Hip pain Flashcards
what is the hip joint commonly affected by in older patients?
DJD
fracture
disorders of the hip are commonly..
age ralated
if an infant has a hip disorder it is most likely
congential
when does an adolescent have hip problems?
vascular and growth plate problems
when does a young adult have hip problems?
traumatic injuries
diagnosis of hip pain is often dependant on?
radiographs
hip pain can be from?
intrinsic pathology or referred
what can help identify the hip pain?
associated pain in lumbopelvic region or abdominal areas
insidious onset of hip pain suggests?
DJD if in adult/senior
AVN, SCFE, reactive synovitis if child or adolescent
what must you assess if a child has hip pain?
knee
direct trauma that causes thigh pain is due to?
contusion
sudden onset of thigh pain with movement
strain
anterior numbness, paresthesias or weakness in the thigh area?
femoral nerve involvement
lateral sensory complaints in the thigh
lateral femoral cutaneous nerve involvement or trigger point referral
posterior neurological complaints of thigh pain
sciatic nerve irritation, referral from trigger points or lumbar/sacral facet problem
anteversion
femoral head faces forward with relative posteiror positioning of the greater trochanter
retroversion
femoral head faces posterior with positioning of the greater trochanter anteirorly
femoral angle
120-130 degrees
what tests can be used to evaluate hip pain?
fabre patrick’s
axial compression
femoral acetabular impingement tests
thomas test
DJD/OA
narrowing of the superior joint space with osteophyte formation, cystic change, sclerosis
RA
uniform, symmetrical loss of joint space with demineralization, cystic change, acetabular protrusion
paget’s disease
accentuate trabeculation, cortical thickening, brim sign, bone softening changes
AVN
mottled bone density, crescent sign, flattening deformity, fragmentation
legg-calve perthes disease
small or absent epiphysis, flattening, sclerosis, fissuring, fragmentation, mushroom deformity
SCFE
abnormal Klein’s line
developmental dysplasia of the hip
putti’s triad
FAI
aspherical head of the femoral head, lack of femoral head neck offset and retroversion of the acetabulum
acetabular dysplasia
increased inclination of the acetabulum
what hip pathologies require medical referral
fracture, dislocation, SCFE, AVN, infection, tumor or visceral pathlogy
classic presentation of hip fracture
pain
unable to bear weight
history of a fall onto hip
elderly with hip fractures is usually due to?
osteoporosis
what are the types of hip fractures?
intracapsular (subcapital, transcervical, basicervical)
extracapsular (intertrochanteric, subtrochanteric
stress fractureclassic presentation
young active patient, often participating in actiities such as long distance running, gymnastics, etc
pain is insidious and worse with weight bearing
impaction fracture
shortened height, causing a zone of sclerosis
insufficiency fracture
normal stress to an abnormal bone
what are the clasic tests for early detection of congenital hip dislocation?
ortolani’s
barlow’s
radiographic examination of congenital hip dysplasia may reveal?
putti’s triad
what needs to happen if someone does have congenital hip dislocation?
orthopedic consult
putti’s triad
small/absent proximal femoral epiphysis
lateral displacement of the femur
increased inclination of acetabular roof
what lines are used to check for congenitlal hip dysplasia?
shenton’s
hilgenreiner’s
perkin’s
perkin’s line and hilgenreiner’s line should equal out to?
28 degrees or less
ddx of dysplasia of the hip
SCFE
congenital hip dysplasia
AVN
if the femur head looks inferior on the film, what kind of dislocation is it?
anterior
if the femur head looks superior on the film, what kind of dislocation is it?
posterior
posterior hip dislocation
90% of sports related hip dislocations
major iforce is applied to a flexed abducted hip, after the injuryy the hip is held in flexion, adduction and internal rotation
anteiror hip dislocation
force to an extended, externally rotated leg, after the injury the leg is held in felxion, abudction and internal rotation
who usually gets SCFE?
overweight child or young rapidly growing adolescent
s/s of SCFE
possible hormonal influcences bilateral occurances common pain with limp children may only have knee pain abnormal kline's line
what is the next step for a SCFE?
orthopedic consult
s/s of AVN
mild hip pain with associated limp of insidious onset
young patient may have knee pain
may have limited hip abduction and internal rotaiton
positive trendelenburg tes
etiology of AVN
disruption of vasuclar supply related to an undetermined etiology or trauma, long-term steroid use, hyperlipidemia, alcoholism, pancreatitis, hemoglobinopathies, etc
legg-calve-perthes
small or absent femoral capital epiphysis, fissuring, fragmentation, flattening, mottled density, sclerosis, crescent sign
adult AVN
mottled density change, flattening, crescent sign, sclerosis, fragmentation
AVNs need?
MRI
orthopedic consult
femoral acetabular impingement syndrome
clinical syndrome of painfully limited hip motion
result of certain types of underlying morphological abnormalities in the femoral head/neck region and/or surrounding acetabulum
lead to early degenerative disease and labral tears
s/s of femoral acetabular impingement syndrome
sharp, deep hip pain with squatting ,running, stopping and starting or changing direction may also cause pain
pain is often felt anteirorly
etiology of femoral acetabular impingement syndrome
different types of hip abnormalities that limit motion, in particular flexion and internal rotation
pincer impingement
more common in middle aged women, occuring at an average of 40 years, and can occur with various disorders
CAM impingement
more common in young men, occuring at an average age of 32 years
CAM type
abnormalities of the femur wiht decreased offset between the femoral head and neck
pincer type
due to acetabular abnromalities which lead to excessive coverage by the anteiror acebatular rim
