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CONA 1 LECTURE > Hip Injuries and Conditions--week 10 QUIZ > Flashcards

Hip Injuries and Conditions--week 10 QUIZ Flashcards

1
Q

Hip Anatomy

Boney landmarks

 ________________= SARTORIUS and tensor fasciae latae
 Iliac crest – Gluteal muscle attachment
 ___________=Rectus femoris attachment
 Greater trochanter – Vastus lateralis and gluteal muscles
 Posterior superior iliac spine (PSIS)
 _____________Hamstring muscles
 Pubic ramus – Adductors

A

Anterior superior iliac spine (ASIS)

Anterior inferior iliac spine (AIIS)

Ischial tuberosity

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2
Q

Hip Anatomy

Flexors:

  1. Iliopsoas
  2. ______ _____
  3. Sartorius, Pectineus, TFL

Extensors:

  1. ________ __________
  2. Long head of Biceps Femoris,Semitendinosis
  3. Semimembranosis, Adductor Magnus

Abductors/internal rotators:
1. Gluteus Medius/Minimus, _________

A

Rectus Femoris

Gluteus Maximus

TFL

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3
Q

Hip Anatomy

Adductors:

  1. Adductor longus, brevis & magnus
  2. Gracilis, Pectineus

External rotators:

  1. ________ ________
  2. Piriformis
  3. Quadratus Femoris

No pure internal rotators

A

Gluteus maximus

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4
Q

Hip Pain

Common complaint
• Etiology can be numerous
Note: patients often claim “hip pain” when in fact the pain is in ________, groin, pelvis etc.

A

low back

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5
Q

Hip Pain

Appropriate History
• Rule out more _______ _________
– ask about night sweats, fevers, weight loss
– history of menstrual irregularities, amenorrhea
• To help r/o ______ _____ of the hip pain – ask about nausea, vomiting, diarrhea, changes in stools, or presence of blood in stools
• To help r/o _______ _________
– ask about LBP; radiation of pain down the leg into the calf, foot, or toes
– numbness, tingling, or weakness in the leg or foot

A

dangerous pathologies

abdominal sources

spinal causes

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6
Q

Differential Diagnoses of Hip/Groin Pain

Metabolic bone diseases
 – e.g. Paget’s
• Neoplasms
– e.g. Osteoid osteoma, metastatic disease
• \_\_\_\_\_\_\_\_\_ condition 
– e.g. Osteomyelitis
• Referred pain
– e.g. L/S, pelvic viscera: prostatitis, UTI, GYN disorders
• \_\_\_\_\_\_\_\_\_ conditions
– e.g. AS, Reactive Arthritis (Reiter’s)
• Hernia
A

Infectious

Inflammatory

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7
Q

Hip Examination

Exam of the ____ and __________ _______
Important – > establishes if the patient’s hip pain is referred pain from these sites

A

knee

lumbosacral spine

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8
Q

General NMS Diagnosis

What is the source of the patient’s problem?
• Is it vascular? _____ ________
• Is it neural? Neural tension tests
• Is it muscular? Muscle tests
• Is it ligamentous? Stretch tests
• Is it joint? ___________ tests
• Is it disc? Patient position/compression tests

A

Check pulses

Compression

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9
Q

Allis Test

Positive Finding: femur protrudes farther caudally and/or tibia protrudes higher

• Indication: femoral length discrepancy and /or tibial length discrepancy

A

Know

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10
Q

Ortolani’s Test

Positive Finding: A palpable or audible click or clunking sensation (as the head of the femur slips back into the socket)

• Indication: Displacement of the femoral head in or out of the acetabular cavity

A

Know

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11
Q

Muscle Strains/Ruptures

• Most common athletic injury of the hip
Mechanism of injury:
– Violent contraction OR forceful stretching
– May also occur from sudden stopping, rapid __________ & _________
• Increased chance w/muscles that move 2 joints (ie: hamstrings, quadriceps)

