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AGPC 3 Exam 1 > Hip Disorders > Flashcards

Hip Disorders Flashcards

1
Q

What are are the most common conditions affecting the hip?

A

Trochanteric and gluteus medius bursitis, osteoarthritis, and fractures of the femur

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2
Q

What are the Two bony prominences that project from the femoral neck?

A

the greater trochanter laterally and the lesser trochanter medially

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3
Q

T/F: Lateral hip pain is unlikely to be due to hip joint disease.

A

TRUE

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4
Q

dX FOR Lateral hip pain that is aggravated by direct pressure

A

its classic pattern of trochanteric bursitis.

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5
Q

Patient with Progressive lateral hip pain that is aggravated by direct pressure and weight bearing. accompanied with weight loss, older adult, hx of Ca

A

r/o metastatic ca of femur

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6
Q

dx of pt with Lateral hip pain accompanied by paresthesias or hypesthesias

A

meralgia paresthetica (lateral femoral cutaneous nerve entrapment)

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7
Q

dx of pt with Pain in the groin or medial thigh region, anterior hip

A

r/t hip disease

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8
Q

referred to the buttocks and/or lateral thigh is r/t?

A

Pain generated in the lumbosacral spine

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9
Q

why pt has pain in the groin if this is a hip problem?

A

because irritation of the capsule and/or synovial lining refers pain

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10
Q

pt complains of Anterior hip or groin pain with gradual onset with worsening during activity and relief during rest

A

osteoarthritis

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11
Q

pt who using glucocorticoid use complains of acute onset of groin pain and impairment of weight bearing

A

osteonecrosis

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12
Q

t/f: Posterior (gluteal) hip pain is the least common pain pattern affecting the hip.

A

TRUE

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13
Q

What is Trochanteric bursitis?

A

caused by an exaggerated movement of the gluteus medius tendon and the tensor fascia lata over the outer femur. gait impairments can increase friction and pressure over the trochanteric process

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14
Q

What happens if Trochanteric bursitis is left untreated?

A

the normally paper thin bursal wall thickens, fibroses, and gradually loses its ability to lubricate the outer hip

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15
Q

pt complains of lateral hip pain, with point tenderness over the trochanteric bursa.

A

Trochanteric bursitis

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16
Q

Where is the location of the point of tenderness for trochanteric bursa?

A

approximately one inch posterior and superior to the greater trochanter, and is located about 7.5 cm deep to the skin

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17
Q

Age Osteoarthritis most commonly presents in patients?

A

over 40 years of age

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18
Q

The principal symptom associated with osteoarthritis

A

hip pain typically exacerbated by activity and relieved by rest

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19
Q

As lateral hip pain is associated with bursitis, osteoarthritis usually presents with….

A

groin pain that is aggravated by movement rather than by direct pressure

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20
Q

What are the key clinical features suggestive of osteoarthritis?

A
  • internal rotation of less than 15 degrees
  • pain on internal rotation
  • morning stiffness (less than 30 to 60 minutes),
  • flexion less than 115 degrees
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21
Q

hypesthesia

A

numbness and tingling

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22
Q

paresthesia

A

burning pain

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23
Q

Lateral hip pain associated with paresthesias and hypesthesias

A

Meralgia paresthetica - lateral femoral cutaneous nerve, a pure sensory nerve, is susceptible to compression

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24
Q

pt who uses Corticosteroid use with excessive alcohol intake and complains of Groin pain followed by thigh and buttock pain.

A

Osteonecrosis

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25
Q

Referred pain from the lumbosacral spine or sacroiliac joint

A

to hip, gluteal area

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26
Q

first priority in examining the hip

A

patient’s gait, tolerance of squatting, and general ability to move in the examination room

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27
Q

test for referred pain to the hip from the lumbar spinal nerves

A

straight leg raise

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28
Q

how to exam s/s with lateral femoral cutaneous nerve

A

exam sensation in the upper outer thigh

29
Q

how to exam s/s with lower abdominal vascular structures

A

lower extremity pulses

30
Q

Trendelenburg gait

A

the patient shifts the torso over the affected hip, thereby reducing the load on the hip and decreasing pain = hip joint disease and/or weakness of the gluteus medius muscle

31
Q

patient with an antalgic gait

A

spends a shorter time weight bearing on the affected side because of hip pain

32
Q

Characteristics of short leg limp, secondary to leg length discrepancy

A

increase in the up and down movement of the head and shoulders as the body falls onto the short leg and then rises up on the long leg

33
Q

dx with minimal impact upon ambulation.

A

meralgia paresthetica, mild hip arthritis, and most cases of bursitis

34
Q

pt with impaired squatting

A

moderate to advanced hip arthritis, moderate to severe bursitis

35
Q

why Inspect for pelvic obliquity

A

screening maneuver for leg length discrepancy
-The patient is asked to stand. The hands are placed on top of the iliac crests and the level of the pelvis is estimated.

36
Q

Empiric treatment for hip pain

A

-Minimizing weight bearing activities (walking and standing)
●Avoid physically demanding work, especially work that involves repetitious bending or twisting at the waist
●Avoid direct pressure over the outer hip
●Sleep with a pillow between the legs
●Perform daily cross-leg, passive stretching exercises
●Use nonsteroidal antiinflammatory drugs (NSAIDs) for 7 to 10 days

37
Q

pt who has 5 to 10 degrees of internal and external rotation

A

possible Severe osteoarthritis, acute synovitis, and septic arthritis

38
Q

What is the Patrick (Fabere) test

A

assessment of the hip and the sacroiliac joint

39
Q

how to preform the Patrick (Fabere) test

A

examiner Flexes, ABducts, Externally Rotates, and Extends the affected leg so that the ankle of that leg is on top of the opposite knee. The affected leg is then slowly lowered toward the examining table.

