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MSK > Hip conditions > Flashcards

Hip conditions Flashcards

1
Q

Which muscle groups attach to greater trochanter?

A

Abductors and rotators

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2
Q

Which muscle attaches to lesser trochanter of femur?

A

Psoas

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3
Q

What is the labrum?

A

Fibrocartilaginous lining of acetabulum

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4
Q

What is the purpose of the labrum?

A

Deepens socket

Adds stability

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5
Q

What are the branches of the profunda femoris artery?

A

Medial and lateral circumflex arteries

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6
Q

What is the main blood supply to the hip joint?

A

Medial and lateral circumflex arteries from profonda femoris a.

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7
Q

What is the significance of the blood supply to the hip?

A

Fracture of neck of femur can disrupt blood supply and lead to avascular necrosis

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8
Q

What is the function of the hip bursae?

A

Reduce friction between tissues

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9
Q

What is osteoarthritis?

A

Degenerative change of synovial joints
Progressive loss of articular cartilage
Results in secondary bony changes

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10
Q

What is the presentation of osteoarthritis?

A

Pain and stiffness of affected joint

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11
Q

What is the trochanteric bursa and where is it?

A

Fluid-filled sac between hip abductors and ITB

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12
Q

What happens in trochanteric bursitis?

A

Inflammation of bursa and swelling

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13
Q

Which sex does trochanteritic bursitis tend to affect more?

A

Females

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14
Q

What are the causes of trochanteric bursitis?

A

Trauma
Over-use: athletes (runners), repetitive movements
Abnormal movements: distant problem: scoliosis OR local problem: muscle wasting following surgery, THR, OA

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15
Q

How does trochanteric bursitis present?

A

Pain: point tenderness on lateral hip

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16
Q

What is the examination for trochanteric bursitis?

A 
LOOK:
?scars previous surgery
?muscle wasting (gluteals)
FEEL:
?tenderness greater tuberosity
MOVE:
?worst pain active abduction
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17
Q

What is the worst pain in trochanteric bursitis?

A

Active abduction

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18
Q

What are the investigations for trochanteric bursitis?

A

XR
MRI
USS

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19
Q

What else can be done in an USS for trochanteric bursitis?

A

Guided steroid injection

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20
Q

What is the treatment for trochanteric bursitis?

A 
NSAIDs
Rest/activity modification
Physio: strength muscles around joint, stretching
Corticosteroid injections
Surgery: bursectomy
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21
Q

What is avascular necrosis?

A

Death of bone due to loss of blood supply

22
Q

Which sex does avascular necrosis affect more?

A

Males

23
Q

What are the risk factors for avascular necrosis?

A

Trauma: irradiation, fracture, dislocation, iatrogenic
Systemic: idiopathic, hypercoaguable states, steroids, haematological (sickle cell disease, lymphoma, leukaemia), Caisson’s disease, alcoholism

24
Q

What is Caisson’s disease?

A

Decompression sickness

25
Q

What kind of fracture can cause injury to femoral head blood supply?

A

Intracapsular fracture

26
Q

What is the pathoanatomic cascade of avascular necrosis?

A 
Coagulation of intraosseous microcirculation ->
Venous thrombosis ->
Retrograde arterial occlusion ->
Intraosseous hypertension ->
Reduced blood flow to head ->
Cell death ->
Chondral fracture and collapse
27
Q

What are the symptoms of avascular necrosis?

A

Insidious onset of groin pain
Pain with stairs/walking uphill
Limp

28
Q

On examination, how might avascular necrosis present?

A

Largely normal

May replicate early arthritis: reduced ROM, stiff joint

29
Q

What is the non-operative treatment for avascular necrosis?

A 
Reduce weight-bearing
NSAIDs
Biphosphonates
Anticoagulants
Physio
30
Q

What are the surgical management options for avascular necrosis?

A
  • Core decompression = restore blood supply
  • Rotational osteotomy = move lesion away from weight bearing area
  • THR
31
Q

What is femoroacetabular impingement (FAI) a common cause of?

A
  • Hip pathology in younger patient

- Secondary osteoarthritis

32
Q

What 2 categories is femoroacetabular impingement (FAI) divided into?

A

Cam lesion

Pincer

33
Q

What is femoroacetabular impingement (FAI?

A

Impingement of femoral neck against anterior edge of acetabulum

34
Q

What is a cam lesion in FAI?

A

A deformity on the femoral head, grinds the cartilage in the acetabulum

35
Q

What is a pincer lesion in FAI?

A

Acetabulum-based impingement

Extra bone extends out over the normal rim of the acetabulum

36
Q

What does abnormal acetabulum lead to?

A

Anterosuperior acetabular ring overhand

Acetabular protrusion

37
Q

Who is more commonly affected by pincer lesion in FAI?

A

Active females

38
Q

What are associated injuries of FAI?

A

Labral degeneration and tears
Cartilage damage and flap tears
Secondary hip OA

39
Q

How does femoroacetabular impingement (FAI) usually present?

A

Groin pain - worse with flexion
Block to movement
Pain with certain manoeuvres: getting out chair/squatting/lunging

40
Q

How does femoroacetabular impingement (FAI) usually present on examination?

A

Reduced flexion and internal rotation
Positive FADIR test
- Flexion, Adduction, Internal Rotation

41
Q

What is the FADIR test?

A

The FADIR (flexion, adduction, and internal rotation) test is a passive motion test to help diagnose hip impingement

42
Q

What are the investigations for femoroacetabular impingement (FAI)?

A

XR

MRI

43
Q

What is the treatment for femoroacetabular impingement (FAI)?

A

Activity modification
NSAIDs
Physio
Arthroscopy: shaves down defect, deals with labral tears
Open surgery: resection, periacetabular osteotomy or hip arthroplasty (resurfacing or replacement)

44
Q

What is the most common anterosuperior tear of the hip joint?

A

Labral tear

45
Q

Who is commonly affected by labral tears?

A

Any age

Active females

46
Q

What are causes of labral tear?

A 
FAI
Trauma
OA
Dysplasia
Collagen diseases - Ehlers-Danlos
47
Q

What is the presentation of a labral tear?

A

Groin or hip pain
Snapping sensation
Jamming or locking

48
Q

How does a labral tear present on examination?

A

Can be normal

Positive FABER test (Flexion, Abduction, External Rotation)

49
Q

What is the FABER test?

A

The FABER test is used to identify the presence of hip pathology by attempting to reproduce pain in the hip, lumbar spine or sacroiliac region
(Flexion, Abduction, External Rotation)

50
Q

What are investigations for a labral tear?

A

XR
MRI arthrogram
Diagnostic injection

51
Q

What are the treatment options for a labral tear?

A

Non-operative: activity modification, NSAIDs, physio, steroid injections
Operative: arthroscopy (repair or resection)

MSK (17 decks)

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