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MSK > Hip conditions > Flashcards

Hip conditions Flashcards

1
Q

what attaches to the greater trochanter of the femur ?

A

abductors and rotators

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2
Q

what attaches to the lesser trochanter of the femur ?

A

psoas

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3
Q

what type of cartilage is in the acetabulum ?

A

fibrocartilage

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4
Q

what are the branches of the profound femoris artery ?

A

medial femoral circumflex artery

lateral femoral circumflex artery

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5
Q

what are the features of the MFCA ?

A

2 branches
ascend to head
transverse to form cruciate anastomosis

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6
Q

what are features of the LFCA ?

A

3 branches
ascending to joint capsule
transverse tp cruciate anastomosis
descending branch

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7
Q

what is the clinical significance of the femur head blood supply ?

A

the primary supply enters via capsule
in fractures the intracapsular supply is disrupted
extra capsular supply is maintained

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8
Q

what is osteoarthritis and what are its characteristics ?

A

progressive loss of articular cartilage, secondary bony changes
pain and stiffness of affected joint, limiting everyday life

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9
Q

what is trochanteric bursitis ?

A

the bursa on the greater trochanter communicating with the ileotibial band is inflammed

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10
Q

what causes trochanteric bursitis ?

A

F>M
trauma
over use - runners
abnormal movements - scoliosis, total hip replacement, OA

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11
Q

how does trochanteric bursitis present ?

A

pain - point tenderness on lateral hip

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12
Q

what are signs of trochanter bursitis ?

A

look - scars from previous surgery, gluteal muscle wasting
feel - tenderness at greater tuberosity
move - worse pain in active abduction

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13
Q

what are investigations of trochanter bursitis ?

A

Xray - may be normal, OA
MRI
USS - guided injection

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14
Q

what is the treatment for trochanter bursitis ?

A 
rest
NSAIDs 
physio
corticosteroid injection
surgery - bursectomy
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15
Q

what is avascular necrosis ?

A

death of bone due to loss of blood supply

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16
Q

what gets avascular necrosis ?

A

M>F
35-50
80% bilateral
3% multifocal

17
Q

what are traumatic risk factors for avascular necrosis ?

A

irradiation
fracture
dislocation
iatrogenic

18
Q

what are systemic risk factors for avascular necrosis ?

A 
idiopathic
hypercoaguable states
steroids
haematological - sickle cell, lymphoma, leukaemia
Caisson's disease
alcoholism
19
Q

what are symptoms of avascular necrosis ?

A

insidious onset of groin pain

pain with stairs, walking uphill, impact activities

20
Q

what is seen on exam of avascular necrosis ?

A

largely normal

may replicate early arthritis - reduced ROM, stiff joint

21
Q

how is avascular necrosis investigated ?

A

Xray

MRI

22
Q

what is the non-operative treatment of avascular necrosis ?

A 
reduce weight bearing
NSAIDs
bisphosphonates
anticoagulants
physio - keep moving
23
Q

what is the surgical treatment of avascular necrosis ?

A

restore blood supply - core decompression, vascularised graft
move lesion away from weight bearing are
total hip replacement

24
Q

what is femoroacetabular impingement FAI

A

impingement of femoral neck against anterior edge of acetabulum
younger patients, can develop secondary arthritis

25
Q

what are the different types of FAI ?

A

cam lesion - young athletic males, excess bone on head of femur
pincer - young females, abnormal acetabulum overhangs

26
Q

what are associated injuries with FAI ?

A

labral degeneration and tears
cartilage damage and flap tears
secondary OA

27
Q

what is the presentation of FAI ?

A

groin pain - worse with flexion

mechanical symptoms - block to movement, pain with certain movements squatting lunging etc

28
Q

what is seen on exam of FAI ?

A

reduced flexion and internal rotation

positive FADIR - flexion adduction and internal rotation

29
Q

what are the examinations for FAI ?

A

Xray

MRI

30
Q

what is the non-operative treatment for FAI ?

A

activity modulation
NSAIDs
physio

31
Q

what is the operative treatment for FAI ?

A

arthroscopy - shave down defect, deal with tears

open - resection, periacetabular osteotomy, hip arthroplasty (replacement)

32
Q

what is the most common labral tear ?

A

anterosuperior tear

33
Q

who is most at risk of a labral tear ?

A

mostly active females of all ages

34
Q

what causes labral tears ?

A 
FAI
trauma
OA
dysplasia
collagen disease - Ehlers-Danlos
35
Q

how does a labral tear present ?

A

groin or hip pain
snapping sensation
jamming or locking

36
Q

what is seen on exam of labral tears ?

A

can be normal

positive FABER - flexion, abduction, external rotation

37
Q

what are the investigations for labral tears ?

A

Xray
MRI
diagnostic injection

38
Q

how do you treat labral tears ?

A

non-op - NSAIDs, rest, physio, steroid injection

op - arthroscopy

MSK (29 decks)

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