Hip conditions Flashcards
Snapping hip syndrome
Characterised by audible ‘snap’ or ‘pop’ typically occurring with dynamic hip movement
Source of pain + snapping noise produced by subluxation of iliopsoas tendon during ROM
What its snapping noise associated with for snapping hip syndrome
Thickened IT band, causing slippage back and forth over greater trochanter –> pain + audible snapping
Epidemiology of snapping hip
tight muscle
Internal- Iliopsoas tendon snapping over ant aspect of fem head
External- Tight IT band snapping over greater trochanter
Age groups affected by snapping hip
Younger people (athletes) as hips become very tight during growth spurts
Risk factors of snapping hip
Overuse- particularly in sport, repetitive strain on a muscle
Clinical presentation of snapping hip
Palpable or audible snapping sensation that is heard during movement
Commonly localise pain to greater trochanter
Prognosis for snapping hip
May asymptomatic, therefore benign condition, amenable by stretching/conservative treatment
If Pt not relieved by 6 months surgical options may be necessary
Iliopectineal bursitis
Inflammation of bursa located beneath iliac muscle
Epidemiology of iliopectineal bursitis
Acute trauma
Overuse injury
Age groups affected by iliopectineal bursitis
Seen predominately in males, generally doesn’t occur till after skeleton has matured
40-60
Risk factors of iliopectineal bursitis
Having OA or RA
Clinical presentation of iliopectineal bursitis
Variable symptoms
Pain, mass lesion, or compression syndrome of inguinal compartment
Prognosis of iliopectinal bursitis
RICE
Should get better on own
Ischial/trochanteric bursitis
Condition of inflammation of bursa between ischial tuberosity + gluteus mediums
Epidemiology of ischial/trochanteric bursitis
Receptive stress/microtrauma on ischial bursa, causing inflammation
Can happen when sitting for long periods
Playing sports which require repetitive motion
Age groups affected by ischial/trochanteric bursitis
Seen predominately in male, generally doesn’t occur till skeleton has matured
40-60
Risk factors of ischial/trochanteric bursitis
Having OR or RA
Clinical presentation of ischial/trochanteric bursitis
Gluteal pain
Aching in lateral hip, localised to area lying over greater trochanter/palpable tenderness
Sharp/intense
Radiation down outer thigh towards knee, rarely beyond IT band insertion
Exacerbated while lying on affected side/climbing stairs
Prognosis for ischial/trochanteric bursitis
NSAIDs and PT to strengthen and stretch surrounding muscles
Some don’t respond to conservative treatment, therefore may need surgery
Trochanteric bursitis DDX
Snapping hip
Meralgia parasthetica
Disorder characterised by tingling, numbness, and burning pain in outer side of thigh
Compression of lateral femoral cutaneous nerve
Epidemiology meralgia parasthetica
Obesity
Pregnancy
Local trauma
Diseases such as diabetes (related to nerve injuries)
Tight clothes
Age groups affected by meralgia parasthetica
People aged between 30-60 at higher risk
Risk factors of meralgia parasthetica
Age
Diabetes
Pregnancy
Obesity
Clinical presentation of meralgia parasthetica
complaints of pain, burning, numbness, muscle aches in lateral thigh
Pt may have mild symptoms with spontaneous resolution or may have more severe pain that limits function
Prognosis of meralgia parasthetica
Good prognosis
Improvements seen with conservative treatments
Can spontaneously resolve
Acquired dislocation of hip
Native dislocations or dislocations after total hip replacement
Epidemiology of acquired dislocation of hip
Motor vehicle accident- occur when knee hits dashboard in a collision force drives thigh backwards, driving head of femur out of socket
High level fall
Age groups affected by acquired hip dislocation
16-40
Risk factors of acquired hip dislocation
Majority occur from motor vehicle accidents
Clinical presentation of acquired hip dislocation
Severe pain- separation of femur head from acetabulum, surrounding muscles and tendons damaged
Radiating knee pain
Prognosis of acquired hip dislocation
Complications include post-traumatic arthritis, femoral head fracture, recurrent dislocation
Nerve damage, may impact sciatic nerve
Protrusion acetabuli
Socket too deep and bulges into cavity of pelvis
Epidemiology of protrusion acetabuli
Unilateral may be caused by tuberculosis arthritis
fibrous dysplasia (increase in abnormal cell growth)
Age groups affected by protrusio acetabuli
Reported cause of hip pain in OA young adults
Risk factors of protrusio acetabuli
BMI >25
Female- develops soon after puberty, at this stage usually no symptoms just limited ROM
May occur later in life secondary to bone softening disorders
Clinical presentation of protrusion acetabuli
Radiographs of pelvis with an acetabular line projecting medial to ilioischial line
Limited ROM
Pain
Prognosis of protusio acetabuli
Total hip arthroplasty recommended for older adults
Coxa vara
Rare disorder or early childhood
When child starts to crawl or stand, femoral neck bends or develops stress fracture, with continued weightbearing it collapses into virus
Epidemiology of coxa vara
Defect of endochondral ossification in medial part of femoral neck
Age groups affected by coxa vara
Infants
Signs do not arise until early adulthood of femoral shaft
Clinical presentation of coxa vara
May be shortening or bowing of femoral shaft
Prognosis of coxa vara
If shortening is progressive the deformity should ne corrected by an ostomy
Femoral anti-version epidemiology
Excessive anteversion of femoral neck
Int rotation of hip is increased and ext rotation diminished
Age groups affected
Infants
Children should adopt buddha position (knees turned outwards)
Clinical presentation of femoral ante version
Toes point inwards
Prognosis of femoral ante version
Usually improves with growth
Slipped upper femoral epiphysis
