Hip Pain Flashcards
Hip joint anatomy
Ilium, ischium, and pubis = acetabulum
Multiu-axial ball and socket joint
Groin
Lateral pain
Posterior
C-sign
Think intra-articular
Generally not the hip joint,,think soft tissue
Could by hip, but probably SI< buttock, or lumbosacral spine
C-sign is suspicious for hip joint…if they cup their hand around the side of the hi
Passive ROM
Gait
Log rolling is one of the best ways to assess femoroacetabular motion
Antalgic (limping where stance phase is shortened) or tendelenberg gait (normally due to muscle weakness…sag one side of the hip)
SI joint anatomy
Join with sacrum posteriorly and meet anteriorly
Partially synovial…no muscles that control movements but infleucned by lumbar spine and hip joints
DDH patho and risk factors
ABnormal contact of femoral head with acetabulum leading to abnormal development
Female, breech, genetics, swaddling
Exam of DDH
Ortolani test - flex hip 90 degrees…gently abduct while fingers lift the greater trochanter…positive if femoral head relocates into acetabulum
Barlow - adduct and flex the hip…hold distal and push posteriorly…positive test is femoral head slides posterioloy…dislocated femoral head
Galexazzi - flex hips and knees…affected knee lower
Tx for DDH
Harness that puts hips into correct position…urgent ortho evaluation
SCFE
Clinical manifesation and patho
Inferior and posterior slpipage of proximal femoral epiphysis
Chronic is most common
Acute if fall from height
Dull, nonradiating groin, thigh, or knee pain worse with activatu
Decreased internal rotation
Bilateral in 25%
Place in a non-bearing state immediately
Most obese and prepubertal
Hx and exam of SCFE
Insidious onset
Dull and worse with moving
Groin to medial aspect of knee with painful limp
Obese adolescent male
Hold lower extremity in exteneral rotation
Decreased internal and increased external rotation
Management of SCFE
Non-weight bearing and strict bed rest
Surgical fixtion
Close follow-up especially of contralteral hip
LCP patho and clinical
Idiopathic avascular necrosis of femroal epiphysis
4-8 y/o
Persistent hip or knee pain with a limp
Pathophys, characteristics of LCP
Self-limiting
Blood flow to femorla head interrupted….tip dies over 1-3 weeks…new blood supply causes new bone supply to appear over -12 months…new bone then replaces old bone within 2-3 years
Tend to be shorter
Hx of LCP and PE
Insidious onset with painless limp (maybe mild pain in the knee)
Shortening of the limp
Decreased internal rotation and abduction of the hip
Atrophy of muscles in upper thigh
Tx of LCP
Avoid impact activities and containment
Transeint synovities
Benign and self limited
Unknown cause but think preceding URI
Boys 3-8 (most under 5)
Transient joint effusions for 7-10 days
Limp
ESR<40 and WBC<12000
Septic exam
Acute, monoarticular
Knee mostly
Erythema and warmth not in hip
Usually febrile
Pseudoparalysis due to intense pain
Septic dx and tx
Aspiration
Emergent, ABs, and drainage if Hip/knee/shoulder
Osteomyelitis
Acute or chronic
Hematogenous typically…could be extnsion or direct inoculation
S. aurues most coommon but can differ
Osteo in children vs. adults
Moe acute hema, better prognosis because of blood supply, easier to tx
In adults, more likely to be chronic, can involve foreign bodies, more difficult to tx
Greater torchanter bursitis
Separates gluteus maximus from the laterla side of greater trochanter
Irritation of burse produces lateral hip pain
Point tender over greater trochanter
Hx, exam, tests, and managmenet of greater trochanter bursitis
Hip pain with exercise or direct pressure
Tender over greater torchanter or ilioopsoas tendon
NSAIDs, PT, intra-articular GCs
Meralgia paresthetica
Hx, exam, tests, management
Lateral femoral cutaneous nerve entrapment
Localized area of pain…nerve pain
Not affect by movmeent or pressure
None
Education, avoid tight garments, weight loss
Hip OA
Hx, exam, tests, managmenet
Age over 40, stiffness, radiate to groin
Pain with hip rotation or FABER test…limited ROM later
Radiography
PT, analgesics, surgical replacement
Osteonecrosis causes
Femoral neck fracture or dislocation
GCs, alcohol, idiopathic, sickle cell
Osteonecrosis hx, exam, tests, mangement
Anterior groion pain with joint use that can lead to thigh or buttock pain
Freuqnet pain on walking and at rest
Often steroid hx
Pain with ROM
Radiography
Preserve the joint…non-op, preserving procedures, joint replacement
Femoral neck fractures
Elderly
Falls and osteoporosis
Complications - immobility and avascular necoriss and nonunion
Also increase risk of DVT or PE
Surgical repair needed and manage comorbidities
SI joint dysfunction
Hx, exam, tests, managment
Pain radiates…more in females and common in pregnancy
FABERE test eleicits posterior pain localized to SI joint…SI joint tenderness
Radiography, possibly none, narrowing and slcerotic changes
Determine cause, TNF alpha inhibitors, analgesics, PT, joint infections
Lumbar spinal stenosis hx, exam, tests, managmenet
Lateral and posteriro hip pain radiating down lower leg or going…wors with standing and better with leaning forward
Usually normal exam…could have abnormal reflexes
Narrowing of intraspinal canal…see on MRI or CT
NSAIDs, PT, steroid injections, srugery