A

deceleration & acceleration

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12
Q

Risk Factors for Hip Injury
• Inadequate flexibility&warm-up
• Muscle strength imbalances
• Weakened by previous injury (_____ ______) & lack of rehab or faulty rehab & Muscle weakness.
Increasedage
• Muscle fatigue
• Poor technique with sport
• Muscles subjected to prolonged exposure to cold
• Sports demanding maximum muscular work

A

scar tissue

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13
Q

Classification of Muscle Strains

Grade I Strain:
• Mild injury
• Overstretching w/ rupture of NONE or

A

pull

structural

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14
Q

Classification of Muscle Strains

Grade II Strain:
• Moderate injury
• ________ _______ of muscle- tendon unit–partial rupture

A

Incomplete rupture

Pop

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15
Q

Classification of Muscle Strains

Grade III Strain:
• Severe injury; possible \_\_\_\_\_\_\_
• Complete rupture
• Moderate to severe functional loss
• Palpable defect across entire belly
• Muscle may ‘bunch up’ & form a lump
• Unable to contract muscle
• Tenderness & swelling
• After 24 hrs: bruising
• X-ray to r/o avulsion fx
A

avulsion

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16
Q

Hamstring Strain

Classic Presentation
• Athlete or weekend warrior, sudden pull or pop
• Onset of pain following forceful knee ________
– Over contraction while in position of stretch

• Strength imbalance hamstrings
– Strength imbalance of _____% or more between right & left hams OR
– Flexor-extensor strength ratio of

A

extension

10

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17
Q

Hip Adductor Strain (Groin Pull)

Classic Presentation
• Athlete,sudden I ncapacitating pulling in groin
– Kicking, sprinting, sideways kicks in soccer, hard track running, ice hockey, skiing, hurdlers, high-jumpers
• MC site = _______ ________
• Pain at pubic attachment or w/in adductors itself
– PN with _________ and resisted adduction
• Contributing factors:
– Inadequate warm-up
– Poor flexibility, endurance
– Leg length discrepancy

A

adductor magnus

abduction

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18
Q

Hip Adductor Strain
DDX
• _______ muscle injury,osteitis pubis,hernia, disorder of bowel, bladder, testicles, kidneys

A

Abdominal

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19
Q

Rectus Femoris Strain

Classic Presentation
• Pain just above hip joint or ant thigh
• Sudden contraction of _____
• Sudden stopping

Physical Examination
• Palpable tenderness
• Pain w/active knee extension
• Pain with resisted hip flexion/knee extension
• Pain w/isometric quad contraction w/ leg ext
• Possible defect on resisted extension
• Strength imbalance w/hamstring

A

quads

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20
Q

Treatment of Muscle Strain

GOAL:
Restore strength, stability & fxn
1. Decrease _______
2. Promote ST healing
3. _______ muscle
4. Regain muscle power, strength and flexibility
5. Regain endurance and aerobic conditioning

A

pain

Stretch

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21
Q

“R.I.C.E.”

Rest:
–

A

Crutches

Hemorrhage

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22
Q

“M.I.C.E”

“Addition of a talocrural _________] to the RICE protocol in the management of ankle inversion injuries necessitated fewer treatments to achieve pain-free dorsiflexion and to improve stride speed more than RICE alone.”

  • Early mobilization within pain-free range of motion
A

mobilization

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23
Q

M.E.T.H.–End of the ice age?
Mobilization Elevation Traction Heat

“These data suggest that topical cooling, a commonly used clinical intervention, seems to not improve but rather delay recovery from
________ exercise–induced muscle damage”.

A

eccentric

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24
Q

Treatment
Conservative Treatment:
– Massage
– Ultrasound
– Electrical muscle stimulation
– Rehabilitation
• Sign and symptoms of injury resolve but ________ deficits persist;
TX / REHAB GOAL: restore ______] function
– CMT
– Stretch: gentle w/ caution as early as possible when tolerable – Re-strengthen: begin when ___% of normal ROM available – Nutritional advice, anti-inflammatory diet

A

functional

normal

75

25
Q

Treatment

Early: Initiate ____ _____ to prevent atrophy & promote healing
– Stationary bike, pool therapy, proprioceptive exercises

Conventional Treatment
– NSAIDs, muscle relaxants, etc.

