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MD2 Medicine > Hip Pain > Flashcards

Hip Pain Flashcards

1
Q

Pain in the buttock can be referred from?

A

Lumbosacral spine

Hip joint

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2
Q

Pain in the groin can be referred from?

A

Hip joint - typically where it’s referred to
Lumbosacral spine
Sacro-iliac joint

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3
Q

Pain in the anterior thigh can be referred from?

A

Hip joint

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4
Q

Pain in the lateral pelvis can be referred from?

A

Gluteal muscles

Trochanteric bursa

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5
Q

What is the innervation of the hip joint?

A

Articular branches from

  • Femoral and obturator nerves - L2-4
  • Superior gluteal nerve - L4-S1
  • Nerve to quadratus femoris - L4-S1
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6
Q

What are some risk factors for hip pain?

A 
Obesity
Age
Previous injury
FHx
Previous cancer
Immunosuppression
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7
Q

What are the risk factors for avascular necrosis?

A

Steroid use
Smoking
Severe alcohol use

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8
Q

What are some associated symptoms of hip pain?

A 
Stiffness
Clicking/grating
Limping
Leg weakness - sensation of giving way
Limb numbness/paraesthesia
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9
Q

How can the severity of hip pain be assessed, aside from a visual analogue scale?

A

Limitations of ADLs
Walking distance
Sleep disturbance
Analgesic/NSAID use

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10
Q

What pathology can cause hip pain?

A 
Fracture
Arthritis
Bursitis
Tendinopathy
Not to be missed
- Infection
- Tumour
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11
Q

What are the risk factors for secondary osteoarthritis?

A 
Hx of trauma
Other pre-existing joint disease
- Gout
- Inflammatory arthritis
- Childhood developmental disorders
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12
Q

What are the radiological signs of avascular necrosis of the neck of femur?

A

Flattening of femoral head
Subchondral lucency
Joint space narrowing

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13
Q

On which imaging modality is avascular necrosis seen?

A

MRI

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14
Q

What is functional leg length discrepancy?

A

Feel off-balance > put block under leg > feel on-balance again

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15
Q

How is apparent leg length measured?

A

Umbilicus to medial malleolus

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16
Q

How is true leg length measured?

A

ASIS to medial malleolus

17
Q

How is osteoarthritis of the hip diagnosed?

A

History - stiffness
Examination - limited range of movement, especially internal and external rotation
Investigations - not blood test
- Blood tests to exclude other arthritides

18
Q

What are the radiological signs of osteoarthritis on x-ray?

A

LOSS

  • L = loss of joint space
  • O = osteophytes
  • S = sclerosis
  • S = subchondral cysts
19
Q

What are the goals of management of osteoarthritis?

A

Relieve pain

Improve mobility

20
Q

What exercise is recommended in the management of osteoarthritis?

A

Any regular low impact exercise that doesn’t worsen symptoms

21
Q

What can be done before and after exercise to relieve pain and inflammation in osteoarthritis?

A

Local heat before

Cold packs after

22
Q

Is physiotherapy effective in the management of osteoarthritis in the lower limb?

A

Not that effective in hip

Far more effective in knee and ankle

23
Q

What are the pharmacological therapies available for the management of osteoarthritis?

A 
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
24
Q

What are the side effects of NSAIDs?

A 
Nausea
Abdominal pain
Diarrhoea
Gastritis
Ulcerss
GI bleeding, especially if on antiplatelets/anticoagulants
25
Q

What are the indications for a total hip replacement?

A

Disabling pain with failed non-operative treatment

26
Q

What are the goals of total hip replacement?

A 
Relieve pain
Correct deformity
Restore
- Range of movement
- ADLs
27
Q

What are the intra-operative complications of a total hip replacement?

A

Injury to neurovascular structures

Fracture

28
Q

What are the early post-operative complications of a total hip replacement?

A

Haematoma
Infection
Wound dehiscence

29
Q

What are the late post-operative complications of a total hip replacement?

A 
Dislocation
Leg length discrepancy
Fracture
Loosening
Heterotopic ossification
30
Q

What are the options for anticoagulation post-operatively after a total hip replacement?

A 
Keep mobile
Chemophylaxis
- LMW heparin
- Aspirin
- Warfarin
Mechanical
- Foot pump
- Compression stocking
31
Q

What is greater trochanteric pain syndrome?

A

Spectrum of diseases including
- Gluteus medius tendinopathy
- Trochanteric bursitis
Analogous to rotator cuff tendon degeneration/subacromial bursistis at shoulder

32
Q

What are the management options for greater trochanteric pain syndrome?

A

US guided corticosteroid injection
Oral NSAIDs
Simple analgesics
Hip abductor strengthening exercises

MD2 Medicine (18 decks)

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