Hip pain Flashcards
common hip problems are due to:
bone or joint injury
in senior pts, the hip/weight bearing joint is commonly affected by:
DJD and fracture
hip issues in infants are usually from:
congenital disorders
hip issues in adolescents are usually from:
vascular and growth plate problems
hip issues in young adults are usually from:
traumatic injuries
hip issues in older pts are usually from:
arthritis and fracture
hip diagnosis is often dependent on
xrays
hip pain may be due to
intrinsic pathology or referred
insidious onset of pain in adult/senior could be from
DJD
with children, remember that this area could be a common referral sit for hip disorders
knee
thigh pain from direct trauma
contusion
thigh pain from sudden movement onset
strain
anterior thigh numbness, paresthesia, or weakness
femoral nerve involvement
lateral thigh sensory complaints
lateral femoral cutaneous nerve
posterior thigh neurological complaints
sciatic nerve irritation or lumbar/sacral facet problems
femoral head faces forward with relative posterior positioning of greater trochanter
anteversion
femoral head faces posterior with anterior positioning of greater trochanter
retroversion
hip issues with pediatric/childhood onset
hip dysplasia/congenital hip dislocation
hip issues with adolescent/young adult insidious onset
SCFE or AVN
hip issues with adolescent/young adult sudden/traumatic onset
SCFE, synovitis, stress fracture
hip issues with middle-aged/adult onset
hip pain is unusual in this age
hip issues with older age onset
DJD, fractures
xrays show narrowing of superior joint space with osteophyte formation, cystic changes, and sclerosis
osteoarthritis
xrays show uniform, symmetrical loss of joint space with demineralization, cystic changes, acetabular protrusion
RA
xrays show accentuated trabeculation, cortical thickening, brim sign, bone softening changes
Paget’s
xrays show mottled bone density, crescent sign, flattening deformity, fragmentation
AVN
xrays show small or absent epiphysis, flattening, sclerosis, fissuring, fragmentation, mushroom deformity
Legg-Calve-Perthes disease
xrays show abnormal Klein’s line
SCFE
xrays show Putti’s triad
developmental dysplasia of the hip
xrays show aspherical femoral head, lack of femoral head neck offset, and retroversion of the acetabulum
FAI
xrays show increased inclination of the acetabulum
acetabular dysplasia
management for fracture, dislocation, SCFE, AVN, infection, tumor, or visceral pathology
medical referral
classic presentation is pain, unable to bear weight, and history of fall on hip
hip fracture
2 divisions of hip fractures
intra-capsular and extra-capsular
type of hip fracture that is twice as common and more likely to result in complications such as necrosis, nonunion, infection, thromboembolic disease
intra-capsular
classic presentation is a young and active patient, often participating in activities like long-distance running or gymnastics
stress fracture
pain is insidious and worse with weight bearing, pain is often anterior and deep
stress fracture
2 types of stress fractures
fatigue and insufficiency
most sports related hip dislocations are in this direction
posterior
major force applied to a flexed abducted hip
posterior hip dislocation
major force to an extended, externally rotated leg
anterior hip dislocation
seen in overweight children or rapidly growing adolescents, trauma in 50% of the cases, hormonal influences may play a role, bilateral occurrences common, hip pain with a limp
slipped capital femoral epiphysis
mild hip pain and associated limp with insidious onset, young pt may present with knee pain, may have limited hip abduction and internal rotation
avascular necrosis
clinical syndrome of painfully limited hip motion, results from certain types of underlying abnormalities in the femoral head/neck or surrounding acetabulum
femoral acetabular impingement (FAI)
pt often complains of sharp deep hip pain with squatting running stopping or changing directions, pain is often felt anteriorly
femoral acetabular impingement
impingement that is due to acetabular abnormalities which lead to excessive coverage by the anterior acetabular rim, more common in middle aged women, can occur with various disorders
Pincer impingement
impingement that is due to abnormalities of the femur with decreased offset between the femoral head and neck, more common in young men
CAM impingement
middle aged and elderly pts with hip pain and possibly butt, groin, or knee pain with insidious onset; restricted passive internal rotation and extension, pain may be produced by axial compression, xrays show nonuniform loss of joint space with superior compartment involvement, subchondral cysts, sclerosis, osteophytes
degenerative joint disease
classically in females between 25 and 55 with hip pain, soft tissue swelling, stiffness, decreased ROM, usually bilateral, shows pannus on xray
RA
Putti’s Triad
small/absent proximal femoral epiphysis
lateral displacement of femur
increased inclination of acetabular roof
the acetabular angle using Hilgenreiner’s line should be less than this many degrees at birth
28 degrees
the line drawn perpendicular to Hilgenreiner’s line, and intersects the lateral most aspect of the acetabular roof
Perkin’s line
SCFE has abnormal __ line
Klein’s line
AVN disease in a young patient
Legg-Calve-Perthes disease
