Hip + pelvis Flashcards
Gradual onset of unilateral or bilateral groin or anterior thigh pain
Buttock, lateral thigh, knee
Initial = activity → increased frequency + intensity to pain at rest and at night
Stiffness at rest that subsides w/ activity
Difficulty putting shoes/socks on, getting into car
hip osteoarthritis
RF for hip osteoarthritis
Trauma, obesity, childhood hip diseases, family history, AVN
Correlated w/ age
hip osteoarthritis is caused by –
loss of articular cartilage in the hip joint
Less ROM as disease progresses
→ internal rotation is usually first to occur
→ pain at end point
→ flexion contractures (compensation)
Gait that becomes a limp
XR: AP + frog lateral
Joint space narrowing
Osteophyte formation
Subchondral cyst
Subchondral sclerosis
hip osteoarthritis
How do you treat hip osteoarthritis?
Conservative treatment: acetaminophen, NSAIDs, activity modification, cane/walker, ice/heat, gentle ROM, non-weight bearing exercise, correct obesity
Intra-articular steroid injections
If conservative treatment fails, → refer
Require total hip arthroplasty, metal on metal hip resurfacing
Motion extremely painful, often unable to move extremity
Commonly other injuries to knee, abdomen, head, chest
hip dislocation
Femoral head displaced from acetabulum from severe/high energy trauma (MVA), commonly resulting from direct trauma to knee while hip + knee are flexed
Ass w/ posterior acetabular wall fracture
Anterior dislocations are less common - force to knee w/ thigh abducted + externally rotated
hip dislocation
Assess neurovascular status → sciatic nerve/ femoral nerve palsy can occur (foot drop)
Posterior: leg is shortened w/ hip flexed, adducted, internally rotated
Anterior: leg held in mild flexion, abducted and externally rotated
Evaluate knee! Rule out other fractures
XR: AP view of pelvis, AP + lateral of femur with knee
Posterior, head looks smaller, with anterior, appears larger
Acetabular fracture → CT to further evaluate extent of fracture
hip dislocation
type of hip dislocation: leg is shortened w/ hip flexed, adducted, internally rotated
posterior
type of hip dislocation: leg held in mild flexion, abducted and externally rotated
anterior
How do you treat a hip dislocation?
Closed reduction attempted ASAP: Allis maneuver
Rule out fracture/loose bodies before reduction is performed
Post reduction and CT are necessary
Document neurovascular function before + after reduction
Closed reduction fails → open reduction (or if there are bony fragments)
Abduction pillow + dislocation precautions
Weight bearing status depends on acetabular fracture
Crutch assistance w/ WBAT 2-4 weeks, progression to exercises → cane
the —- —– is used for a closed reduction in hip dislocation
allis maneuver
Gradual onset of progressive pain to groin, lateral hip/buttock, limp + loss of motion
– severe pain in initial phases with bone death
avascular necrosis
avascular necrosis is common in
30s-50s
Trauma, chronic alcoholism, sickle cell, rheumatoid arthritis, SLE, steroids
Death of bone in femoral head, from traumatic disruption of vascular supply or progressive arthritis
Often bilateral
is caused by
avascular necrosis
Pain with straight leg raise (+) and ROM → decreased especially internal rotation
Antalgic or trendelenburg gait
XR: AP pelvis and AP, frog leg lateral of affected hip – may be normal to patchy areas
Crescent sign appears
Eventual collapse + change in shape
IF XR is normal, get MRI
Flattened top of femoral head
avascular necrosis
How do you treat avascular necrosis?
Refer!
