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Hip Clinical Presentations Flashcards

1
Q

List common clinical presentations at the hip

A
  1. Osteoporosis
  2. Fractures
    • Avulsion
    • Stress
  3. AVN
  4. Osteoarthropathy
  5. Labral Tear
  6. FAI
  7. Loose Bodies
  8. Snapping Hip Syndrome
  9. Tendinopathy
  10. Muscle Strain
  11. Bursitis
  12. Greater Trochanteric Pain Syndrome (GTPS)
  13. Nerve Entrapments
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2
Q

Fractures of the Hip and mortality and prognostic indicators

A
  • >/= 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
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3
Q

Negative Prognostic indicators for hip fractures

A
  1. Male gender
  2. age >86 y/o
  3. >/=2 comorbidities
  4. anemia
  5. mini mental test score = 6/10
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4
Q

Fractures of the hip general info

A
  1. Proximal 1/3 of the femur
  2. Prognosis
    • displaced vs nondisplaced
    • comminution
    • vascular integrity
    • reduction
    • fixation
  3. High risk for thrombosis/embolism
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5
Q

categories for hip fractures

A
  1. Intertrochanteric → between greater and lesser trochanters
  2. Subtrochanteric → refer to common surgery procedures
  3. Femoral neck
    • monitor for AVN and non-union
    • Compression frx more stable than tension frx
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6
Q

Hx and Symptomlogy of hip fractures

A
  1. Hx
    • older adult
    • trauma (fall) vs. spontaneous
  2. Symptomology
    • severe groin and anterior thigh pain more likely than severe lateral hip pain
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7
Q

Physical Exam Findings for Fractures of the Hip

A
  1. Shortening of the LE
  2. Limited/painful squat in LQS
  3. Painful/limited hip AROM/PROM
  4. Painful/weakness with strength testing
  5. +Fulcrum and pubic percussion tests
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8
Q

Common Surgical procedures for fractures of the hip

A
  1. Arthroplasty
  2. External fixation (rare and temporary)
  3. Open reduction internal fixation (ORIF)
    • full w/b 8-12 weeks post op (commonly)
  4. Intramedullary fixation
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9
Q

what is AVN?

A

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
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10
Q

Hx and risk factors for Osteonecrosis

A
  1. Risk Factors
    • trauma
    • corticosteroid use
    • excessive alcohol consumption
    • coagulation disorders
    • hemoglobinopathies
    • Dysbaric phenomena
    • Autoimmune disease
    • storage disease
    • smoking
    • hyperlipidemia
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11
Q

Symptomology and Hx for AVN of the femoral head

A
  1. Hx
    • 3-5th decade
    • risk factors
  2. Symptomology
    • deep groin, buttock, knee pain
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12
Q

Physical Exam findings for AVN of femoral head

A
  1. limited squat LQS
  2. limited/painful AROM and PROM (IR)
  3. pain/weakness with resistive testing
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13
Q

prognostic indicators for AVN

A
  1. Extent of lesion
  2. location
  3. bone marrow edema presence
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14
Q

Hx for osteoarthropathy

A
  1. Insidious onset
  2. Hx trauma
  3. family Hx
  4. obesity
  5. hypermobility
  6. joint shape abnormality
  7. physical activity level
  8. Age > 50 years
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15
Q

Osteoarthropathy symptomology

A
  1. Dull vs sharp buttock, groin, thigh, knee pain
  2. C-Sign
  3. Hip stiffness (greater following prolonged sitting/inactivity)
  4. Difficulty with donning pants/socks/shoes
  5. Stair ambulation limitations
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16
Q

physical examination findings for osteoarthropathies

A
  1. limited AROM and PROM, painful at end-range (greatest IR, flexion, abduction)
    • >1 plane
  2. +Scower test
  3. +/- weakness or pain with resistive testing
  4. joint hypomobility
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17
Q

CPR for hip OA

A
  1. Self-report squatting as aggravating activity
  2. Lateral pain with active hip flexion
  3. Passive hip IR = 25
  4. Pain with active hip extension
  5. Postive Scower test with adduction
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18
Q

Acetabular labral tears are assocaited with what?

A
  1. Degenerative osteoarthropathy
  2. Developmental hip dysplasia
  3. Aspherical femoral head
  4. Slipped Captial Epiphysis
  5. Legg-Calve-Perthes disease
  6. Hip trauma
  7. Athletics involving repetitive pivoting/flexion
  8. FAI
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19
Q

what is FAI?

