Hip complaint Flashcards
What is an early symptom of a hip disease? What motion does this action require?
Difficulty putting on shoes, which requires external rotation of the hip, which is the first motion that is lost with a hip difficulty.
What is the order of motion movements that are lost with a hip disease?
- External rotation of the hip
- AB/ADduction of the hip
- hip flexion
What are the most common conditions that affect the hip?
Trochanteric and gluteus medius bursitits, osteoarthritis, and fractures of the femur
Describe neuralgia paresthtetica
characterized by a localized area of pain that is not influenced by direct pressure, hip movement, or lower back movement
DUE TO LATERAL FEMORAL CUTANEOUS NERVE ENTRAPMENT
What does anterior hip pain that is not aggravated by direct pressure or repetitive flexion suggest?
Presence of an inguinal hernia, lower abdominal pathology, or pain that is from a higher lumbar spinal roots
What is the classic pattern of trochanteric bursitis?
Lateral hip pain that is aggravated by direct pressure
cannot sleep on the affected side
What does posterior hip pain (glut pain) suggest?
SI joint disease
Lumbar radiculopathy
herpes zoster
What are the different variables that can cause anterior thigh pain?
Primary disease of the hip joint, lesions of the upper femur, stress fractures, radiculopathy
unless the pain can be reproduced with movements of the hip, require radiographic testing
Describe the three ways in which you would be able to evaluate the patients ambulation
- Evaluate the patients gait
- Tolerance of squatting
- See how they are able to move in the examination room
What is a Trendelenberg gait?
The patient shifts the torso over the affected hip and reduced the load on the hip
Basically they are moving the affected hip inward so that there is less weight being put on the joint with every step
What is an antalgic gait?
The patient spends a shorter amount of time weight bearing on the affected side because of pain
How do you determine a short leg limp?
If the patients head and shoulders move up and down as they walk; up with the long leg and down the short leg
How do you inspect for pelvic obliquity?
The patient is asked to stand and you place your hands on the top of the iliac crests to see if it is equal
If it is not, then there is a leg length discrepancy, pelvic fracture, scoliosis, unilateral paraspinal muscle spasm
What does the Patrick (fabere test) test?
Tests the hip and the sacroiliac joint
Flexes, Abducts, Externally rotates, and extends the affected legs that the ankle is on the opposite knee and the affected leg is lowered towards the table
What does a positive result of the Patrick test indicate? Differentiate between a positive and a negative test
A positive test is when the affected leg (the one that is in the figure 4) stays above the opposite leg and is not able to lower fully to the table
A negative test is when the affected leg is able to stay parallel with the affected leg
A positive test could be indicative of hip disease, iliopsoas spasm, or SI disease
Describe how to examine for trochanteric bursitis
Hip must be flexed to 90 degrees (patient seated)
Apply pressure over the area where the trochanteric bursa should be, especially in obese patients
tenderness is typically due to bursitis in most cases but can also be caused by an occult fracture, stress fracture, or metastasis
For a patient that has neuralgia parestetica, where would you expect them to have sensory deficits
anterolateral thigh secondary to entrapment of the lateral cutaneous femoral nerve
CAN be classified by loss of sensation (hypesthesia) or heightened sensation (dysesthesia)
Describe the straight leg raise including the causes of pain at different levels
- 30-70 degrees of hip flexion
- less than 30 degrees of hip flexion
- greater than 70 degrees of hip flexion
- lumbar disc herniation at the L4-S1
- Spondylolithesis, gluteal abscess, disc protrusion of extrusion, tumor
- tightness of muscles or SI joint pathology
Which muscle is involved in hip flexion and what is it innervated by?
Iliopsoas muscle
Femoral nerve (L2-L4) Ventral rami of lumbars (L1-L2)
Which muscle is involved in hip extension and what is it innervated by?
Gluteus maximus muscle
Inferior Gluteal nerve (L5, S1, S2)
Which muscle is involved in hip abduction and what is it innervated by?
Gluteus medius and minimus muscle
Superior Gluteal nerve (L5, S1)
Which muscle is involved in hip adduction and what is it innervated by?
Adductor longus muscle
Obturator nerve (L2-L4)
What are the 4 compartments of the hip?
Central, Peripheral, Lateral, Anterior
What is in the central compartment of the hip?
Labrum
Ligamentum Teres
Articular Surfaces