Non weight bearing w/ use of crutches may allow regeneration of involved segment
Pulse magnetic electrical fields
Surgical treatment - core decompression
Collapse → surgery
Fall → groin pain + inability to bear weight or ambulate, referred pain to the knee
External rotation, abduction, shortening of affected leg
May have no deformity with nondisplaced/stress fracture
hip fracture
RFs for hip fractures include
Elderly
Osteoporosis
Age
Decreased proprioception, increased fall, dizziness, stroke, syncope, meds, white women, sedentary, smoking, alcoholism, dementa, urban
— and — determines risk of compromise of a hip fracture
location and displacement
dx for hip fracture
Unable to perform straight leg raise
XR: AP + cross table lateral reveal fracture
MRI to rule out occult fracture
tx for hip fracture
Refer to ortho + internist → needs surgery within 48 hours:
Displaced: hemiarthroplasty or total hip arthroplasty
Nondisplaced/impacted: pinning
Intertrochanteric: ORIF or IM nail
Severe thigh pain w/ deformity, inability to move or bear weight, often multi-system bc of high impact
femoral shaft fracture
consider risk of —- —– with a femoral shaft fracture
fat embolism
PE: deformity, swelling, open fracture
Check vascular + neuro status, joints
XR: AP and lateral of affected extremity, pelvis and knee
femoral shaft fracture
tx of femoral shaft fracture
Splint + immediate referral
Surgery to perform external fixation, traction, IM nailing
Point tenderness over greater trochanter radiating down lateral aspect of leg w/ inability to lie on that side
Worsened with rising from seated position, improvement w/ a few steps before worsening after 30 min of walking
Pain worse with active hip abduction, adduction of him or adduction + internal rotation
greater trochanter bursitis
On XR for greater trochanter bursitis you may see
XR: AP + frog lateral - may see calcific deposits
greater trochanter bursitis tx
NSAIDs, activity modification, IT band stretching, ice, short term cane, hip abduction strengthening, steroid
Referral to orthopedist when treatment fails
Rarely surgery
IT band (external) = snapping or popping w/ walking or rotation of the hip
→ patients will point to trochanteric area
Iliopsoas (internal) = popping felt in groin when rising from a chair (no pain)
snapping hip
Snapping or popping sensation occurring with tendons moving over bony prominences: MC = band snapping over greater trochanter
Or iliopsoas tendon, intra-articular tears
snapping hip
PE: IT band felt over greater trochanter when patient stands + rotates hip while adducted
Iliopsoas palpated as hip is extended
XR: AP pelvis + lateral hip
CT, MRI to rule things out
snapping hip
How do you treat snapping hip?
Avoid provocative maneuvers, stretching, strengthening NSAIDs, steroid
Pain over injured muscle that is exacerbated when area continues to be used - location specific to muscle, often from overuse or vigorous muscle contraction
hip strain
PE: pain w/ palpitation, stretch, movement against resistance
XR of pelvis and frog-lateral to rule out others, avulsion injury common
hip strain
How do you treat a hip strain?
RICE + protected weight bearing
Rehab - PROM, heat, e-stim, US, activity modification, home exercise, strength, flexibility
Hamstring → sudden onset of posterior thigh pain while running or other rapid movements, may feel a “pop”
Localized tenderness at muscle sit, possible ecchymosis
Often from direct blow
thigh strain
Hamstring - pain w/ combined flex of hip + extension of knee
Quads - pain with flexion of knee
thigh strain
tx of thigh strain
RICE - rehab, NSAIDs, prevent long-term complications
groin pain, lateral hip pain or buttock pain worsened with weight bearing or inability to bear weight
Pain with hip ROM + straight leg raising, antalgic gait
low energy pelvic fracture
ABCs, pelvis for swelling, ecchymosis, deformity, lacerations, neurovascular status, GI injury
high energy pelvic fracture
3 types of pelvic fracture:
Stable pelvic ring → one side, unilateral
Unstable pelvic ring → disruption of pelvic ring at two sites
Acetabular fracture → intra-articular injuries
How does diagnosis process differ between low + high energy pelvic fractures?
Low impact = AP of pelvis
High impact = XR – trauma - AP, lateral of C-spine and AP of pelvis, CT
treatment of pelvic fractures
Based on degree of instability + associated injuries
Low impact → analgesics, rest, gait training w walker ~6 weeks for fracture healing + improved pain, evaluation for osteoporosis
High impact → hemodynamic resuscitation + injury treatment
Pelvic binding w/ sheet, skeletal traction, surgery once stable