A

muscle action

26
Q 
Return to Activity
• When strength is within \_\_\_\_% of uninjured side – Guided by symptoms & objective signs
• Coordination
• Strength balance
• Speed, endurance
• Painless athletic participation 
• Full flexibility
• Grade1:w/ncoupleweeks
• Grade2:w/n4-6weeks
• Grade3 (full rupture):w/n3-4months
A

10

27
Q 
Hip Fracture
Classic Presentation
• Elderly \_\_\_\_\_\_ patient
• Hip pain,unable to bear weight(?)
 • Possible fall on to hip
– \_\_\_\_\_\_\_ trauma - such as a stumble or fall from standing height

Causes
• Elderly:MC = ___________
• Young:(other than major trauma or stress fracture if active) r/o tumor
– Benign: fibrous dysplasia, unicameral bone cyst – malignant: Osteogenic sarcoma, Ewing’s sarcoma

A

female

Minimal

osteoporosis

28
Q

Hip Fracture
• Relatively common in older adults,often lead to devastating consequences.
Disability frequently results from persistent pain and limited physical mobility
• Associated w/substantial morbidity & mortality.
Approximately ____-____% of patients die within 1-year of hip fracture

Complications of surgery and/or immobilization: including development of deep vein thrombosis, pulmonary embolism, pneumonia, congestive heart failure, muscular deconditioning (loss of _______)

A

15-20

function

29
Q

Slipped Capital Epiphysis (Adolescent Coxa Vara)

Classic Presentation
• MC hip condition in _______
– Ball at upper end of the femur slips off in a ________ direction - cause unknown
• Overweight child or young, tall rapidly growing adolescent (8-17 yoa)
• Trauma, but may be minor
– ___% have no obvious traumatic HX
–Occurs due to weakness of the growth plate.Often develops during periods of accelerated growth, shortly after the onset of puberty.
• Acute: Salter-Harris type 1 epiphyseal FX
• Chronic: gradual hip pain with antalgia
• May only have knee pain
Management
• Surgical pinning is often used
• Manipulation of slippage is contraindicated: may result in dire consequences including avascular necrosis

A

adolescents

backward

50%

30
Q

Bilateral slipped capital femoral epiphysis

  • Chronic: evidence of remodeling of the neck and an _______ bone bump that restricts flexion
  • Acute: absence of any evidence of __________
A

anterior

remodeling

31
Q

Avascular Necrosis (AVN)

Cellular death of bone components due to ____________ of the blood supply
– Bone structures then collapse, resulting in bone destruction, pain, and loss of joint function

A

interruption

32
Q

Avascular Necrosis of Hip

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Disease
 One form of AVN
Classic Presentation
• Male, MC 4---9yoa
• Mild hip pain,limp,insidious onset
 • 15%have knee pain only
• HX of trauma or metabolic disease
NOTE: The younger the age of onset the \_\_\_\_\_\_\_\_\_ the prognosis- Children >10 yoa have a very high risk of developing OA.
Cause
• Believed to be due to disruption of vascular supply to \_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_.
A

Legg Calve-Perthes

better

femoral head

33
Q

AVN of Hip

***NOTE: May be asymptomatic and occasionally discovered incidentally on radiographs!

Classic Presentation
• _____ is typically the presenting symptom
• Patients with AVN of the femoral head often report ______ pain that is exacerbated by weight bearing.
• The pain may initially be mild but progressively worsens over time and with use.
• Eventually, pain is present at rest and may be present at night.

A

Pain

groin

34
Q

Avascular Necrosis

Management
• Definitive DX: Radiographs
• Under ____ yoa or with minor involvement no TX is required – observation only
• ________ may be indicated - Bed rest and ___________ stretching exercises are often recommended.
• Surgery required only in severe cases
• Healing takes ~____ months
• NOTE: LCPD may result in femoral head deformity and degenerative joint disease

