Hip Pain Flashcards
Physical Examination of the hip
- observe gait
- palpation of landmarks
Inspection
- observe the gait/stance, how the patient climbs on the examining table
- consider looking at the leg length discrepancy
- observe the C sign
Neurovascular
Femoral Artery and sensation of hip/thigh
VITAMIN CDE
- V – Vascular (avascular necrosis)
- I – Inflammatory (Infection ie. Septic arthritis, Impingement)
- T – Traumatic (stress fracture, fracture)
- A – Autoimmune (rheumatoid arthritis)
- M – Metabolic (Osteoporosis)
- I – Iatrogenic/Idiopathic (chronic steroid use w/ risk of osteoporosis)
- N – Neoplasia
- C – Congenital (developmental dysplasia of hip)
- D – Degenerative, Drugs (DJD, OA)
- E – Endocrine (longterm steroid use)
Anterior Hip Pain
– Meralgia Paresthetica
– Sports hernias
Anterolateral Hip Pain
– Femoroacetabular impingement – Hip labral tear – Legg Calve Perthes Disease – Osteoarthritis – – Osteonecrosis of hip Hamstring strain Ischiofemoral impingement Piriformis syndrome Sacroiliac joint dysfunction – Septic hip – Slipped Capital Femoral Epiphysis
Lateral Hip Pain
– External snapping hip
– Greater Trochanteric Bursitis
Posterolateral Pain
– Gluteal muscle tear
– Iliac crest apophysis avulsion
Posterior Pain
- Hamstring strain
- Ischiofemoral impingement
- Piriformis syndrome
- Sacroiliac joint dysfunction
FABER Test
– labral tear, loose bodies, chondral lesions, femoral acetabular impingement, osteoarthritis,
sacroiliac joint dysfunction, iliopsoas bursitis
Trendelenburg
– labral tear, transient synovitis, Legg-Calvé-Perthes disease, SCFE
FADIR
-labral tear, loose bodies, chondral lesions, femoral acetabular impingement
Log Roll Test
– Piriformis syndrome, SCFE
Straight Leg Test
-sports hernia, SCFE, femoral acetabular impingement
PACE or FAIR Test
-Piriformis syndrome
Ober Test
-External snapping hip, greater trochanteric pain syndrome
Development Dysplasia of the Hip
Ortolani test and Barlow part of the newborn exam after delivery and during follow-up
Test for developmental dysplasia of the hip which if found, requires bracing early to prevent adverse affects later
Usually if test positive, needs an ultrasound of the hip to confirm diagnosis before treatment (bracing) initiated
Trochanteric Bursitis
Most common cause of lateral hip pain, over greater trochanter
• Tendinopathy of the gluteus minimus and medius, also involves the inflammation of the bursa
• >50 yo at onset, female > males
• Causes/ risk factors: female gender, obesity, knee pain, iliotibial band tenderness, low back pain.
• Clinical presentation:
– Lateral hip pain especially when lying on affected side, local tenderness on the
greater trochanter
– Specialty test: may have positive test on FABER and Ober test
Osteonecrosis of hip
• Multiple causes including medications (i.e. longterm steroid use), serious medical conditions (i.e. sickle cell anemia, SLE, etc), trauma, transplantation
• Mechanism of causes: decreased or poor blood supply, mechanical trauma, genetic factors, metabolic factors
• Clinical presentation:
– Groin pain, pain with activity, pain at rest
– May be asymptomatic for a while
• Imaging: perform Xray initially but MRI will help definitively diagnose
• Treatment:
– Medications: bisphosphonates, vasodilators, statin (lipid lower drugs), anticoagulation
– Osteotomy
– Grafting
– Surgical fixation i.e. total hip replacement
Legg-Calve-Perthes Disease
• Idiopathic avascular necrosis (osteonecrosis) of the hip, decreased perfusion to the femoral hear
• Affects children 3 to 12 yo, male >female
• Risk factors include skeletal immaturity, obesity and lower socioeconomic
status
• Causes: Clinical presentation:
– Acute or insidious onset of pain with limping, decreased ROM or stiffness
• Imaging: Xray shows osteochondral loose bodies
• Treatment:
– Nonweight bearing with sling – surgery
Slipped Capital Femoral Epiphysis (SCFE)
• Pain and limitation in movement of limb due to femoral epiphysis that slipped posteriorly
• Causes/risk factor: obesity in adolescent (8-15 yo), growth spurt, endocrine disorder
• Clinical presentation:
– Obese adolescent presenting with hip pain with limping and impaired internal rotation, occasionally after minor trauma
• Imaging: AP or Lateral view Xray of hip can show the slippage. Ultrasound and MRI can also be performed
• Treatment:
– Initially keep non-weight bearing with crutches or wheelchair and prompt
referral to orthopedic surgeon
– Surgery to stabilize slippage to prevent complications
Femoroacetabular Impingement
• Pain on anterolateral hip/ groin due abnormal contact between the anterior femoral head and acetabular rim
• Can in risk of osteoarthritis of the hip
• Causes: Clinical presentation:
– Pain increased with prolonged sitting, leaning forward and getting out of the car
– Insidious pain usually in the groin area and sometimes buttocks
– Specialty testing: C sign, positive FABER and FADIR test
• Imaging: MRI used for diagnosis
• Treatment:
– Physical therapy
– Inraarticular injection
– Arthroscopy
Acetabular Labral Tear
• Pain on the anterior aspect of the hip
• Causes: post trauma or insidious in onset (from longterm microtrauma)
• Can hasten osteoarthritis
• Clinical presentation:
– Pain with activity
– Specialty testing: positive Thomas test
• MRI and Xray not sensitive, may use MR arthrography
• Treatment:
– Joint injection
– Hip arthroscopy
Septic Arthritis
• Infection in the joint (can be any joint including knee, hip, shoulder, ankle, elbow, wrist)
• Risk factors: Age >80, DM, RA, Prosthetic joint, recent joint surgery, skin infection, IV drug
abuse, previous Intraarticular corticosteroid injection, etc
• Mechanism of infection: hematogenous spread to joint, bite, trauma, exposure during joint surgery, etc
• Common organism
– Healthy patient staph aureus and streptococcal, N gonorrhea (sexually active, young
patient)
– Immunocompromised Gram negative bacteria, mycobacterial species, fungal species
• Clinical presentation:
– Pain in joint along with fever, inflammation at the joint, decreased ROM of the
affect joint
– Joint fluid aspiration needed
• Imaging: MRI
• Treatment:
– Broad spectrum antibiotics
