hip history

Question 1

what are components of a subjective exam?

Answer 1

patient profile
area of symptoms
behavior of symptoms
history
special questions

Question 2

from the patient profile why is age important?

Answer 2

legg-calve-perthes disease
slipped capital femoral epiphysis
labral pathology
fractures
osteoarthritis

Question 3

what else is important from the patient profile?

Answer 3

occupation (tasks, hours, conditions)
length of employment (previous work)
physical restrictions or limitations
what would the patient like to be bale to do and in what period of time?
hobbies or recreational activities (type, amount, frequency)
limitations or restrictions
what would the patient like to be able to do and in what period of time?

Question 4

why is area of symptoms important?

Answer 4

develop a symptom map
formulate initial hypothesis
identify future questions

Question 5

what are some questions to ask in regards to the area?

Answer 5

location (can you show me where your area pain is- outline it?, additional areas?)
quality (can you describe how it feels- sensation?)
behavior (is it with you all the time- come and go? have it now?)
behavior (does the intensity of pain vary?)

Question 6

what are some locations or boundaries for symptoms?

Answer 6

anterior thigh, groin, low back, greater trochanter, knee, anterior tibia, medial buttocks

Question 7

rank the order of pain location OA hip

Answer 7

greater trochanter (77%)
groin (53%)
anterior thigh (42%)
buttock (38%)

Question 8

which of the following would a 65 y/o female with a 1 week h/o hip pain be least concerned with for a diagnosis?
fracture
OA
slipped capital femoral epiphysis
labrum tear

Answer 8

slipped capital femoral epiphysis because it is common in younger patients not adults

Question 9

review of dermatomes:
L1
L2
L3
L4
L5
S1
S2

Answer 9

L1- upper thigh
L2- middle thigh
L3- lower thigh knee joint region
L4- medial (and post-med) shin, medial malleolus
L5- lateral (and post-lat) shin, top of foot, great toe
S1- lateral border of foot, heel, middle of posterior calf
S2- popliteal fossa, posterior thigh

Question 10

review of myotomes:
L1-L2
L3
L4
L5
S1
S2
S3-S4

Answer 10

L1-L2- hip flexion
L3- knee extension
L4- ankle DF
L5- great toe extension
S1- ankle PF
S2- knee flexion
S3-S4- toe flexion

Question 11

review of DTR/MSR (reflexes):
L3/L4
S1

Answer 11

L3/L4: patellar tendon
S1: achilles tendon

Question 12

You are evaluating a 30 y/o male with a 2 week h/o left posterior hip and lateral thigh pain. on myotomal assessment, you note weakness of the left quadriceps. which myotome is most likely implicated?

Answer 12

L3

Question 13

what are some behaviors of symptoms for chemical pain?

Answer 13

constant pain, high levels of pain, often diffuse, recent onset, easy aggravation of pain by all movements, takes time to calm down, responds favorably to NSAIDs

Question 14

what are some behaviors of symptoms for mechanical pain?

Answer 14

intermittent pain, variable levels of pain, usually local, fairly to recent chronic, changes in position or movements in a particular direction ease pain, symptoms short lived, variable response to NSAIDs

Question 15

what are we thinking when we ask about the behavior of symptoms for aggravating factors?

Answer 15

are there any positions or activities that make your symptoms worse? (amount of activity, amount of time to return to resting level)

Question 16

what are some suggestive questions to ask for a lumbar variant? What is it like….

Answer 16

sitting, moving from a sit to stand, standing in one place, walking, bending forward, being in a partially bent position, coughing or sneezing, straining when having a bowel movement

Question 17

what are some suggestive questions to ask for a hip variant? What is it like….

Answer 17

crossing your legs, putting on your socks, walking, sitting in a low vs high chair, sleeping on affected side, squatting, stepping up a curb

Question 18

what are we thinking when we ask about the behavior of symptoms for easing factors?

Answer 18

are there any positions or activites that make your symptoms feel better? (amount of rest required, beneficial treatments- prescribed Rx and self Rx, decreased/altered activity, time)

Question 19

what are we thinking when we ask about the behavior of symptoms for 24 hour pattern?

Answer 19

night: are you able to sleep through the night or do your symptoms wake you up from sleep?
AM: how are you when you first get out of bed?
COD: how are you as the day goes on? - whats it like at the end of the day?, whats it like in th eevening?
when is the worst time of day?

Question 20

T/F: in your history, “behavior of symptoms” deals with identifying what your patient would like to be able to do and in what period of time and where their pain is located.

Answer 20

false. behavior of symptoms is aggravating, easing and 24 hour pattern factors

Question 21

what do we want to know with current history?

Answer 21

when did this problem begin- if chronic when did it most recently worsen)
how did it begin (what happened- insidious or traumatic, any recent changes in your lifestyle, any recent changes in your job duties)
have you had any treatment for this problem (what did it comprise of? was it helpful?)
how are you now compared to when it first happened (how did the symptoms progress?)

Question 22

what do we want to know for past history?

Answer 22

have you ever had this problem, or anything like it before?
have you had any treatment for this problem? (what did it comprise of? was it helpful?)
have you had any other episodes between that first time and this most recent one? (how many? when was the most recent? have they been increasing in frequency? have they been lasting longer? is it more easily provoked than in the past? are the more recent episodes more severe than in the past?)

Question 23

what are differential diagnosis to rule out?

Answer 23

chondral damage or loose bodies
femoral neck or pubic ramus stress fracture
labral tear
neoplasm
AVN of femoral head
SCFE
Paget’s disease
psoriatic arthropathy
RA
infection/septic hip arthritis
referral from lower GI/UG disorder