Hip Disorders Flashcards
What are are the most common conditions affecting the hip?
Trochanteric and gluteus medius bursitis, osteoarthritis, and fractures of the femur
What are the Two bony prominences that project from the femoral neck?
the greater trochanter laterally and the lesser trochanter medially
T/F: Lateral hip pain is unlikely to be due to hip joint disease.
TRUE
dX FOR Lateral hip pain that is aggravated by direct pressure
its classic pattern of trochanteric bursitis.
Patient with Progressive lateral hip pain that is aggravated by direct pressure and weight bearing. accompanied with weight loss, older adult, hx of Ca
r/o metastatic ca of femur
dx of pt with Lateral hip pain accompanied by paresthesias or hypesthesias
meralgia paresthetica (lateral femoral cutaneous nerve entrapment)
dx of pt with Pain in the groin or medial thigh region, anterior hip
r/t hip disease
referred to the buttocks and/or lateral thigh is r/t?
Pain generated in the lumbosacral spine
why pt has pain in the groin if this is a hip problem?
because irritation of the capsule and/or synovial lining refers pain
pt complains of Anterior hip or groin pain with gradual onset with worsening during activity and relief during rest
osteoarthritis
pt who using glucocorticoid use complains of acute onset of groin pain and impairment of weight bearing
osteonecrosis
t/f: Posterior (gluteal) hip pain is the least common pain pattern affecting the hip.
TRUE
What is Trochanteric bursitis?
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
What happens if Trochanteric bursitis is left untreated?
the normally paper thin bursal wall thickens, fibroses, and gradually loses its ability to lubricate the outer hip
pt complains of lateral hip pain, with point tenderness over the trochanteric bursa.
Trochanteric bursitis
Where is the location of the point of tenderness for trochanteric bursa?
approximately one inch posterior and superior to the greater trochanter, and is located about 7.5 cm deep to the skin
Age Osteoarthritis most commonly presents in patients?
over 40 years of age
The principal symptom associated with osteoarthritis
hip pain typically exacerbated by activity and relieved by rest
As lateral hip pain is associated with bursitis, osteoarthritis usually presents with….
groin pain that is aggravated by movement rather than by direct pressure
What are the key clinical features suggestive of osteoarthritis?
- internal rotation of less than 15 degrees
- pain on internal rotation
- morning stiffness (less than 30 to 60 minutes),
- flexion less than 115 degrees
hypesthesia
numbness and tingling
paresthesia
burning pain
Lateral hip pain associated with paresthesias and hypesthesias
Meralgia paresthetica - lateral femoral cutaneous nerve, a pure sensory nerve, is susceptible to compression
pt who uses Corticosteroid use with excessive alcohol intake and complains of Groin pain followed by thigh and buttock pain.
Osteonecrosis
Referred pain from the lumbosacral spine or sacroiliac joint
to hip, gluteal area
first priority in examining the hip
patient’s gait, tolerance of squatting, and general ability to move in the examination room
test for referred pain to the hip from the lumbar spinal nerves
straight leg raise
how to exam s/s with lateral femoral cutaneous nerve
exam sensation in the upper outer thigh
how to exam s/s with lower abdominal vascular structures
lower extremity pulses
Trendelenburg gait
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
patient with an antalgic gait
spends a shorter time weight bearing on the affected side because of hip pain
Characteristics of short leg limp, secondary to leg length discrepancy
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
dx with minimal impact upon ambulation.
meralgia paresthetica, mild hip arthritis, and most cases of bursitis
pt with impaired squatting
moderate to advanced hip arthritis, moderate to severe bursitis
why Inspect for pelvic obliquity
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.
Empiric treatment for hip pain
-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
pt who has 5 to 10 degrees of internal and external rotation
possible Severe osteoarthritis, acute synovitis, and septic arthritis
What is the Patrick (Fabere) test
assessment of the hip and the sacroiliac joint
how to preform the Patrick (Fabere) test
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.
negative Patrick (Fabere) test
when the test leg falls at least parallel to the opposite leg
positive Patrick (Fabere) test
when the affected leg remains above the opposite leg= hip disease, iliopsoas spasm, or sacroiliac disease
pt with Asymetry of the iliac crests during Inspection for pelvic obliquity
leg length discrepancy, pelvic fracture, scoliosis, and unilateral paraspinal muscle spasm.
trochanteric process
most prominent portion of the femur
Palpation of the trochanteric bursa maneuver
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.
What maneuver is used for pt with suspected meralgia paresthetica
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.
What maneuver is used to determine the presence of radiculopathy/ degree of irritation of the nerve roots
straight leg raise maneuver
How do you preform the straight leg raise maneuver?
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.
positive straight leg maneuver s/s and meaning
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.
if tightness or pain is felt only in the hamstring area during straight leg maneuver
test is inconclusive
how to preform Lower extremity neurologic examination
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.
5th lumbar root (L4-5 disk) is responsible for ??
sensation over the top of the foot and for dorsiflexion
S1 root (L5-S1 disk) is responsible for ???
sensation on the bottom of the foot and plantarflexion
Where to Palpate of the sacroiliac joint
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
pt c/o Posterior (gluteal) hip pain
= is the least common pain pattern affecting the hip. It is most often a sign of sacroiliac joint disease–> palpate sacroiliac joint
what is the apparent leg length
distance from the umbilicus to the medial malleolus.
Pelvic obliquity
checking asymmetry–> causing an apparent leg-length discrepancy
What is the true leg length
distance from the anterior superior iliac spine to the medial malleolus
cause for antalgic gait
pain versus Abductor (gluteus medius and gluteus minimus) weakness
if antalgic gait is related to abductor dysfunction, pt will…
likely have an abductor, or Trendelenburg lurch (compensation)= pelvis tilts toward the unsupported side during one-legged stance
Thomas test
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
how to preform Ober test
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
purpose of Ober test
checks for tightness of the iliotibial band & TFL fexibility (iliotibial band syndrome)
purpose of Ely’s test
determines if femoral nerve or root compression is present
purpose of Patrick (FABERE Test)
assess for the sacroiliac joint or hip joint being the source of the patient’s pain
AP Laterla view of hip characteristics for developmental dysplasia of the hip.
up-sloping lateral edge of the acetabulum
What has CT been replaced by MRI for detailed evaluation of the soft tissues around the hip
CTs limited soft tissue contrast
if using radiology for screening of hip pathology, NP should NOT use_____, but _____ instead?
MRI -because its ability to detect bony pathology is limited.
-Use conventional radiographs instaed
pt with c/o Groin pain with internal rotation of the hip
hip pathology UNTIL proven otherwise
