Hip Pain

Question 1

Hip joint anatomy

Answer 1

Ilium, ischium, and pubis = acetabulum

Multiu-axial ball and socket joint

Question 2

Groin
Lateral pain
Posterior
C-sign

Answer 2

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

Question 3

Passive ROM

Gait

Answer 3

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)

Question 4

SI joint anatomy

Answer 4

Join with sacrum posteriorly and meet anteriorly

Partially synovial…no muscles that control movements but infleucned by lumbar spine and hip joints

Question 5

DDH patho and risk factors

Answer 5

ABnormal contact of femoral head with acetabulum leading to abnormal development

Female, breech, genetics, swaddling

Question 6

Exam of DDH

Answer 6

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

Question 7

Tx for DDH

Answer 7

Harness that puts hips into correct position…urgent ortho evaluation

Question 8

SCFE

Clinical manifesation and patho

Answer 8

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

Question 9

Hx and exam of SCFE

Answer 9

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

Question 10

Management of SCFE

Answer 10

Non-weight bearing and strict bed rest

Surgical fixtion

Close follow-up especially of contralteral hip

Question 11

LCP patho and clinical

Answer 11

Idiopathic avascular necrosis of femroal epiphysis

4-8 y/o

Persistent hip or knee pain with a limp

Question 12

Pathophys, characteristics of LCP

Answer 12

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

Question 13

Hx of LCP and PE

Answer 13

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

Question 14

Tx of LCP

Answer 14

Avoid impact activities and containment

Question 15

Transeint synovities

Answer 15

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

Question 16

Septic exam

Answer 16

Acute, monoarticular

Knee mostly

Erythema and warmth not in hip

Usually febrile

Pseudoparalysis due to intense pain

Question 17

Septic dx and tx

Answer 17

Aspiration

Emergent, ABs, and drainage if Hip/knee/shoulder

Question 18

Osteomyelitis

Answer 18

Acute or chronic

Hematogenous typically…could be extnsion or direct inoculation

S. aurues most coommon but can differ

Question 19

Osteo in children vs. adults

Answer 19

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

Question 20

Greater torchanter bursitis

Answer 20

Separates gluteus maximus from the laterla side of greater trochanter

Irritation of burse produces lateral hip pain

Point tender over greater trochanter

Question 21

Hx, exam, tests, and managmenet of greater trochanter bursitis

Answer 21

Hip pain with exercise or direct pressure

Tender over greater torchanter or ilioopsoas tendon

NSAIDs, PT, intra-articular GCs

Question 22

Meralgia paresthetica

Hx, exam, tests, management

Answer 22

Lateral femoral cutaneous nerve entrapment

Localized area of pain…nerve pain

Not affect by movmeent or pressure

None

Education, avoid tight garments, weight loss

Question 23

Hip OA

Hx, exam, tests, managmenet

Answer 23

Age over 40, stiffness, radiate to groin

Pain with hip rotation or FABER test…limited ROM later

Radiography

PT, analgesics, surgical replacement

Question 24

Osteonecrosis causes

Answer 24

Femoral neck fracture or dislocation

GCs, alcohol, idiopathic, sickle cell

Question 25

Osteonecrosis hx, exam, tests, mangement

Answer 25

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

Question 26

Femoral neck fractures

Answer 26

Elderly

Falls and osteoporosis

Complications - immobility and avascular necoriss and nonunion

Also increase risk of DVT or PE

Surgical repair needed and manage comorbidities

Question 27

SI joint dysfunction

Hx, exam, tests, managment

Answer 27

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

Question 28

Lumbar spinal stenosis hx, exam, tests, managmenet

Answer 28

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