Hip osteoarthritis Flashcards
Hx
69 yr F, L groin pain and knee pain 3 yr hx. Pain progressively worse and keeps her awake at night. Hard to put on shoes and clip her toenails. No Hx of trauma.
look/ inspection
Trendelenberg gait
Feel
no tenderness, measure leg lengths for discrepancy true and apparent
active movement
decreased ROM of L hip [all movements]
passive movement
decreased ROM of L hip [medial rotation of hip - stiffness at end of available range]
resisted movement
nil of note
special tests for hip examination
Trendelenburg test
Thomas’s test
Other exam results
BMI, Normal hip exam
DDx
Hip OA
Knee OA
Nerve root impingement
Trochanteric bursitis
Why is Hip OA likely/
Hx site of pain left groin and left knee
Exam findings Trendelenburg gait, reduced AROM & PROM hip. Positive Thomas test L hip
Why is Knee OA unlikely?
knee exam normal
pain is radiating from groin to knee
Why is nerve root impingement unlikely?
associated hip stiffness
pattern of pain referral [buttock and post thigh pain]
Why is trochanteric bursitis unlikely?
a/w advanced hip OA, but can occur in isolation. Tenderness over the greater trochanter is pathognomonic. Relieved with steroid injection.
What investigations would you do?
Xray AP pelvis and lateral Xray left hip
joint space narrowing
subchondral sclerosis
pseudocyst formation
osteophyte formation
Primary care tx
analgesia
refer for physio
promote wt loss
ortho referral
