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Orthopaedic Conditions > Hip conditions > Flashcards

Hip conditions Flashcards

1
Q

Snapping hip syndrome

A

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

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2
Q

What its snapping noise associated with for snapping hip syndrome

A

Thickened IT band, causing slippage back and forth over greater trochanter –> pain + audible snapping

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3
Q

Epidemiology of snapping hip

A

tight muscle
Internal- Iliopsoas tendon snapping over ant aspect of fem head
External- Tight IT band snapping over greater trochanter

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4
Q

Age groups affected by snapping hip

A

Younger people (athletes) as hips become very tight during growth spurts

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5
Q

Risk factors of snapping hip

A

Overuse- particularly in sport, repetitive strain on a muscle

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6
Q

Clinical presentation of snapping hip

A

Palpable or audible snapping sensation that is heard during movement
Commonly localise pain to greater trochanter

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7
Q

Prognosis for snapping hip

A

May asymptomatic, therefore benign condition, amenable by stretching/conservative treatment
If Pt not relieved by 6 months surgical options may be necessary

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8
Q

Iliopectineal bursitis

A

Inflammation of bursa located beneath iliac muscle

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9
Q

Epidemiology of iliopectineal bursitis

A

Acute trauma
Overuse injury

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10
Q

Age groups affected by iliopectineal bursitis

A

Seen predominately in males, generally doesn’t occur till after skeleton has matured
40-60

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11
Q

Risk factors of iliopectineal bursitis

A

Having OA or RA

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12
Q

Clinical presentation of iliopectineal bursitis

A

Variable symptoms
Pain, mass lesion, or compression syndrome of inguinal compartment

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13
Q

Prognosis of iliopectinal bursitis

A

RICE
Should get better on own

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14
Q

Ischial/trochanteric bursitis

A

Condition of inflammation of bursa between ischial tuberosity + gluteus mediums

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15
Q

Epidemiology of ischial/trochanteric bursitis

A

Receptive stress/microtrauma on ischial bursa, causing inflammation
Can happen when sitting for long periods
Playing sports which require repetitive motion

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16
Q

Age groups affected by ischial/trochanteric bursitis

A

Seen predominately in male, generally doesn’t occur till skeleton has matured
40-60

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17
Q

Risk factors of ischial/trochanteric bursitis

A

Having OR or RA

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18
Q

Clinical presentation of ischial/trochanteric bursitis

A

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

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19
Q

Prognosis for ischial/trochanteric bursitis

A

NSAIDs and PT to strengthen and stretch surrounding muscles
Some don’t respond to conservative treatment, therefore may need surgery

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20
Q

Trochanteric bursitis DDX

A

Snapping hip

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21
Q

Meralgia parasthetica

A

Disorder characterised by tingling, numbness, and burning pain in outer side of thigh
Compression of lateral femoral cutaneous nerve

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22
Q

Epidemiology meralgia parasthetica

A

Obesity
Pregnancy
Local trauma
Diseases such as diabetes (related to nerve injuries)
Tight clothes

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23
Q

Age groups affected by meralgia parasthetica

A

People aged between 30-60 at higher risk

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24
Q

Risk factors of meralgia parasthetica

A

Age
Diabetes
Pregnancy
Obesity

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25
Q

Clinical presentation of meralgia parasthetica

A

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

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26
Q

Prognosis of meralgia parasthetica

A

Good prognosis
Improvements seen with conservative treatments
Can spontaneously resolve

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27
Q

Acquired dislocation of hip

A

Native dislocations or dislocations after total hip replacement

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28
Q

Epidemiology of acquired dislocation of hip

A

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

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29
Q

Age groups affected by acquired hip dislocation

A

16-40

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30
Q

Risk factors of acquired hip dislocation

A

Majority occur from motor vehicle accidents

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31
Q

Clinical presentation of acquired hip dislocation

A

Severe pain- separation of femur head from acetabulum, surrounding muscles and tendons damaged
Radiating knee pain

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32
Q

Prognosis of acquired hip dislocation

A

Complications include post-traumatic arthritis, femoral head fracture, recurrent dislocation
Nerve damage, may impact sciatic nerve

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33
Q

Protrusion acetabuli

A

Socket too deep and bulges into cavity of pelvis

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34
Q

Epidemiology of protrusion acetabuli

A

Unilateral may be caused by tuberculosis arthritis
fibrous dysplasia (increase in abnormal cell growth)

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35
Q

Age groups affected by protrusio acetabuli

A

Reported cause of hip pain in OA young adults

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36
Q

Risk factors of protrusio acetabuli

A

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

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37
Q

Clinical presentation of protrusion acetabuli

A

Radiographs of pelvis with an acetabular line projecting medial to ilioischial line
Limited ROM
Pain

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38
Q

Prognosis of protusio acetabuli

A

Total hip arthroplasty recommended for older adults

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39
Q

Coxa vara

A

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

40
Q

Epidemiology of coxa vara

A

Defect of endochondral ossification in medial part of femoral neck

41
Q

Age groups affected by coxa vara

A

Infants
Signs do not arise until early adulthood of femoral shaft

42
Q

Clinical presentation of coxa vara

A

May be shortening or bowing of femoral shaft

43
Q

Prognosis of coxa vara

A

If shortening is progressive the deformity should ne corrected by an ostomy

44
Q

Femoral anti-version epidemiology

A

Excessive anteversion of femoral neck
Int rotation of hip is increased and ext rotation diminished

