Hip Pathology Flashcards
Know and understand signs and symptoms of the most common hip pathologies
Hip OA-Osteoarthritis
- Typically and insidious onset
- Defined by symptoms and or pathology
- Prevelance 4.4%.55years old
3. 6 female 5.5 male
What is the first way to diagnose HIP OA
Pain in the Hip and Internal hip rotation < 15* and ESR< _45*mm/hr or hip flexion<_115 if ESR unavaliable
What is the second way to diagnose HIP OA
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
Epidemiology
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
Hip Fractures
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
What are the two types of hip fractures
Intercapsular vs. Extracapsular
Where does an intercapsular hip fracture occur
In the femoral neck
Where foes an extra capsular hip fracture occur
Either intertrochanteric or Subtrochanteric
What types of fractures are considered Pelvic Fractures
- 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
What are the indications for operative fixation in a LE Hip/pelvic fracture
- 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
Fracture Risk Assessment Tool
Developed by the World Health Organization
Avascular Necrosis (Osteonecrosis)
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)
What is legg-calve-perthes
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
What is the clinical presentation of lag-calve-perthes
- antalgic gait
- positive trendelenbrg sign
- limited hip ROM, especially hip AB and IR
- Reports pain in the groin, hip or knee
What is slipped capital femoral epiphysis
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
What is the clinical presentation of slipped capital femoral epiphysis
-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
What are the different types of Hip stress fractures
Compression, Tension, and Displaced.
What are the treatment options for Hip Stress Fractures
Compression–reduced weightbearing (rest/crutches)
Tension/displaced–surgical fixation
What are the three types of HIP Bursitis?
Trochanteric, Iliopsoas, and Ischial
What are the clinical findings for trochanteric Hip Bursitis?
Pain with Palpation
Pain with MMT of abductors, extensors, and or External Rotators
Tightness of lateral soft tissue
What is a key symptom of trochanteric bursitis
Localized pain over the outer part of the hip…superficial pain
Before treating for bursitis what must you rule out
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
What might a Snapping hip indicate?
Internal=Illiopsoas tendon tightness
External=Iliotibial Band tightness
What is piriformis syndrome?
Entrapment of the sciatic nerve by the piriformis
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
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
What are the four categories of femoral acetabular impingement Labral Injuries
- Normal
- CAM superior femoral head labral tear
- Mixed–superior femoral head/acetabuler labral tear
- Pincer-superior actabular notch tear
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)
What major joints and muscle groups are involved in athletic pucalgia and groin injuries
- Lumbar Spine/SacroIliac/hip
- Hip Flexors, groin Muscles, abdominals
What is a sports hernia?
Caused from a weakening of lower abdominal wall
—internal oblique and transversalis
Where might one feel pain from a Sports hernia?
Pain radiates into the groin region.
What might a sports hernia be aggravated by?
- Sports involving sudden changes in direction
- any increase in abdominal pressure(ie. sneezing, coughing, bowel movement)
What is the sign of the buttock?
A collection of signs that indicate the presence of serious pathology requiring medical referral.
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
What is the capsular pattern for the hip
limitations of internal rotation and abduction lost first
flexion more limited than extension
What is the open pack position for the hip
10-30’flexion
10-30’abduction
0-5’ External rotation
What is the closed pack position for the hip
full hip extension, external rotation, abduction
What planes does the hip allow movement in?
All three planes
Frontal: abduction and adduction
Saggital: flexion and Extension
Transverse: internal and external roatation