A

4

Bracing

abduction

18

35
Q

Hip Bursitis, Tendinitis, Tendinosis

• Occur commonly in active individuals:
– Runners, cyclists, cutting sports such as football, hockey, soccer, etc.
• Can occur after an ____ injury,such as an adductor strain from soccer, OR
• Present as a chronic pain,such as a hamstring
tendinosis from repetitive activities such as running
• Training errors,biomechanical issues,and sudden increases in activity levels are risk factors
• In adolescents:traction Injures such as ____ _______ can occur

A

acute

avulsion fracture

36
Q

TendonITIS vs. TendinOSIS

Tendinitis
• Inflammation
• Involve _______ injuries accompanied by inflammation
• Typically resolve with rest, ice, rehab, and anti-inflammatory modalities, anti-inflammatory meds

A

acute

37
Q

TendonITIS vs. TendinOSIS

Tendinosis
• Chronic degeneration without ___________
• Main problem is failed ________, not inflammation
– Accumulation of microscopic Injuries that don’t heal properly
– Inflammation can be involved in initial stages of injury,but inability of tendon to heal perpetuates the pain & disability
•____________ medication may actually impair tendon recovery
• Tx designed to designed to stimulate healing – Graston, ART, laser

A

inflammation

healing

Anti-inflammatory

38
Q

2003 more than 3.5 million children under 15 suffered a sports related injury requiring medical treatment. Estimated ____% are overuse injuries. 1990’s it was 20%.

A

75

39
Q

Hip Bursitis

Bursae
– flattened synovial-lined sacs
– Serve as a protective buffer between bones & overlapping
muscles OR b/w bones & tendons/skin
– Filled with minimal amounts of fluid to facilitate movement during muscle contraction
• Inflammation caused by ________ use,trauma, _________
• Inflammation causes synovial cells to multiply, increases collagen formation and fluid production

A

repetitive

infection

40
Q

Hip Bursitis

Locations
• Ischial tuberosity
• Iliopsoas region
• Greater trochanter

Causes
• Friction from ______ OR trauma from direct blow

A

overuse

41
Q

Subtrochanteric Bursitis

Classic Presentation
• 40-60yoa
• Painful inflammation of the bursa under ITB & gluteus tendon
– subgluteus medius and maximus
• Local pain at greater trochanteric region of the lateral hip - May radiate to low back, lateral thigh and knee; not all the way to ______
• PN worse when the patient ______ on the affected bursa; may wake pt at night when rolls onto affected bursa

A

foot

lies

42
Q

Subtrochanteric Bursitis

Causes
• Acute ________
– Contusions from falls, contact sports, and other sources of impact
• Repetitive, cumulative irritation
– Often occurs in runners but can also be seen in less active individuals

A

trauma

43
Q

Subtrochanteric Bursitis

Evaluation
• Some loss of internal rotation
• Tenderness and swelling over greater trochanter, pain with
FABERE’s
Management
• Reduce inflammation
• Correction of abnormal \_\_\_\_\_\_\_\_
– leg length discrepancy
A

biomechanics

44
Q

Iliopsoas Bursitis

Classic Presentation
• Anterior hip pain w/antalgic gait
– May radiate into ant. leg (pressure on ________ nerve)

Cause
• Hip flexor tightness, repetitive activity
– Constant friction from overlying psoas tendon

Management
• Rest, stretching of hip flexors
• MRT of psoas with caution

A

femoral

45
Q

Ischial Bursitis

Classic Presentation
• Pt reports sitting for long periods of time,fall on buttocks, horse-back riding
• Athlete,sprinter-excessive hamstring contraction
• Referral down leg mimicking ________

A

sciatica

46
Q

Osteoarthritis

Classic Presentation
• Primary OA:Middle aged or elderly
• Secondary OA: may have HX of trauma or other joint involvement, i.e.. _____
• Hip,possible buttocks,groin or knee pain
• Insidious onset
• Slow stiffening (especially _________ rotation)
– Pt may walk with hip in external rotation
• May c/o LBP

A

Gout

internal

47
Q

Osteoarthritis
• Restricted passive Internal rotation and extension of hip
• Radiographs: _________ joint space narrowing with subchondral cysts and osteophytes - Hallmark of OA
Management
• Weight loss if indicated
• Non-wt bearing exercise:pool,bicycle
• Strengthening joint,helps relieve pain
• Stretching of hip contractures PNF or Myofascial Release
• Use of cane only if pain is severe

