Hip Pathology

Question 1

Hip OA-Osteoarthritis

Answer 1

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

Question 2

What is the first way to diagnose HIP OA

Answer 2

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

Question 3

What is the second way to diagnose HIP OA

Answer 3

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

Question 4

Epidemiology

Answer 4

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

Question 5

Hip Fractures

Answer 5

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

Question 6

What are the two types of hip fractures

Answer 6

Intercapsular vs. Extracapsular

Question 7

Where does an intercapsular hip fracture occur

Answer 7

In the femoral neck

Question 8

Where foes an extra capsular hip fracture occur

Answer 8

Either intertrochanteric or Subtrochanteric

Question 9

What types of fractures are considered Pelvic Fractures

Answer 9

• 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

Question 10

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

Answer 10

• 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

Question 11

Fracture Risk Assessment Tool

Answer 11

Developed by the World Health Organization

Question 12

Avascular Necrosis (Osteonecrosis)

Answer 12

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)

Question 13

What is legg-calve-perthes

Answer 13

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

Question 14

What is the clinical presentation of lag-calve-perthes

Answer 14

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

Question 15

What is slipped capital femoral epiphysis

Answer 15

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

Question 16

What is the clinical presentation of slipped capital femoral epiphysis

Answer 16

-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

Question 17

What are the different types of Hip stress fractures

Answer 17

Compression, Tension, and Displaced.

Question 18

What are the treatment options for Hip Stress Fractures

Answer 18

Compression–reduced weightbearing (rest/crutches)

Tension/displaced–surgical fixation

Question 19

What are the three types of HIP Bursitis?

Answer 19

Trochanteric, Iliopsoas, and Ischial

Question 20

What are the clinical findings for trochanteric Hip Bursitis?

Answer 20

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

Question 21

What is a key symptom of trochanteric bursitis

Answer 21

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

Question 22

Before treating for bursitis what must you rule out

Answer 22

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

Question 23

What might a Snapping hip indicate?

Answer 23

Internal=Illiopsoas tendon tightness

External=Iliotibial Band tightness

Question 24

What is piriformis syndrome?

Answer 24

Entrapment of the sciatic nerve by the piriformis

Question 25

What are the clinical findings for piriformis syndrome?

Answer 25

• restricted HIP addudction/Internal Rotation
• positive FABER test
• Weak glutes/hamstrings
• Neurologic symptoms in the posterior limb

Question 26

What are the clinical findings for a -

acetabular labral tear

Answer 26

-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

Question 27

What are the four categories of femoral acetabular impingement Labral Injuries

Answer 27

1. Normal
2. CAM superior femoral head labral tear
3. Mixed–superior femoral head/acetabuler labral tear
4. Pincer-superior actabular notch tear

Question 28

What is Pubalgia?

Otherwise termed Athletic pubalgia/groin injuries

Answer 28

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)

Question 29

What major joints and muscle groups are involved in athletic pucalgia and groin injuries

Answer 29

• Lumbar Spine/SacroIliac/hip

- Hip Flexors, groin Muscles, abdominals

Question 30

What is a sports hernia?

Answer 30

Caused from a weakening of lower abdominal wall

—internal oblique and transversalis

Question 31

Where might one feel pain from a Sports hernia?

Answer 31

Pain radiates into the groin region.

Question 32

What might a sports hernia be aggravated by?

Answer 32

• Sports involving sudden changes in direction

- any increase in abdominal pressure(ie. sneezing, coughing, bowel movement)

Question 33

What is the sign of the buttock?

Answer 33

A collection of signs that indicate the presence of serious pathology requiring medical referral.

Question 34

What are the signs of the buttock?

Answer 34

-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

Question 35

What is the capsular pattern for the hip

Answer 35

limitations of internal rotation and abduction lost first

flexion more limited than extension

Question 36

What is the open pack position for the hip

Answer 36

10-30’flexion
10-30’abduction
0-5’ External rotation

Question 37

What is the closed pack position for the hip

Answer 37

full hip extension, external rotation, abduction

Question 38

What planes does the hip allow movement in?

Answer 38

All three planes
Frontal: abduction and adduction
Saggital: flexion and Extension
Transverse: internal and external roatation