A

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
  • Most common is a mixture of Cam and Pincer
  • Hip pain and degeneration
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20
Q

Hx and Symptomology of FAI

A
  1. Hx
    • hockey players, golfers, dancers, football, soccer players
  2. Symptomology
    • sharp, deep anterior hip pain
    • pain/limitation with deep squat, cutting, lateral movements, painful ER
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21
Q

Physcial Exam findings for FAI

A
  1. Cam → hip flexion/adduction/IR ROM painful/limited (potentially bony end-feel)
  2. +FABER Test described
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22
Q

what are loose bodies

A
  • free-floating body (cartilage/bone) within joint
  • vary in size
  • often secondary to degenerative changes in hip
  • may cause muscle inhibition (weakness/discoordination)
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23
Q

Hx and symptomology of loose bodies

A
  1. Hx
    • chronic hip pain
    • advanced OA
    • prior traumatic hip dislocation
    • prior AVN
  2. Symptomology
    • anterior hip/groin pain
    • catching, locking, clicking, giving way of LE
    • sudden pain w/b activities
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24
Q

clinical implications of loose bodies

A

ID, refer, likely managed with arthroscopy

25
Snapping hip syndrome can be classifed in what 3 ways?
1. Intra-articular 2. Internal 3. External
26
causes of intra-articular snapping hip syndrome
1. synovial chondromatosis 2. loose bodies 3. labral tears 4. long head of biceps over ischium and iliofemoral ligament over femoral head
27
describe internal snapping hip syndrome
1. causes: * iliopsoas over femoral head, lesser trochanter, pectineus fascia, iliopectineal eminenc e * fibrosis/tenosynovitis of iliopsoas tendon 2. snapping/painful anterior hip (especially extending from flexed position) 3. pain/snap with movement from FABER position to extension, adduction, IR
28
describe external snapping hip syndrome
1. ITB/glut max over greater trochanter 2. lateral hip pain/snapping 3. aggravated by running on slanting surfaces, directional change on planted LE 4. ITB contracture vs weak glut med and hip ERs 5. Painful Ober Test 6. can lead to greater trochanteric bursitis
29
external snapping hip syndrome may be observed at \_\_\_\_
1. Hip * increased compression on soft tissue structures between greater trochanter and ITB 2. Knee * increased compression on soft tissue structures between lateral femoral condyle and ITB
30
external snapping hip syndrome is also known as \_\_\_\_\_\_\_\_\_\_\_
IT Band Friction Syndrome
31
tendinopathy at the hip commonly includes what structures?
rectus femoris iliopsoas glutes
32
Hx and symptomology of tendinopathy at the hip
1. Hx * internal snapping hip syndrome 2. Symptomology * anterior thigh/groin pain
33
Physical exam findings for tendinopathy at the hip
1. painful/weak resisted hip flexion 2. painful/limited hip extension and IR ROM * guarded or empty end feel
34
general physical exam findings for muscle strains
1. TTP muscle bellies with possible palpable defect 2. antalgic gait 3. on-going ecchymosis/edema several day 4. painful/weak resistance testing of involved musculotendinous unit * limited/painful AROM w/concentric contraction 5. Painful/limited A/PROM placing stretch on musculotendinous unit
35
Hamstring muscle strain Hx and risk factors
1. risk factors * prior history * hamstring weakness * older adults 2. Hx * distinct injury/audible pop * common MOI → sprinting with trunk flexion and fast running
36
Adductors mucle strain
1. risk factors * prior history * decreased ROM 2. clinical correlations * soccer, hockey 3. common MOI * directional change while running 4. symptomology * groin pain (worse quick stops/starts)
37
Iliopsoas muscle strains
1. Common MOI * forced hip extension during active hip flexion 2. Symptomology * anterior hip/groin pain * painful high stepping
38
T/F: rectus femoris strains have great prognosis
FALSE worse (rectus central lesions) and also have longer recovery durations
39
risk factors and common MOI for quad strains
1. Risk factors * older athletes * dry playing field * shorter height * dominant LE strength/flexibility 2. MOI * kicking while running * sprinting (during acceleration and deceleration)
40
Hx and symptomology for glute med/min strains
1. Hx * fall, increased duration/frequency of loading sport-related injury * middle-aged women 2. Symptomology * buttock/lateral hip/groin pain
41
two types of bursitis at the hip
1. Trochanteric 2. Iliopsoas/Iliopectineal
42
Trochanteric Bursitis demographics
1. greater risk 40-60 year olds 2. females \> males
43