40
Q

negative Patrick (Fabere) test

A

when the test leg falls at least parallel to the opposite leg

41
Q

positive Patrick (Fabere) test

A

when the affected leg remains above the opposite leg= hip disease, iliopsoas spasm, or sacroiliac disease

42
Q

pt with Asymetry of the iliac crests during Inspection for pelvic obliquity

A

leg length discrepancy, pelvic fracture, scoliosis, and unilateral paraspinal muscle spasm.

43
Q

trochanteric process

A

most prominent portion of the femur

44
Q

Palpation of the trochanteric bursa maneuver

A

palpated to assess for tenderness. pt must be sitting with hip flexed@90 degrees to be able to adequately identify the superior aspect of the trochanteric process. Apply Firm pressure to determine local tenderness in the obese patient.

45
Q

What maneuver is used for pt with suspected meralgia paresthetica

A

Sensation over the anterolateral thigh–> skin is tested for light touch, pinprick, and deep pain sensation. Loss of sensation (hypesthesia) or a feeling of heightened sensation (dysesthesia) is characteristic of meralgia paresthetica.

46
Q

What maneuver is used to determine the presence of radiculopathy/ degree of irritation of the nerve roots

A

straight leg raise maneuver

47
Q

How do you preform the straight leg raise maneuver?

A

performed in the sitting or lying position. The leg is gradually moved to the fully extended position. Ankle dorsiflexion can be added in full extension to bring out subtle cases.

48
Q

positive straight leg maneuver s/s and meaning

A

reproduces the patient’s pain in the leg, buttock, or back at 60 degrees or less of leg elevation. The pain is usually worsened by dorsiflexion at the ankle and relieved by flexion of the knee and hip. A positive test = indicates S1 or L5 root irritation.

49
Q

if tightness or pain is felt only in the hamstring area during straight leg maneuver

A

test is inconclusive

50
Q

how to preform Lower extremity neurologic examination

A

Sensory testing of the feet for light touch, pinprick, and deep pain sensation are combined with motor testing of dorsiflexion and plantarflexion to determine the integrity of lower extremity neurologic function.

51
Q

5th lumbar root (L4-5 disk) is responsible for ??

A

sensation over the top of the foot and for dorsiflexion

52
Q

S1 root (L5-S1 disk) is responsible for ???

A

sensation on the bottom of the foot and plantarflexion

53
Q

Where to Palpate of the sacroiliac joint

A

1 inch medial and 1 inch inferior to the posterior superior iliac spine. The patient is placed in the prone position. Firm to hard pressure is placed directly over the upper portion of the sacroiliac joint.

  • tenderness= severe paraspinal muscle spasm
  • no tenderness= involvement of the adjacent bone
54
Q

pt c/o Posterior (gluteal) hip pain

A

= is the least common pain pattern affecting the hip. It is most often a sign of sacroiliac joint disease–> palpate sacroiliac joint

55
Q

what is the apparent leg length

A

distance from the umbilicus to the medial malleolus.

56
Q

Pelvic obliquity

A

checking asymmetry–> causing an apparent leg-length discrepancy

57
Q

What is the true leg length

A

distance from the anterior superior iliac spine to the medial malleolus

58
Q

cause for antalgic gait

A

pain versus Abductor (gluteus medius and gluteus minimus) weakness

59
Q

if antalgic gait is related to abductor dysfunction, pt will…

A

likely have an abductor, or Trendelenburg lurch (compensation)= pelvis tilts toward the unsupported side during one-legged stance

60
Q

Thomas test

A

checks for hip flexion contractures/ tests for anterior or lateral capsular restrictions or hip flexor tightness

  • pt sits at end of table, lays back and brings knees to chest & lower left leg down while holding right knee
  • positive tightness if thigh doesn’t touch table or stays extended
61
Q

how to preform Ober test

A

patient lies on the uninvolved side with hip and knee flexed in a 90-degree angle. The examiner placed the knee in a 5° flexion angle, fully abducts the lower extremity that needs to be tested, then allows the force of gravity to adduct the extremity until the hip cannot adduct any further.

**Modified= patient is positioned on the side of the unaffected leg with the hip in neutral position and the knee in full extension

62
Q

purpose of Ober test

A

checks for tightness of the iliotibial band & TFL fexibility (iliotibial band syndrome)

63
Q

purpose of Ely’s test

A

determines if femoral nerve or root compression is present

64
Q

purpose of Patrick (FABERE Test)

A

assess for the sacroiliac joint or hip joint being the source of the patient’s pain

65
Q

AP Laterla view of hip characteristics for developmental dysplasia of the hip.

A

up-sloping lateral edge of the acetabulum

66
Q

What has CT been replaced by MRI for detailed evaluation of the soft tissues around the hip

A

CTs limited soft tissue contrast

67
Q

if using radiology for screening of hip pathology, NP should NOT use_____, but _____ instead?

A

MRI -because its ability to detect bony pathology is limited.
-Use conventional radiographs instaed

68
Q

pt with c/o Groin pain with internal rotation of the hip

A

hip pathology UNTIL proven otherwise

AGPC 3 Exam 1 (8 decks)

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