45
Q

Age groups affected

A

Infants
Children should adopt buddha position (knees turned outwards)

46
Q

Clinical presentation of femoral ante version

A

Toes point inwards

47
Q

Prognosis of femoral ante version

A

Usually improves with growth

48
Q

Slipped upper femoral epiphysis

A

Displacement of proximal femoral epiphysis
Uncommon
If one side slips there is a 30% risk of other side slipping

49
Q

Epidemiology of slipped upper femoral epiphysis

A

2/3 Pt are overweight and sexually under developed
Usually tall and thin

50
Q

Age groups affected by slipped femoral epiphysis

A

Confined to children going through pubertal growth spurts
Boys affected more than girls
Boys 14-15

51
Q

Risk factors of slipped upper femoral epiphysis

A

30% case have history of trauma

52
Q

Clinical presentation of slipped upper femoral epiphysis

A

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

53
Q

Prognosis for slipped upper femoral epiphysis

A

Following surgery improvements should be

54
Q

Pyogenic arthritis

A

Staphylococcus reaches joint
Unless infection is aborted rapidly the femoral head is destroyed by proteolytic enzymes of bacteria and puss

55
Q

Age groups affected by pyogenic arthritis

A

Usually seen in children under 2

56
Q

Clinical presentation of pyogenic arthritis

A

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

57
Q

Prognosis of pyogenic arthritis

A

Once given ABs symptoms should alleviate

58
Q

Tuberculosis

A

Starts as synovitis, or osteomyelitis in adjacent bones
Once arthritis develops, destruction is rapid and may result in pathological dislocation

59
Q

Clinical presentation of tuberculosis

A

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

60
Q

Prognosis of tuberculosis

A

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

61
Q

The irritable hip

A

Probably due to non-specific, short lived synovitis with an effusion in hip joint

62
Q

Irritable hip epidemiology

A

Exact cause unknown

63
Q

Age groups affected by irritable hip

A

most common cause of acute limp and/or hip pain in children
14/1000
Usually occurs 3-8 years
Boys 2x more affected

64
Q

Risk factors of irritable hip

A

Being male

65
Q

Clinical presentation of irritable hip

A

Pain around hip and limp
Often intermittent and following activity
Restricted ROM

66
Q

Prognosis of irritable hip

A

Most children recover within a few days
Deterioration in signs and symptoms require urgent assessment

67
Q

Rheumatoid arthritis

A

Progressive bone destruction on both sides of joint without reactive osteophyte formation

68
Q

Epidemiology of RA

A

Another rheumatoid disease
Arthritis in other regions

69
Q

Age groups affected by RA

A

Middle aged

70
Q

Risk factors of RA

A

Women
Middle-aged
Family history
Excess weight

71
Q

Clinical presentation of RA

A

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

72
Q

Prognosis of RA

A

Disease can be arrested by general treatment
Hip deterioration may be slowed down
Once cartilage and bones are eroded, no treatment will influence progression

73
Q

Osteoarthritis

A

Most common form
Eventual degeneration joint destruction

74
Q

Epidemiology of OA

A

Obesity= significant contributing factor
Ageing
History of injury

75
Q

Age groups affected by OA

A

More common before 45 for men
More common for women over 45

76
Q

Risk factors of OA

A

Obesity
Female
Genetics
Repetitive stress on joint

77
Q

Clinical presentation of OA

A

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

78
Q

Prognosis of OA

A

Extremely variable
Different to predict course of treatment

79
Q

Femoroacetabular impingement

A

Abnormal contact of femoral head or neck against acetabular rim during movement

80
Q

CAM impingement

A

Fem head not round

81
Q

Pincer impingement

A

Fem head pinces acetabulum

82
Q

Epidemiology of femoroacetablar impingement

A

Can be related to specific osseous abnormalities (congenital or degenerative)

83
Q

Clinical presentation of femoroacetabular impingement

A

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

84
Q

Prognosis of femoroacetabular impingement

A

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

85
Q

Perthes disease

A

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)

86
Q

Perthes Hx

A

P in groin
Medial thigh or knee P (w/o knee patho)

87
Q

Perthes S+S

A

Antalgic gait
Red ROM
Hip may refer P down to knee

88
Q

Acetabular labral tear Hx

A

Prior trauma
Deep hip/groin P
Worse with full hip flexion
Possible locking

89
Q

Acetabular labral tear SSx

A

Audible click with motion
P with full passive hip flexion

90
Q

Hernia- inguinal or femoral Hx

A

M>F 9:1
Prior heavy lifting
Lifting with Valsalva causes more P

91
Q

Hernia SSx

A

Palpable protrusion worse with valsalva
Red flags- nausea, fever, vomiting, discolouration indicative of strangulated hernia= medical emergency

92
Q

Hernia DDx

A

Groin strain
Testicular torsion

93
Q

Piriformis syndrome Hx

A

Possible P down back of leg
Worse when sitting on hard surfaces
P getting out of bed
P in buttock worse with movement

94
Q

Piriformis syndrome SSx

A

Tender to palpation
+ve SLR

95
Q

Piriformis syndrome DDx

A

Lumbar radiculopathy
Disc herniation
Lumbar sprain/strain

Orthopaedic Conditions (11 decks)

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