Hip Pathlogies

Question 1

What is the myositis ossificans presentation and cause

Answer 1

presentation- direct blow followed by swelling and decreeased ability to flex knee

cause- dame to mm with hematoma

Question 2

What is a hip pointer, cause, prognosis

Answer 2

Disabling contusion of iliac crest due to direct trauma/fall on hard surface

prog- normally 3 weeks

Question 3

what is the mc hip dislocation, how does ant and post dislocations present

Answer 3

post mc (car accident)– medical emergency!

post- flex adducted, int rot

ant- ext rot, abducted, flex or extend

Question 4

cause of atruamatic hip instability and possible symptoms

Answer 4

cause- repetative microtrauma from axial loading and ext rot.

symptoms- pain, psoas/it snapping, apprehension, instability

Question 5

what are the 3 types of bursistis (mc)

Answer 5

Tracnteric (mc)

Ischial (prox hamstring origin)

Iliopectineal (deep to psoas tendon)

Question 6

what is a better diagnosis than trochanteric bursitis and what does it include

Answer 6

Greater trochanteric pain syndrome

including trochanteric bursitis, thickening/thinning/tears or tendinopathy of the gluteals and external coxa saltans (snapping hip)

Question 7

What is gluteal tendinopathy mc in and ways to dx

Answer 7

females 40+, 35% of those w low back pain

dx via palpation, provocation, RROM, obers, faber

Question 8

tx of greater trochanteric pain syndrome

Answer 8

• anti inflammatory measures (rice)
• soft tissue work (not over bursae)
• Corticosteroid injections

Question 9

What is the presentation of snapping hip syndrome, mc pop, pathology

Answer 9

presentation- snapping sensation with fear of dislocation
mc- in younger women

pathology- tendons become inflamed.irrated from rubbing over bursae/bony prominances

Question 10

Adductor strain- cause,mc mm involved, tests

Answer 10

forecefull contraction in stretched pos

mc- adductor longus/magnus

tests- Direct palp, resisted adduction, passive abduction

Question 11

Hamstring strain- moi, what makes the injury worse

Answer 11

moi- forced flex at hip with knee extenion or excessive contraction

More prox injury the longer recovery

Question 12

ext hip rotator strain- moi, symptoms

Answer 12

moi- overuse, lack of ext rot flex/mobility with int contracture of hip

symptoms- vague butt pain with resisted ext rot, may cause sciatic nerve compression (piriformis syndrome)

Question 13

Piriformis syndrome- moi, symptoms

Answer 13

moi- contracture (overuse), prolonged ext pressure,congenital variations

symptoms- butt pain, pain w sitting, tenderness over greater sciatic notch, increased pain with maneuvers that place piriformis under tension.

Question 14

What is the pathology of a sports hernia and presentation

Answer 14

• bulge/ post inguinal wall hernia w/o presentation of true hernia due to abnormalities in RA, partial avulsion of IO from pubic tubercle

pres- generally high performance athletes (men in 20s)

Question 15

What are the symptoms of a sports hernia

Answer 15

-inguinal canal pain that is chronic, insidious and intermittent (increase w coughing,straining,twisting), usually after strenous actiuty

Question 16

How to assess for sports hernia

Answer 16

Squeeze knees/feet together while suprine

resisted sit up

Question 17

moi, Presentation, dx of osteitis pubis

Answer 17

moi- Forced adduction

pres- pain w activity (localized to pubic region)

dx- xray- widening at he pubis (>10mm), iregularity/sclerosis of pubic margins

Question 18

Presentation of hip stress fx and mc pop

Answer 18

pres- insidious, deep ant pain with weight bearing, possible limp, night pain

mc- young and active pts. (distance runners etc)

Question 19

Hip fx risks

Answer 19

malunion, AVN, biomechanical problems

Question 20

Presentation of hip osteoarthritis, mc age, pain loc

Answer 20

Middle age to elderly

• Modertate ant/lat hip pain, pain w standing
• Moring stiffness >1hr
• LBP from compensation
• • trendelenburg

Question 21

tx of hip osteoarthritus + prog

Answer 21

• reduce inflammatory response
• keep them moving and maintain WB function
• lose weight/activity modification

prog- if left untreated, natural history is progressive and can lead to severe disability/jt replacement

Question 22

common pop that is affected by rheumatoid arthritis + presentation

Answer 22

women 25-55, bilateral pain, periarticular swelling

-likely has hands/wrist involvent (ulnar dev)

Question 23

What is the pathology of rheumatoid arthritis

Answer 23

Chronic synovial inflammation results in jt destruction

Question 24

what % of hip pain does acetabular labral tears account for and moi

Answer 24

22-55% of hip groin pain

moi- rot + hyperextension or repeated pivoting/twisting

Question 25

Diagnostic gold standard of acetabular labral tears

Answer 25

Ct arthrography

Question 26

S/S of labral tear

Answer 26

• Ant groin pain, mechanical hip symptoms, instabilty
• end range pain (faddir)
• c sign walk/limp
• Scour test, log roll, long axis distraction

Question 27

What is FAI and what are the signs/symptoms

Answer 27

mechainical impingemt of femoral head/neck on acetabulum

-pain in anterior aspect of the hip, motion/position related (occurs when long siiting/hip flexion)

Question 28

what is developmental dyplasia common in

Answer 28

breech delivery
Females
First born infants
+ family history of DHD

Question 29

What is the presentation of transient synovitis

Answer 29

• child <10 years old with gradualpain in inguinal areas and difficulty bearing weight
• isidious limp

Question 30

Slipped capital femoral epiphysis- population affected , how can it present, moi

Answer 30

occurs in rapudly growing or overweight children (age-8-17)

-often history of trauma

-may present as knee pain alone
(x-ray is diagnostic)

Question 31

What is the xray finding of legg calve perthes disease

Answer 31

decreased size of prox femoral epiphysis (form of avascular necrosis)

Question 32

presentation of legg calve perthes (mc age, symptoms)

Answer 32

5-7 yoa
insidious mild hip pain and limp w decreased hip abduction/int rot
May also present as knee pain only

Question 33

What is meralgia paresthetica due to and how does it present

Answer 33

Numbness/tingling of lat thigh due to compression of lat femoral cutaneous nerve under inguinal lig

• prolonged sitting, overweight/obese, tight belt
• Symptoms worse with direct pressure over nerve