criteria for diagnosing trochanteric bursitis
1. lateral hip pain 2. distinct tenderness about the greater trochanter 3. pain at the extreme of rotation, abduction, or adduction, especially positive FABERE test 4. pain on hip abduction MMT 5. Pseudoradiculopathy-pain radiating down the lateral aspect of thigh
44
Iliopsoas/Iliopectineal bursitis info
1. frequency un-recognized 2. anterior hip pain 3. painful/limited hip flexion ROM 4. painful/limited hip extension and ER 5. Local TTP * between anterior hip joint and iliopsoas
45
Greater Trochanteric Pain Syndrome Info
1. TTP over greater trochanter w/pt in side-lying 2. may involve glut max/med/min bursae, muscle attachments, and/or other overlying soft tissue structures 3. Clinical correlations * hip/lumbar/knee OA * tendinopathy * ER strain 4. Prevalence * 20-35% for individuals w/mechanical LBP * 17.6% older adults at high risk for knee OA
46
Hx for GTPS
1. Female 2. Obesity 3. LBP/Chronic arthropathy of hip/knee 4. Middle-age/older adults
47
conditions associated with GTPS
1. Ipsilateral and/or contralateral hip arthritis 2. L/S degenerative OA 3. L/S degenerative disc disease 4. Chronic mechanical LBP 5. RA 6. LLD 7. Post-op lumbar disc disease 8. Radiculopathy or other neuro sequalae 9. Obesity 10. Fibromyalgia 11. ITB syndrome 12. Totatl hip arthroplasty 13. lower limb amputation 14. pes planus
48
symptomolgy for GTPS
1. Pain greater at night 2. aggravted w/standing \>/= 15 min 3. radiating symptoms (paresthesia, pain, etc) 4. limitation/pain with donning/doffing socks/shoes 5. symptoms may radiate to the knee or below the knee
49
Physical exam findings for GTPS
1. excessive hip ABD vs adduction during gait 2. TTP lateral hip 3. ITB tightness 4. +FABER (lateral hip pain) 5. +Resisted External Derotation Test 6. Pain/limitations with hip adduction ROM (possibly hip IR as well) 7. Pain/weakness with hip abduction and ER resistance testing and AROM
50
Sciatic nerve entrapments
1. Potential areas of compression * piriformis, ischial tuberosity/GT long head BF 2. Motor distribution * hamstrings, fibular and tibial distributions 3. Sensory distribution * lower leg tibial and fibular dist 4. Other clinical indicators * achilles and hamstring DTR diminished
51
Obturator nerve entrapments
1. Potential areas for compression * overlying fascia 2. Motor distributions * adductors/IR 3. Sensory distributions * med thigh and knee joint 4. other clinical indicators * Hx pelvis frx, THA pelvic operation, prolonged labor
52
Femoral nerve entrapments
1. Potential areas of compression * inguinal canal 2. Motor distribution * knee extensors 3. Sensory distribution * anterior thigh/lower leg 4. Other clinical indicators * diminished patellar reflex * aggravated w/hip extension * 50% compound action potential (EMG) good prognostic indicator for recovery within a year
53
Lateral femoral cutaneous nerve entrapment
1. Potential areas of compression * inguinal canal 2. Sensory Distribution * anterio-lateral thigh 3. Other clinical indicators * latrogenic, compression from tool belts, seat belts, or tight waist bands * obesity * pregnancy * improves with hip flexion/sitting * worsens with standing/walking
54
avulsion fractures info
1. males \> females 2. commonly 2nd decade 3. may mimic apophysitis 4. common involving: * ischial tuberosity * AIIS * ASIS * Pubic symphysis * Iliac Crest * Other: lesser and greater trochanters
55
Hx and symptomology of avulsion fractures
1. Hx * vigorous activites 2. Symptomology * known trauma * local pain (worse with activity, improves with rest)
56
physical exam findings for avulsion fractures
1. TTP 2. antalgic gait/limping 3. hematoma 4. crepitus 5. muscle guarding 6. limited/painful hip ROM (stretching involved contractile unit) 7. painful/weak resistance testing (of action that unit is responsible for)
57
Stress fractures info
1. femoral head and neck * inferior surface → subject to compression * superior surface → tensile loading (more likely to become unstable) 2. 5% of all stress fractures 3. fatigue fractures * normal bone, abnormal stress 4. insufficiency fractures * normal stress, abnormal bone
58
Hx and symptomology of stress fractures
1. Hx * risk factors → female and amenorrhea * change in exercise program/training intensity * smoking * prolonged steroids use 2. Symptomology * exercise-induced pain * hip, groin, thigh, or referred to knee * night pain * aggravated by w/b activities (pending stage in progression)
59
Physical exam findings for stress fractures
1. possible diffuse groin/hip pain with testing procedures 2. +Patellar-Pubic percussion test 3. +Fulcrum test 4. MRI, bone scan findings

MSK 2 (20 decks)

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