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PCM-exam 1 + 2 > Hip Pain > Flashcards

Hip Pain Flashcards

1
Q

Physical Examination of the hip

A
  • observe gait

- palpation of landmarks

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2
Q

Inspection

A
  • observe the gait/stance, how the patient climbs on the examining table
  • consider looking at the leg length discrepancy
  • observe the C sign
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3
Q

Neurovascular

A

Femoral Artery and sensation of hip/thigh

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4
Q

VITAMIN CDE

A
  • 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)
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5
Q

Anterior Hip Pain

A

– Meralgia Paresthetica

– Sports hernias

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6
Q

Anterolateral Hip Pain

A 
– 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
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7
Q

Lateral Hip Pain

A

– External snapping hip

– Greater Trochanteric Bursitis

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8
Q

Posterolateral Pain

A

– Gluteal muscle tear

– Iliac crest apophysis avulsion

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9
Q

Posterior Pain

A
  • Hamstring strain
  • Ischiofemoral impingement
  • Piriformis syndrome
  • Sacroiliac joint dysfunction
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10
Q

FABER Test

A

– labral tear, loose bodies, chondral lesions, femoral acetabular impingement, osteoarthritis,
sacroiliac joint dysfunction, iliopsoas bursitis

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11
Q

Trendelenburg

A

– labral tear, transient synovitis, Legg-Calvé-Perthes disease, SCFE

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12
Q

FADIR

A

-labral tear, loose bodies, chondral lesions, femoral acetabular impingement

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13
Q

Log Roll Test

A

– Piriformis syndrome, SCFE

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14
Q

Straight Leg Test

A

-sports hernia, SCFE, femoral acetabular impingement

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15
Q

PACE or FAIR Test

A

-Piriformis syndrome

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16
Q

Ober Test

A

-External snapping hip, greater trochanteric pain syndrome

17
Q

Development Dysplasia of the Hip

A

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

18
Q

Trochanteric Bursitis

A

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

19
Q

Osteonecrosis of hip

A

• 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

20
Q

Legg-Calve-Perthes Disease

A

• 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

21
Q

Slipped Capital Femoral Epiphysis (SCFE)

A

• 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

22
Q

Femoroacetabular Impingement

A

• 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

23
Q

Acetabular Labral Tear

A

• 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

24
Q

Septic Arthritis

A

• 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

25
Q

Piriformis Syndrome

A

• Entrapment of the sciatic nerve resulting in pain on buttock
• Causes:
– May develop after trauma to buttock or piriformis muscle causing strain and scarring around nerve
– Structure of the piriformis muscle .i.e. nerve passing through bifid piriformis muscle • Clinical findings/ exam findings:
– May complain of buttock pain and also develop paresthesia
– Wallet sign: pain with sitting on wallet
– Neurologic examine normal
– Specialty test:
• log roll test elicits pain
• PACE test: FAIR (flexion, adduction, and internal rotation) test • Treatment:
Pace Test
– Physical therapy
– Nerve pain medications

26
Q

Meralgia Paresthetica

A

• Compression of the lateral femoral cutaneous nerve as it passes through the inguinal ligament
• Pain on the lateral aspect of hip and thigh
• Causes: Tight fitting clothes, obesity, diabetes, pregnancy
• Clinical findings/ exam findings:
– numbness and tingling or decreased sensation over the lateral hip and thigh
– Specialty test: positive FABER • Treatment:
– Conservative therapy (explaining the condition is self limiting)
– Nerve Block
– Nerve pain with neuropathic pain

27
Q

Hip Fracture

A

• Fractures in children due to high impact trauma
• Elderly are the most prone to fractures, average age ~80
• Females> Males
• Risk Factors: age, female gender, previous hip fracture, family history of hip fractures and low socioeconomic status, use of certain medications, osteoporosis, vit d deficiency
• Causes: Clinical presentation:
– Stress and nondisplaced fracture may not show any obvious deformity
– Displaced hip fracture usually present with external rotation and abduction and leg looks shortened
– Pain with log roll and axial load
• Imaging: Xray usually gives the diagnosis, if not consider MRI
• Treatment:
– Surgery
• Prophylactic antibiotic before surgery
• Physical therapy after surgery

28
Q

Central

A

Labrum, L Teres, Articular Surfaces

Log roll, c sign, labral loading and distraction, scour, Faber 1

29
Q

Peripheral

A

Femoral neck, synovial lining

Log roll, rectus femoris test

30
Q

Lateral

A

Gluteus mediums/minimus, piriformis, IT band, Trochanteric bursae

Jump sign, straight leg raise, piriformis, faber 2

31
Q

Anterior

A

Iliopsoas and iliopsoas bursae

Thomas, faber 3

PCM-exam 1 + 2 (14 decks)

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