Displacement of proximal femoral epiphysis
Uncommon
If one side slips there is a 30% risk of other side slipping
Epidemiology of slipped upper femoral epiphysis
2/3 Pt are overweight and sexually under developed
Usually tall and thin
Age groups affected by slipped femoral epiphysis
Confined to children going through pubertal growth spurts
Boys affected more than girls
Boys 14-15
Risk factors of slipped upper femoral epiphysis
30% case have history of trauma
Clinical presentation of slipped upper femoral epiphysis
Pain in groin/anterior part of thigh or knee
May limp
Onset may be sudden
On examination leg is externally rotated
Leg tends to be 1-2cm shorter
Limitation in abduction and int rotation
Prognosis for slipped upper femoral epiphysis
Following surgery improvements should be
Pyogenic arthritis
Staphylococcus reaches joint
Unless infection is aborted rapidly the femoral head is destroyed by proteolytic enzymes of bacteria and puss
Age groups affected by pyogenic arthritis
Usually seen in children under 2
Clinical presentation of pyogenic arthritis
Child is ill and in pain
Movement attempts are resisted
Local signs of inflammation absent and blood samples are normal
X-ray shows lateral displacement of femoral head, suggesting presence of joint effusion
Prognosis of pyogenic arthritis
Once given ABs symptoms should alleviate
Tuberculosis
Starts as synovitis, or osteomyelitis in adjacent bones
Once arthritis develops, destruction is rapid and may result in pathological dislocation
Clinical presentation of tuberculosis
Pain in hip
In late, neglected cases a cold abscess may present on thigh or buttock
Pt may walk with limp
Muscle wasting may be observed
Limited/painful movement
Prognosis of tuberculosis
Early disease may heal leaving normal/almost normal hip
If joint is destroyed the usual result is unsound fibrous ankylosis, leg is scarred and thin, shorter
The irritable hip
Probably due to non-specific, short lived synovitis with an effusion in hip joint
Irritable hip epidemiology
Exact cause unknown
Age groups affected by irritable hip
most common cause of acute limp and/or hip pain in children
14/1000
Usually occurs 3-8 years
Boys 2x more affected
Risk factors of irritable hip
Being male
Clinical presentation of irritable hip
Pain around hip and limp
Often intermittent and following activity
Restricted ROM
Prognosis of irritable hip
Most children recover within a few days
Deterioration in signs and symptoms require urgent assessment
Rheumatoid arthritis
Progressive bone destruction on both sides of joint without reactive osteophyte formation
Epidemiology of RA
Another rheumatoid disease
Arthritis in other regions
Age groups affected by RA
Middle aged
Risk factors of RA
Women
Middle-aged
Family history
Excess weight
Clinical presentation of RA
Pt normally already has rheumatic disease affecting many joints
Pain in groin usually comes on gradually
Advancing disease may cause difficulty getting into/out of chair
Wasting of buttock/thigh
Limb usually held in ext rotation and fixed flexion
All movements restricted and painful
Prognosis of RA
Disease can be arrested by general treatment
Hip deterioration may be slowed down
Once cartilage and bones are eroded, no treatment will influence progression
Osteoarthritis
Most common form
Eventual degeneration joint destruction
Epidemiology of OA
Obesity= significant contributing factor
Ageing
History of injury
Age groups affected by OA
More common before 45 for men
More common for women over 45
Risk factors of OA
Obesity
Female
Genetics
Repetitive stress on joint
Clinical presentation of OA
Often complain of insidious pain in groin/inguinal region
Pain on side buttock/upper thigh
Exacerbated through physical activity and weight bearing activities
Stiffness in morning, doesn’t last longer than 30 mins, eases following movement
Prognosis of OA
Extremely variable
Different to predict course of treatment
Femoroacetabular impingement
Abnormal contact of femoral head or neck against acetabular rim during movement
CAM impingement
Fem head not round
Pincer impingement
Fem head pinces acetabulum
Epidemiology of femoroacetablar impingement
Can be related to specific osseous abnormalities (congenital or degenerative)
Clinical presentation of femoroacetabular impingement
Complaints of anterolateral hip and/or groin pain
Pain exacerbated from activities requiring deep flexion
Sharp, stabbing pain
Intermittent dull ache in initial stages
Complaints from prolonged sitting, rising from seat
Prognosis of femoroacetabular impingement
Conservative treatments used to increase flexibility and strengthen in core and hip
May cause damage to chondral surface due to repetitive impingement, therefore referral to orthopaedic surgeon may be necessary
Perthes disease
Rare childhood condition that affects the hip
Occurs when blood supply to head of femur is temporarily disrupted
Without adequate blood supply, bone cells die (aka avascular necrosis)
Perthes Hx
P in groin
Medial thigh or knee P (w/o knee patho)
Perthes S+S
Antalgic gait
Red ROM
Hip may refer P down to knee
Acetabular labral tear Hx
Prior trauma
Deep hip/groin P
Worse with full hip flexion
Possible locking
Acetabular labral tear SSx
Audible click with motion
P with full passive hip flexion
Hernia- inguinal or femoral Hx
M>F 9:1
Prior heavy lifting
Lifting with Valsalva causes more P
Hernia SSx
Palpable protrusion worse with valsalva
Red flags- nausea, fever, vomiting, discolouration indicative of strangulated hernia= medical emergency
Hernia DDx
Groin strain
Testicular torsion
Piriformis syndrome Hx
Possible P down back of leg
Worse when sitting on hard surfaces
P getting out of bed
P in buttock worse with movement
Piriformis syndrome SSx
Tender to palpation
+ve SLR
Piriformis syndrome DDx
Lumbar radiculopathy
Disc herniation
Lumbar sprain/strain
