Hip Joint Flashcards
Hip joint pain location
Anteriorly or medially around groin
Trochanteric injury or lumbar referred pain location
Lateral pain
SIJ, piriformis syndrome, lumbar referred pain location
Posterior pain
Hip pain location
Inferiorly or superiorly
What is Legg-Calve-Perthes Disease
Necrosis of femoral head in pediatric patients
What are the radiographic findings of Legg-Calve-Perthes Disease
- increase density of femoral capital epiphysis
- femoral head flattening
- demineralization of the meaphysis
What is slipped capital femoral epiphysis?
Wearing of the epiphyseal plate at the junction of femoral head and neck
What happens to the femoral head in slipped capital femoral epiphysis
Slips posterior, medial and inferior in relation to the femoral neck
What are the symptoms of slipped capital femoral epiphysis
- groin, hip, knee pain of insidious onset
- limited ROM: IR, flexion
- antalgic gait
What are the common intracapsular Fracture sites in a proximal femur fracture
- capital
- subcapital
- transcervical
What are the common extracapsular fracture sites in proximal femur fracture
- intertrochanteric
- subtrochanteric
What is the typical MOI for fracture to ilium, ischium or pubis
MVA, fall
What is the common MOI for acetabulum fracture
MVA, fall from significant height - often co-occurring with damage to other boney structures or soft tissue around hip and pelvis
MOI for pelvic stress fracture
repetitive high impact activity, osteoporosis
What are the gold standard sets for hip fracture diagnosis
Radiographs and CT scan
What is the patellar pubic percussion test
Clinical test for femur fracture diagnosis
- form of osteophony or auscultatory percussion
- bell of stethosocpe placed on ipsilateral pubic bone, examiner taps the patella
Neg test = sharp, distinct sound
Pos test = dissipated sound
What are some of the pathology we see in hip OA
- loss of hyaline cartilage
- subchondral bone sclerosis
- joint space narrowing
- osteophyte formation
What is one of the hallmark clinical symptoms of hip OA
Pain and stiffness in the morning or after prolonged periods of rest and improves with movement
`What is the scale used to describing Hip OA
Kellgran-Lawrence scale
Grade 0 on Kellgran-Lawrence scale
No OA
Grade 1 on kellgran-Lawrence scale
Doubtful - possible narrowing of joint space medially
Grade 2 on kellgran-Lawrence scale
mild - definite narrowing of joint space inferiorly
Grade 3 on kellgran-Lawrence scale
Moderate - marked narrowing of joint space
Grade 4 on kellgran-Lawrence scale
Severe - gross loss of joint space with sclerosis ad cysts
What grade of kellgren-Lawrence was predictive of progression of symptomatic hip OA
Grade 2
What is ACR diagnostic criteria for hip OA cluster 1
- pain reported in the hip
- less than 115 deg hip flexion
- less than 15 deg hip IR
What is ACR diagnostic criteria for hip OA test cluster 2
- pain with hip internal rotation
- more than 60 minutes morning stiffness
- grater than 50 years of age
What are some functions of the labrum
- enhances joint stability
- deepens acetabulum
- acts as a seal to maintain negative intra-articular pressure
What is femoroacetabular impingement (FAI)
Abnormal morphology of proximal femur and/or acetabulum
- results in increased hip contact forces in flexion
What are the symptoms of FAI
Increased pain with hip flexion, IR, abduction (ie squat)
What is Cam impingement
Femoral head enlarged compared to acetabulum
What is pincer impingement
Acetabulum enlarged with overcoverage of the femoral head
What direction is traumatic tears versus degenerative tears
Traumatic - vertical
Degenerative - horizontal
What location of the labrum is usually torn
Anterior superior, or posterior superior margins of labrum
Symptoms of labrum tears
- increased pain with sitting and climbing stairs
- possible clicking, locking and/or giving way during WB activities
- pain located in groin, buttock , trochanteric region, thigh
- pain/limitation during passive internal rotation with hip flexed but not extended
What type of imaging is used for labral tears
MRI
What type of clinical tests are used for labral tears
- FADIR
- FABER
- log roll
What type of surgical invention is used for labral tears
Debridement - minimally invasive procedure to trim torn or weaker area
Labral repair - repaired with sutures, may have better outcomes and patient less likely to have total hip replacement
- surgical interventions are arthrosscopically done