Hip Dx and Txment Flashcards
what is CC of true hip pain?
groin
- sometimes buttock
- anterior thigh to knee
- C sign (captain morgan sign)
what is different from lumbar spine vs hip pain?
spine is difficult to reproduce with exam
hip is reproducible with palpation and motion
where does sacroiliac or lumbar spine pain present?
posterior thigh
buttock
where does bony pelvis pain present?
pain in groin
lateral thigh
anterior thigh
what is a thomas test?
opposite hip flexed, observe for amount of flexion affected hip attains
observe for hip flexion contracture
FABER test is good to test for what?
hip joint pathology or sacroiliac pathology
pain is a positive sign
when would you see a dislocation of the hip?
high energy trauma
MVA
fall
Most are posterior
what is the clinical presentation of hip dislocation?
severe pain
inability to move
what are the sequelae of hip dislocation?
avascular necrosis of femoral head
sciatic or femoral nerve palsy
chondral defects (early onset arthritis),
labral tears
how do you treat hip dislocation?
- ER
- conscious sedation to reduce
- films to evaluate joint
- WBAT w/assistance
- PT
what are sequelae of femoral shaft fx?
fat embolism!!!!!
vessel or nerve injury
compartment syndrome
what is the txment for femoral shaft fx?
ER
traction
splinting
usu. requires surgical intervention
what should you always think when you see a femoral fx?
pathologic fx
tumor
osteomyelitis
who is most likely to get a stable pelvic ring fx?
elderly-unilateral pubic rami fx
what is most likely to cause an unstable pelvic ring fx?
usu. high energy trauma
ring is broken at two points
how does a pelvic fx present?
pain (groin or buttock)
+/- a fall
+/- ambulation
how do you tx pelvic fx?
limit WB ambulation
DVT prevention
High energy injury requires surgical intervention (can bleed out)
who mostly fx their proximal femur?
elderly sedentary lifestyle smoking EtOH abuse dementia osteoporosis
how does a proximal femur fx present?
hx of a fall non-ambulatory C-sign pain refers distal anterior thigh to knee Pain with any movement of the thigh
when will proximal femur fx be worse?
with activity
what is characteristic of arthritis?
morning stiffness with improvement after activity
what’s another name for lateral femoral cutaneous nerve syndrome?
meralgia paresthetica
what is meralgia paresthetica?
pain, burning along lateral border of the thigh
no motor involvement (sensory only)
who is more susceptible for meralgia paresthetica?
obesity
tight clothing
scar tissue
trauma
what is the dx test for meralgia paresthetica?
EMG/NCV
what might cause osteonecrosis of the hip?
clotting trauma chronic steroid use sickle cell RA lupus
how does osteonecrosis usu. present?
b/w 30-50 yo
often bilateral
how do you treat AVN?
difficult to tx (pain is primary complaint)
Early: protective weight bearing, remove offending agent
Last resort: arthroplasty
which test is dx of AVN?
MRI (to properly stage)
what is a snapping hip?
caused by iliotibial band snapping across the greater trochanter
what can a snapping hip cause?
trochanteric bursitis
who is more likely to get a snapping hip?
young females
what studies do you do for snapping hip?
XR and MRI to r/o labral and other joint pathology
how do you treat snapping hip?
reassurance
PT (stretching)
injection into trochanteric bursa
what is a common overuse injury of the hip?
strain of the hip
how does a hip strain present?
pain over injured tissue
pain with resisting action of muscle group
how do you treat a hip strain?
PT (stretch and strengthen)
what might you feel with a thigh strain?
a pop
sudden onset of pain during activity
where do most muscle strains occur?
myoteninous junction
how does transient osteoporosis of the hip present?
acute onset of pain
common in middle aged men or women in 3rd trimester of pregnancy
how do you treat transient osteoporosis?
resolves spontaneously
how does trochanteric bursitis present?
pain over trochanter that refers to lateral thigh or knee
unable to lie on one side
no acute injury
how do you treat trochanteric bursitis?
PT
NSAIDS
steroid injection
