Hip Pathology Flashcards

Know and understand signs and symptoms of the most common hip pathologies

1
Q

Hip OA-Osteoarthritis

A
  • Typically and insidious onset
  • Defined by symptoms and or pathology
  • Prevelance 4.4%.55years old
    3. 6 female 5.5 male
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2
Q

What is the first way to diagnose HIP OA

A

Pain in the Hip and Internal hip rotation < 15* and ESR< _45*mm/hr or hip flexion<_115 if ESR unavaliable

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3
Q

What is the second way to diagnose HIP OA

A

Pain int he hip and internal hip rotation >_ 15* and pain associated with internal hip and morning stiffness of the hip <_60 minutes and over 50 years of age

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4
Q

Epidemiology

A

231000 total hip replacement procedures were performed in the US in 2006…majority performed on individuals over the age of 65 while 40% were performed on individuals between the ages of 45-64
-Incidence of primary THR is projected to increase 174% to 572000 by 2030 and THR revisions is projected to increase by 137% to 96700

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5
Q

Hip Fractures

A

Hip Neck Fractures occur at a rate of 98/100,000 in the US
Average occurrence in the 70’s
Hip joint fractures are more common in Caucasian adults
More common in women
-87%cases among elderly, typically resulting from a fall

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6
Q

What are the two types of hip fractures

A

Intercapsular vs. Extracapsular

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7
Q

Where does an intercapsular hip fracture occur

A

In the femoral neck

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8
Q

Where foes an extra capsular hip fracture occur

A

Either intertrochanteric or Subtrochanteric

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9
Q

What types of fractures are considered Pelvic Fractures

A
  • Iliac wing fractures
  • ilium fractures with SI involvement
  • transsacral fractures
  • unilateral sacral fractures
  • SI joint fractures/dislocations
  • acetabular fractures
  • pubic ramus fractures
  • ischial fractures
  • pubic symphysis separation
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10
Q

What are the indications for operative fixation in a LE Hip/pelvic fracture

A
  • closed methods have failed
  • closed methods will probably fail
  • displaced intraarticular fractures
  • pathological fracture
  • associated neurovascular injury
  • polytrauma
  • when it will minimize confinement to bed
  • when it will substantially reduce the cost of treatment
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11
Q

Fracture Risk Assessment Tool

A

Developed by the World Health Organization

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12
Q

Avascular Necrosis (Osteonecrosis)

A
Typically affects the superior articular surface (between 10-2 o'clock)
40% bilateral involvement in non-traumatic cases
Ficat Classification
-stage 0 normal
-stage1
-stage2
-stage3
-stage4 (end stage)
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13
Q

What is legg-calve-perthes

A

a form of avascular necrosis
typical age of onset 4-8years old
male to female ration is 5-1
patient typically reports pain in the groin, hip , or knee

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14
Q

What is the clinical presentation of lag-calve-perthes

A
  • antalgic gait
  • positive trendelenbrg sign
  • limited hip ROM, especially hip AB and IR
  • Reports pain in the groin, hip or knee
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15
Q

What is slipped capital femoral epiphysis

A

displacement of proximal femoral epiphysis
typical age of onset is 10-15
male to female ratio is 1-5-1
more prominent in African Americans
obesity reported in as many as 75% of patients
correlates with sudden growth spurts

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16
Q

What is the clinical presentation of slipped capital femoral epiphysis

A

-Pain in the group, anterormedial thigh and knee
-Antalgic
-Leg held in external rotation ER (supine and standing)
Limited with flexion, abduction, and Internal Rotation IR

17
Q

What are the different types of Hip stress fractures

A

Compression, Tension, and Displaced.

18
Q

What are the treatment options for Hip Stress Fractures

A

Compression–reduced weightbearing (rest/crutches)

Tension/displaced–surgical fixation

19
Q

What are the three types of HIP Bursitis?

A

Trochanteric, Iliopsoas, and Ischial

20
Q

What are the clinical findings for trochanteric Hip Bursitis?

A

Pain with Palpation
Pain with MMT of abductors, extensors, and or External Rotators
Tightness of lateral soft tissue

21
Q

What is a key symptom of trochanteric bursitis

A

Localized pain over the outer part of the hip…superficial pain

22
Q

Before treating for bursitis what must you rule out

A

must rule out lumbar radiculopathy andhip joint disorders (eg. stress fracture of the femur, bone/soft tissue tumor, hip infection, AVN…Avascular necrosis, glute medius tendinopathy

23
Q

What might a Snapping hip indicate?

A

Internal=Illiopsoas tendon tightness

External=Iliotibial Band tightness

24
Q

What is piriformis syndrome?

A

Entrapment of the sciatic nerve by the piriformis

25
What are the clinical findings for piriformis syndrome?
- restricted HIP addudction/Internal Rotation - positive FABER test - Weak glutes/hamstrings - Neurologic symptoms in the posterior limb
26
What are the clinical findings for a - | acetabular labral tear
-No restrictions in ROM -Normal radiograohs -Reports prolonged history of anterior hip or group pain/clicking Pain with passive hip flexion combined with adduction and internal rotation (FADDIR) -Pain with resisted SLR
27
What are the four categories of femoral acetabular impingement Labral Injuries
1. Normal 2. CAM superior femoral head labral tear 3. Mixed--superior femoral head/acetabuler labral tear 4. Pincer-superior actabular notch tear
28
What is Pubalgia? | Otherwise termed Athletic pubalgia/groin injuries
A collective term for all disorders that cause chronic pain in the region of the pubic tubercle and the structures attached to the pubic bone(inguinal region)
29
What major joints and muscle groups are involved in athletic pucalgia and groin injuries
- Lumbar Spine/SacroIliac/hip | - Hip Flexors, groin Muscles, abdominals
30
What is a sports hernia?
Caused from a weakening of lower abdominal wall | ---internal oblique and transversalis
31
Where might one feel pain from a Sports hernia?
Pain radiates into the groin region.
32
What might a sports hernia be aggravated by?
- Sports involving sudden changes in direction | - any increase in abdominal pressure(ie. sneezing, coughing, bowel movement)
33
What is the sign of the buttock?
A collection of signs that indicate the presence of serious pathology requiring medical referral.
34
What are the signs of the buttock?
-a limited straight leg raise -limited hip flexion limited trunk flexion -a noncapsular pattern of him restriction -a painful and weak hip extension -gluteal swelling -an empty-end feel on hip flexion
35
What is the capsular pattern for the hip
limitations of internal rotation and abduction lost first | flexion more limited than extension
36
What is the open pack position for the hip
10-30'flexion 10-30'abduction 0-5' External rotation
37
What is the closed pack position for the hip
full hip extension, external rotation, abduction
38
What planes does the hip allow movement in?
All three planes Frontal: abduction and adduction Saggital: flexion and Extension Transverse: internal and external roatation