Hip Pathology Flashcards
hip pain is usually…
anterior/medial
groin pain usually means…
joint pathology
c-sign means
joint pathology
hip joints are _______ unless there is considerable pathology
usually not painful
_________ is typically not joint pain
lateral hip pain
if they point to the trochanter?
tendinopathy vs bursitis
What should you consider when evaluating hip dysfunction?
- consider adjacent joints
- gait and function
congenital hip dislocation/hip dysplasia
- pediatric
- due to malformation of the acetabulum
- instability
congenital hip dislocation
- pediatric
- birth to 6 year old
- may not be observed early (because of increase of activity)
- commonly associated with neurological disordered
- may have implications throughout the lifespan if not correctly early (chronic instability, affect down entire LE, OA)
Legg-Calve Perthes Disease
- pediatric
- lack of femoral head ossification, avascular necrosis (obturator artery)
- flattening of the femoral head
- typically identified between 4-10 years old
- insidious onset of pain
both congenital hip dislocation/dysplasia and legg-calve perthes disease show these upon examination….
- loss of joint motion (often IR)
- possible leg length discrepancy
- antalgic gait pattern (possible delayed pediatric milestones)
slipped capitol femoral epiphysis
- mid to late adolescence (often associated with final growth spurt)
- idiopathic
- ice cream falling off the cone (radiograph)
- possibly linked to endocrine disorders
- more common in obese patients (boys>girls)
What exam findings do you see associated with slipped capitol femoral epiphysis?
- antalgic gait pattern
- idiopathic pain
- pain with joint motion
- medial knee pain
- crepitus
how do you differentiate between LCP and SCFE?
- age
- comorbidities
- activity
What should you consider when evaluating stress fractures?
(adolescent/adult)
- consider training/loading
- overall health
- pain worse with progressive loading
- often not palpable
What are three different kinds of femoral head stress fractures?
- compression (inferior)
- tension (superior aspect)
- displaced
What should you consider for idiopathic stress fractures?
- females are more likely than males. why?
- female athlete triad
What are factors of the female athlete triad?
- eating disorders: nutritional effect
- osteopenia: loss of calcium weakens the bones
- amenorrhea - overworked or high level athlete (dysmenorrhea = abnormal mentration)
What are some traumatic injuries adults and adolescents have?
- contusions (muscle)
- sprains/strains
- myositis ossificans
- femoral acetabular impingement
myositis ossificans
- increased activity with healing
- over stimulation of periosteum
- caused by deep or repeated trauma
contusions
- very painful
- cause bleeding
- never get a chance to heal
- tension during movement keeps reopening bruise back up (glutes, quads, ham)
strains
- 2 joint muscles more likely than 1 joint
- stretched over both joints
- require more neuromuscular control
- sartorius, semitendinosus, biceps femoris
which anterior hip ligaments could a sprain effect?
iliofemoral lig
pubofemoral lig
which posterior hip ligaments could a sprain effect?
ischiofemoral
What is important to consider when it comes to sprains?
MOI
iliofemoral sprain
- anterior/superior
- strong dense (most important)
- prevents trunk and hip extension, hip ER/IR
pubofemoral sprain
- anterior/inferior
- prevents extension, abduction, ER
ischiofemoral
limits hip IR
concerns when examining contusions/strains
will have…
- pain with resisted motion
- pain with stretching
- often pain on palpation
- visible bruising?
concerns when examining sprains specifically
pain with passive and active range of motion
pain at the end range of motion
myositis ossificans exam
- acute management of muscle damage
- non-healing or abnormal pain considering time from injury
femoral acetabula impingement
- normal
- CAM (on femoral head)
- Pincer (on superior acetabulum)
- mixed (both CAM and Pincer)
What to look for when evaluating for femoral acetabular impingement
- anterior hip pain
- pain with hip flexed activities
- pain with combined flexion/IR and ROM loss
Lateral hip pain
(greater trochanteric pain syndrome)
- there’s a difference in trauma vs repetitive motion
- IT band “shortening”
- leg length discrepancy
- weakness in abductors, extensors,and ER
- women>men, age
- repetitive motion
location of trauma fractures
(adolescent/adult)
- femur fractures (shaft injuries)
- hip fractures (joint injuries, if inside the capsule then it is a joint injury)
What to look for when evaluating for a fracture?
- MVA
- Fall (elderly)
- pain with any movement
- inability to bear weight
Adult and Geriatric idiopathic conditions
- osteoarthritis
- hip fractures
osteoarthritis examination considerations
- limited passive and active ROM
- pain with weight bearing
- weak musculature
adult/geriatric hip fracture considerations
- OA
- recognize symptoms
- the break could cause the fall
- consider potential for blood loss if acute
medical management of hip fractures
- blood loss/shock
- surgery (hip pinning, partial joint replacement, total hip replacement)
