Hip ppt Flashcards
What is the minimum palpation for every pt with hip pain?
iliac crest at L4
anterior superior iliac crest
greater trochanter
musculoskeletal differential for anterior hip pain
meralgia paresthesia
sports hernias
musculoskeletal differential for anterolateral hip pain
femoroacetabular impingement hip labral tear legg calve perthes disease osteoarthritis osteonecrosis of hip septic hip slipped capital femoral epiphysis
musculoskeletal differential for lateral hip pain
external snapping hip
greater trochanteric bursitis
musculoskeletal differential for posterolateral hip pain
gluteal muscle tear
iliac crest apophysis avulsion
musculoskeletal differential for posterior hip pain
hamstring strain
ischiofemoral impingement
piriformis syndrome
sacroiliac joint dysfunction
What do you perform the FABER test to test?
labral tear, loose bodies, chondral lesions, femoral acetabular impingement, osteoarthritis, sacroiliac joint dysfunction, iliopsoas bursitis
When do you use the FABER test?
anterolateral/anterior hip pain
When do you use the FADIR test?
anterior hip pain
What does the FADIR test test for?
labral tear, loose bodies, chondral lesions, femoral acetabular impingement
What does the log roll test for?
piriformis syndrome
SCFE
What does the straight leg raise test test for?
sports hernia
SCFE
femoral acetabular impingement
When do you use the straight leg raise test?
anterior/anteriolateral hip pain
When do you use the Ober test?
lateral hip pain
What is the Ober test for?
external snapping hip, greater trochanteric pain syndrome
What does the Trendelenburg gait indicate?
labral tear, transient synovitis, Legg-Calve-Perthes disease
gluteus medius m
What is the Thomas test for?
tendinopathy, rectus femoris tear, fractures
What is the PACE test/FAIR test for?
piriformis syndrome
development dysplasia of the hip tests
Ortolani test - abducting forward
Barlow - adducting posteriorly
+ clunk or dislocation
needs bracing, US hip to confirm
trochanteric bursitis
Where is the pain?
risk factors
most common cause of lateral hip pain, over greater trochanter
tendinopathy of the gluteus minimus and medius, also involves inflammation of bursa
female gender, obesity, knee pain, IT band tenderness, low back pain
PE finding for trochanteric bursitis
lateral hip pain, especially when lying on affected side, local tenderness on the greater trochanter
specialty test: may have + FABER and Ober tests
osteonecrosis of hip
causes
mechanism
medications (longterm steroid use), medical conditions (sickle cell anemia, SLE), trauma, transplantation
decreased or poor blood supply, mechanical trauma, genetic factors, metabolic factors
PE findings for osteonecrosis of hip
groin pain, pain with activity, pain at rest
my be asymptomatic after a while
imaging for osteonecrosis of hip
XR initially
MRI
treatment of osteonecrosis of hip
medications: bisphosphonates (can cause osteonecrosis of jaw), vasodilators, statin (lipid lower drugs), anticoagulation
osteotomy
grafting
surgical fixation (total hip replacement)
Legg-Calve-Perthes disease
who does it affect?
risk factors
idiopathic avascular necrosis of the hip, decreased perfusion to the femoral head
affects children 3 - 12 yo, males>females
skeletal immaturity, obesity, lower socioeconomic status
PE findings Legg-Calve-Perthes disease
acute or insidious onset of pain with limping, decreased ROM or stiffness
imaging for Legg-Calve-Perthes disease
XR shows osteochondral loose bodies
treatment for Legg-Calve-perthes disease
nonweightbearing with sling, surgery
slipped capital femoral epiphysis (SCFE)
cause/risk factor
pain and limitation in movement of limb due to femoral epiphysis that slipped posteriorly
obesity in adolescent (8-15 yo) growth spurt, endocrine disorder
SCFE PE findings
obese adolescent presenting with hip pain with limping and impaired internal rotation, occasionally after minor trauma
imaging for SCFE
AP or lateral view XR of hip, US, MRI
treatment for SCFE
nonweight bearing with crutches or wheelchair, refer to ortho
surgery to stabilize and prevent complications
femoraoacetabular impingement
pain on anterolateral hip/groin due to abnormal contact btwn the anterior femoral head and acetabular rim
can increase risk of osteoarthiritis of hip
PE findings of femoraoacetabular impingement
pain increased with prolonged sitting, leaning forward, getting out of car
insidious pain in groin area and buttocks
specialty testing for femoraoacetabular impingement
C-sign, positive FABER and FADIR test
treatment for femoraoacetabular impingement
physical therapy
inraarticular injection
arthroscopy
acetabular labral tear
causes
can hasten…
pain on anterior aspect of hip
post trauma or insidious in onset (from longterm microtrauma)
…osteoarthritis
PE findings of acetabular labral tear
specialty test
pain with activity
+ Thomas test
imaging for acetabular labral tear
MR arthrography
treatment for acetabular labral tear
joint injection and hip arthroscopy
What are common organisms for septic arthritis?
healthy people
immunocompromised pt
healthy: staph aureus and streptococcal, N gonorrhea
immunocompromised: gram - bacteria, mycobacterial species, fungal species
piriformis syndrome
causes
entrapment of the sciatic N resulting in pain on buttock
may develop after trauma to buttock or piriformis muscle causing strain and scarring around the nerve
structure of piriformis muscle
PE findings of piriformis syndrome
specialty test
buttock pain and paresthesia wallet sign: pain with sitting on wallet neurologic exam normal \+ log roll test \+ PACE test/FAIR test
treatment for piriformis syndrome
physical therapy
nerve pain medications
meralgia paresthetica
causes
compression of the lateral femoral cutaneous nerve as it passes through the inguinal ligament
pain on the lateral aspect of hip and thigh
tight fitting clothes, obesity, DM, pregnancy
PE findings of meralgia paresthica
specialty test
numbness and tingling or decreased sensation over the lateral hip and thigh
+ FABER
treatment for meralgia paresthetica
conservative therapy
nerve block
nerve pain with neuropathic pain
