
- increases 5-10 years post-fracture
- Survivors have shortened life expectancy
- Positive prognostic indicators
- surgery within 48 hours
Negative Prognostic indicators for hip fractures
- Male gender
- age >86 y/o
- >/=2 comorbidities
- anemia
- mini mental test score = 6/10
Fractures of the hip general info
- Proximal 1/3 of the femur
- Prognosis
- displaced vs nondisplaced
- comminution
- vascular integrity
- reduction
- fixation
- High risk for thrombosis/embolism
categories for hip fractures
- Intertrochanteric → between greater and lesser trochanters
- Subtrochanteric → refer to common surgery procedures
- Femoral neck
- monitor for AVN and non-union
- Compression frx more stable than tension frx
Hx and Symptomlogy of hip fractures
- Hx
- older adult
- trauma (fall) vs. spontaneous
- Symptomology
- severe groin and anterior thigh pain more likely than severe lateral hip pain
Physical Exam Findings for Fractures of the Hip
- Shortening of the LE
- Limited/painful squat in LQS
- Painful/limited hip AROM/PROM
- Painful/weakness with strength testing
- +Fulcrum and pubic percussion tests
Common Surgical procedures for fractures of the hip
- Arthroplasty
- External fixation (rare and temporary)
- Open reduction internal fixation (ORIF)
- full w/b 8-12 weeks post op (commonly)
- Intramedullary fixation
what is AVN?
Avascular Necrosis of Femoral Head
- progressive ischemia with secondary bone cell death
- collapsing of bone
- leads to degenerative arthropathy
- possibly conservative management, many managed surgically
Hx and risk factors for Osteonecrosis
- Risk Factors
- trauma
- corticosteroid use
- excessive alcohol consumption
- coagulation disorders
- hemoglobinopathies
- Dysbaric phenomena
- Autoimmune disease
- storage disease
- smoking
- hyperlipidemia
Symptomology and Hx for AVN of the femoral head
- Hx
- 3-5th decade
- risk factors
- Symptomology
- deep groin, buttock, knee pain
Physical Exam findings for AVN of femoral head
- limited squat LQS
- limited/painful AROM and PROM (IR)
- pain/weakness with resistive testing
prognostic indicators for AVN
- Extent of lesion
- location
- bone marrow edema presence
Hx for osteoarthropathy
- Insidious onset
- Hx trauma
- family Hx
- obesity
- hypermobility
- joint shape abnormality
- physical activity level
- Age > 50 years
Osteoarthropathy symptomology
- Dull vs sharp buttock, groin, thigh, knee pain
- C-Sign
- Hip stiffness (greater following prolonged sitting/inactivity)
- Difficulty with donning pants/socks/shoes
- Stair ambulation limitations
physical examination findings for osteoarthropathies
- limited AROM and PROM, painful at end-range (greatest IR, flexion, abduction)
- >1 plane
- +Scower test
- +/- weakness or pain with resistive testing
- joint hypomobility
CPR for hip OA
- Self-report squatting as aggravating activity
- Lateral pain with active hip flexion
- Passive hip IR = 25
- Pain with active hip extension
- Postive Scower test with adduction
Acetabular labral tears are assocaited with what?
- Degenerative osteoarthropathy
- Developmental hip dysplasia
- Aspherical femoral head
- Slipped Captial Epiphysis
- Legg-Calve-Perthes disease
- Hip trauma
- Athletics involving repetitive pivoting/flexion
- FAI
what is FAI?
Femoral-Acetabular Impingement (FAI)
- bony abnormality with decreased femoral-acetabular clearance
- Cam → increased size of femoral head, irregular junction with the neck
- leads to anteriosuperior labral and cartilage damage
- Pincer → increased protrusion of acetabular rim
- Cam → increased size of femoral head, irregular junction with the neck
- Most common is a mixture of Cam and Pincer
- Hip pain and degeneration
Hx and Symptomology of FAI
- Hx
- hockey players, golfers, dancers, football, soccer players
- Symptomology
- sharp, deep anterior hip pain
- pain/limitation with deep squat, cutting, lateral movements, painful ER
Physcial Exam findings for FAI
- Cam → hip flexion/adduction/IR ROM painful/limited (potentially bony end-feel)
- +FABER Test described
what are loose bodies
- free-floating body (cartilage/bone) within joint
- vary in size
- often secondary to degenerative changes in hip
- may cause muscle inhibition (weakness/discoordination)
Hx and symptomology of loose bodies
- Hx
- chronic hip pain
- advanced OA
- prior traumatic hip dislocation
- prior AVN
- Symptomology
- anterior hip/groin pain
- catching, locking, clicking, giving way of LE
- sudden pain w/b activities