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MSK and Soft Tissue > Hip Pain > Flashcards

Hip Pain Flashcards

1
Q

Where may hip pain refer?

A
  • Buttock
  • Groin
  • Anterior thigh
  • Lat thigh
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2
Q

Innervation of the hip joint?

A

Hip joint is innervated by articular branches from the:

  • Femoral and obturator nerves (L2-L4)
  • superior gluteal nerve and nerve to quadratus femoris (both L4 - S1)
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3
Q

How to assess symptom severity / impact?

A
  • PADL, DADL, CADL limitations
    e. g. walking distance/ mobility, sleep disturbance
  • Analgesics / NSAID use
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4
Q

DDx for hip pain?

A
  1. Local: bone/joint, soft tissue
  2. Referred: spine, SIJ
    Pathology: fracture, arthritis, bursitis, tendinopathy,
    -DON’T MISS: infection, tumour
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5
Q

RFx for AVN?

A
  • Steroid use
  • EtoH
  • Idiopathic
  • Fractures / trauma
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6
Q

What is the screening rheumatological exam?

A

GALS: gait, arms, legs and spine. Rate appearance, movement.

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7
Q

What is the Thomas test?

A

-Pt lying flat (spine flat)
-flex both hips
-straighten either leg
Fixed flexion deformity = failure of extension on affected side

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8
Q

Apparent leg length vs true leg length?

A
  • Apparent: measure from umbilicus to medial malleolus (may be due to scoliosis, contracture etc)
  • True: measure from ASIS to MM
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9
Q

What is the Trendelenburg test?

A

Checks abductor mechanisms of pelvis: normally holds pelvis level. Sound side sags.
Positive in any problem with hip joint, lever arm or power arm (with neck and abductors being lever / power)

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10
Q

Benefits of exercise for OA?

A
  • strengthening muscular support around the joints
  • helps weight reduction
  • promotes endurance
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11
Q

Non-operative OA management?

A
  • Exercise
  • PTs (aids etc)
  • Pharmaceutical therapy
  • Corticosteroid injection
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12
Q

Pharmaceutical options for OA Mx?

A
  1. Analgesics: paracetamol, stronger analgesics (tramadol, codeine etc; generally use when pt on op waiting list)
  2. NSAIDs (problematic with renal / GI issues esp in elderly)
  3. Glucosamine and chondroitin: studies show only minor benefit
  4. Intra-articular corticosteroid injections
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13
Q

When are intra-articular corticosteroid injections most effective?

A

Early in natural Hx of OA when major contribution to pain is inflammation, before joint damage is more significant component

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14
Q

Indications for THR?

A
  • disabling pain with failed non-op treatment for 3-6 mo
  • painful hip joint at rest and at night
  • severe impairment ADLs
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15
Q

What are the goals of hip arthroplasty?

A
  • Relieve pain
  • Correct deformity
  • Restore ROM and ADLs
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16
Q

Components of pre admission assessment?

A
  • FBE, UEC
  • Coags (INR, APTT)
  • Blood group and hold
  • MSU, MRSA screen (nose, perineum)
  • ECG for known IHD
  • Adequacy of BP control, Sx of cardiac failure
17
Q

Components of pre op informed consent?

A
  1. Dx and Natural Hx of condition; expected course if surgery not pursued
  2. Recommended treatment and alternative treatment
  3. Risks and complications (general and specific)
  4. Give pt opportunity to ask questions
18
Q

What are the complications of hip replacement?

A

Intra OP: injury to neurovascular structures, fracture
Early post op: haematoma, infection, wound dehiscence
Late post op: dislocation, leg length disrepancy, #, loosening, heterotopic ossification

19
Q

Indications for inpatient rehabilitation post op?

A
  • Medical complications / comorbidities
  • Pre existing functional impairment
  • Post op weight bearing restrictions
  • Persistent pain, decreased ROM
  • Poor social support
20
Q

Anti coagulation post THR?

A

6weeks Clexane OR rivaroxaban

21
Q

D1 post op Mx THR?

A
  • ABx: 1g Cephazolin q8h x3
  • Xray pelvis and hip lat view
  • Blood test: FBE, U&E
  • PCA analgesia
  • PT: bed/standing exercises, breathing exercises
22
Q

Hip precautions for 3 months?

A
  1. Keep bend at hip
23
Q

Red flags for hip pain?

A

-Try and rule out
Tumour
Infection
Trauma

24
Q

What is gluteus medius tendinopathy?

A
  • Part of spectrum of greater trochanteric pain syndrome (GTPS)
  • Tendon tears and calcification may be associated
  • Analogous to rotator cuff tendon degeneration
25
Q

Management of greater trochanteric pain syndrome?

A
  • Corticosteroid injections (US guided)
  • Oral NSAIDs trial
  • Simple analgesics (paracetamol)
  • Hip abductor strengthening exercises

MSK and Soft Tissue (33 decks)

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