Hip Pain Flashcards
Pain in the buttock can be referred from?
Lumbosacral spine
Hip joint
Pain in the groin can be referred from?
Hip joint - typically where it’s referred to
Lumbosacral spine
Sacro-iliac joint
Pain in the anterior thigh can be referred from?
Hip joint
Pain in the lateral pelvis can be referred from?
Gluteal muscles
Trochanteric bursa
What is the innervation of the hip joint?
Articular branches from
- Femoral and obturator nerves - L2-4
- Superior gluteal nerve - L4-S1
- Nerve to quadratus femoris - L4-S1
What are some risk factors for hip pain?
Obesity Age Previous injury FHx Previous cancer Immunosuppression
What are the risk factors for avascular necrosis?
Steroid use
Smoking
Severe alcohol use
What are some associated symptoms of hip pain?
Stiffness Clicking/grating Limping Leg weakness - sensation of giving way Limb numbness/paraesthesia
How can the severity of hip pain be assessed, aside from a visual analogue scale?
Limitations of ADLs
Walking distance
Sleep disturbance
Analgesic/NSAID use
What pathology can cause hip pain?
Fracture Arthritis Bursitis Tendinopathy Not to be missed - Infection - Tumour
What are the risk factors for secondary osteoarthritis?
Hx of trauma Other pre-existing joint disease - Gout - Inflammatory arthritis - Childhood developmental disorders
What are the radiological signs of avascular necrosis of the neck of femur?
Flattening of femoral head
Subchondral lucency
Joint space narrowing
On which imaging modality is avascular necrosis seen?
MRI
What is functional leg length discrepancy?
Feel off-balance > put block under leg > feel on-balance again
How is apparent leg length measured?
Umbilicus to medial malleolus
How is true leg length measured?
ASIS to medial malleolus
How is osteoarthritis of the hip diagnosed?
History - stiffness
Examination - limited range of movement, especially internal and external rotation
Investigations - not blood test
- Blood tests to exclude other arthritides
What are the radiological signs of osteoarthritis on x-ray?
LOSS
- L = loss of joint space
- O = osteophytes
- S = sclerosis
- S = subchondral cysts
What are the goals of management of osteoarthritis?
Relieve pain
Improve mobility
What exercise is recommended in the management of osteoarthritis?
Any regular low impact exercise that doesn’t worsen symptoms
What can be done before and after exercise to relieve pain and inflammation in osteoarthritis?
Local heat before
Cold packs after
Is physiotherapy effective in the management of osteoarthritis in the lower limb?
Not that effective in hip
Far more effective in knee and ankle
What are the pharmacological therapies available for the management of osteoarthritis?
Analgesics - Paracetamol - Stronger analgesics; eg: - Tramadol - Codeine NSAIDs Glucosamine and chondroitin - can relieve symptoms of pain and stiffness for some people Intra-articular corticosteroid injection
What are the side effects of NSAIDs?
Nausea Abdominal pain Diarrhoea Gastritis Ulcerss GI bleeding, especially if on antiplatelets/anticoagulants
What are the indications for a total hip replacement?
Disabling pain with failed non-operative treatment
What are the goals of total hip replacement?
Relieve pain Correct deformity Restore - Range of movement - ADLs
What are the intra-operative complications of a total hip replacement?
Injury to neurovascular structures
Fracture
What are the early post-operative complications of a total hip replacement?
Haematoma
Infection
Wound dehiscence
What are the late post-operative complications of a total hip replacement?
Dislocation Leg length discrepancy Fracture Loosening Heterotopic ossification
What are the options for anticoagulation post-operatively after a total hip replacement?
Keep mobile Chemophylaxis - LMW heparin - Aspirin - Warfarin Mechanical - Foot pump - Compression stocking
What is greater trochanteric pain syndrome?
Spectrum of diseases including
- Gluteus medius tendinopathy
- Trochanteric bursitis
Analogous to rotator cuff tendon degeneration/subacromial bursistis at shoulder
What are the management options for greater trochanteric pain syndrome?
US guided corticosteroid injection
Oral NSAIDs
Simple analgesics
Hip abductor strengthening exercises