A

Superior

48
Q

Contusions and Myositis Ossificans

Classic Presentation & Cause
• MC area is _________
• Direct blow to ______
– Damages underlying muscle, subsequent hematoma formation
• Swelling,___________,decreased ability to flex knee

A

quadriceps

knee

discoloration

49
Q

Contusions and Myositis Ossificans

Myositis Ossificans can develop if _____ is
encouraged to remain.
– Inflammation of muscle leading to bone formation
– ________ response, seen radiographically
– Contributing factors include: forceful stretching after injury, deep massage to area of injury, use of deep heat such as US

A

hematoma

Calcification

50
Q

Contusions and Myositis Ossificans
Management

For Contusion:
• Application of tensor bandage,ice pack In ______ knee position
Alternate ice on 10 min / off 10-20 min Prevents accumulation of blood in area
• Moderate to severe contusion:crutches2-3d

For Myositis Ossificans:
• TX depends on degree of knee flexion restriction and deformity - _________ may be reabsorbed over time
• Surgical excision may be necessary

A

flexed

calcifications

51
Q

Acetabular Labrum Tears

Classic Presentation
• Moderate to severe groin pain,limp – r/o genitourinary pathology
• Night pain
• Worse with activity
• _______ or locking,occasionally giving away
• No trauma or severe trauma
• Many causes/predisposing factors:
– repetitive trauma, hip dysplasia, ________ laxity
• Leads to early degeneration

A

Clicking

capsular

52
Q

Acetabular Labrum Tears

Evaluation & Management
• Assess with FABERE,____________ Test,ROM
• __________ Is considered the“gold standard” for diagnosis and treatment
 Radiographs not helpful, MRI limited: ant. tear visualized / post. tear is not
• Nodatacurrentlyonmanipulation
• Standardmedicalapproach

A

Impingement

Arthroscopy

53
Q

The Impingement Test / Sign

With patient supine,the hip and knee of the affected limb are flexed to 90°
The leg is then adducted and ________ rotated in this position
• Occurrence of sudden exacerbation of pain, typically in the groin, is considered a positive test

***Positive impingement test/sign shown to be present in more than ____% of patients with FAI syndrome (femoral acetabular impingement syndrome)

A

internally

90

54
Q

Snapping Hip Syndrome

Often no pain,just snapping
• Audible snap or click that occurs in or around the hip
• ______ of snapping Indicative of involved structure
• Traumatic:consider acetabular tear
• Intra-articular loose body
– will present w/ signs of mechanical blockage of movement

A

Location

55
Q

Snapping Hip Syndrome

Cause
• Tendon snapping over boney prominence or bursa
– Lateral: ITB snapping over ________ trochanter
– Anterior: iliopsoas tendon involvement or iliofemoral ligament over ant. joint capsule
– Posterior: bicep femoris over ______ tuberosity

A

greater

ischial

56
Q

Snapping Hip Syndrome

Management
• Benign,position dependant
• If painful or irritating,___________ rather than
stretching involved muscles is helpful
• Correct leg length inequalities,muscles imbalances – Overpronation
• ITB involvement: check for weakness of Glut Med. – ITB will substitute for weak Glut Med.

A

strengthening

57
Q

Paget’s Disease (Osteitis Deformans)

Classic Presentation
• 90% \_\_\_\_\_\_\_\_\_\_\_\_\_
• Increase in hat size
• Insidious onset of LBP and/or hip pain IF \_\_\_\_\_\_\_\_\_\_\_\_\_\_
• Middle aged, elderly
A

asymptomatic

symptomatic

58
Q

Paget’s Disease (Osteitis Deformans)

Cause: unknown, ______ etiology suspected
– metabolic disorder characterized by abnormal _________ remodeling
• Radiographs: bone is thickened, more apparent trabeculae (cross-hatching) eventual distortion of femoral neck or shaft
• TX: No medical treatment currently to prevent or cure

A

viral

osseous

**Patient with Paget disease > dense sclerosis involving the femoral head and neck

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