Hip Pain

Question 1

Where can buttock pain be referred from?

Answer 1

Lumbosacral spine

Hip joint

Question 2

Where can pain in the groin be referred from?

Answer 2

Hip joint

Lumbosacral spine

SI joint

Question 3

Where can pain in the anterior thigh be referred from?

Answer 3

Hip

Question 4

Where can pain in the lateral pelvis be referred from?

Answer 4

Gluteal muscles

Trochanteric bursa

Question 5

What determines the risk of steroid related avascular necrosis?

Answer 5

Total dose of steroids (not time or maximum dose at one time)

Question 6

What are some ways to assess the severity of hip pain?

Answer 6

The amount of analgesics taken

Impairment to daily activities

Pain at rest

Waking up at night

Question 7

What is the WOMAC score?

Answer 7

Assess of disability caused by pain using

Pain

Stiffness

Mobility

Question 8

What are some pain scoring systems for hip?

Answer 8

MAPT

Oxford hip score

WOMAC

Question 9

What is disceptive about pathology at the hip joint?

Answer 9

It’s deep so signs of inflammation are usually masked

• But very painful on movement

Question 10

What is the GALS?

Answer 10

Gait Arms Legs Spine - screening MSK examination

Question 11

What can inferred from a negative Thomas’ test?

Answer 11

A patient’s OA, if present, is not significant

Question 12

What pathologies can cause a positive trendelenberg test?

Answer 12

Inhibition by pain

Muscle weakness

Neuromuscular problem

Question 13

What are some signs of OA in the hip on examination?

Answer 13

Limited ROM esp extension, IR, and ER

Question 14

What are possible findings on OA xray?

Answer 14

Loss of joint space and cartilage

Osteophyte formation

Subchondral sclerosis

Subchondral cysts

Question 15

What are the analgesics of choice in OA?

Answer 15

Paracetamol in the long term

Aspirin in the early stage when there is still an inflammatory component

Question 16

Do intra-articular steroid injection work in OA?

Answer 16

In some patients yes

But there is diminishing returns

Question 17

What are the indications for total hip replacements?

Answer 17

Disabling pain with failed non-operative treatment

• Disabling painful hip joint at rest and at night
• Severely deformed hip - decreased ROM and function, impaired ADLs

Question 18

What is the maximum length that a leg can be increased?

Answer 18

3cm

Question 19

What are the small external rotators of the hip

Answer 19

Piriformis

Gemelli inferior and superior

Obturator internus

Question 20

What is done prior to orthopaedic surgery to minimise infection risk?

Answer 20

Screen for UTI and MRSA and attempt to eradicate

Question 21

Why is a ECG performed prior to THR surgery?

Answer 21

Baseline

Question 22

Which pathology will mean that a spinal anaesthetic is contraindicated?

Answer 22

Aortic stenosis