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2 MSK Clinical Conditions > Hip (Session 3) > Flashcards

Hip (Session 3) Flashcards

1
Q

Which muscles in the hip does the superior gluteal nerve supply?

A

Hip ABDUCTORS: Gluteus medius and minimus

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2
Q

How can the superior gluteal nerve get injured?

A

Complication of hip surgery

Buttock injections

Greater trochanter fracture

Hip dislocation

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3
Q

What is the ‘Trendelenburg sign’?

A

Clinical sign- superior gluteal nerve damage. If patient standing on one leg and hip drops on the raised leg- as gluteus medias and minimum of other limb not contracting so pelvis not supported on that side

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4
Q

Where do the hamstring muscles originate?

A

ischial tuberosity

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5
Q

What population is most commonly affected by osteoarthritis?

A

Elderly (20-30% of people over 70 suffer from OA of hip)

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6
Q

Define osteoarthritis.

A

1) Degenerative disorder arising from breakdown of articular hyaline cartilage
2) Clinical syndrome comprising joint pain and functional limitation+ reduced quality of life
3) chronic disease of MSK system= non inflammatory

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7
Q

What are the most common joints affected by osteoarthritis?

A

Hips, knee, cervical spine, lumbar spine, small joints in hands

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8
Q

What is ankylosis?

A

Bony fusion across a joint

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9
Q

What’s the difference between primary and secondary OA?

A

Primary: cause is unknown, Secondary: known cause

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10
Q

What are some risk factors for primary osteoarthritis?

A

Age, female sex, ethnicity, genetics, nutrition

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11
Q

What are some specific causes of secondary osteoarthritis?

A

Obesity, trauma, malalignment, infection, inflammatory arthritis (e.g. rheumatoid), metabolic disorders, haematological disorders, endocrine abnormalities

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12
Q

What are some symptoms of osteoarthritis?

A

Deep+ aching joint pain

Reduced range of motion

Crepitus (grinding)

Stiffness during rest

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13
Q

How does excessive/uneven loading of the joint increase someones risk of osteoarthritis?

A

Damages hyaline cartilage- hyaline cartilage= swollen (increase proteoglycan synthesis by chondrocytes)- attempt to repair cartilage- eventually cartilage softens and loses elasticity- eroded down to bone, loss of joint space

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14
Q

What is eburnation?

A

Subchondral bone–>thicker denser bone

Process in which subchondral bone responds to cartilage surface changes

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15
Q

What are the 4 cardinal signs of OA on an X-ray?

A

LOSS:

Loss of joint space

Osteophytes

Subchondral sclerosis

Subchondral cysts

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16
Q

In what population is osteoarthirits of the hip most common?

A

Males over 40

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17
Q

What symptoms will be experienced by those sufferring from osteoarthritis of the hip? (5)

A
  1. Joint stiffness
  2. Pain in:
    1. Hip
    2. Gluteal region
    3. Groin region–> radiating to knee (via obturator nerve)
  3. Mechanical pain
  4. Crepitus
  5. Reduced mobility
18
Q

How is osteoarthirits of the hip diagnosed?

A

Clinical presentation

Supported by x-ray changes

19
Q

How is osteoarthritis of the hip treated? (conservative) (9)

A
  1. Weight reduction (if overweight)
  2. Activity modification
  3. Walking stick/frame -reduce load
  4. Muscle strengthening exercises/orthotic footwear
  5. Analgesia
  6. Anti-inflammatories (NSAIDs)
  7. Nutritional supplements
  8. Steroid injections-reduce swelling
  9. Hyaluronic acid injections- increase lubrication
20
Q

What is the only ‘cure’ for hip osteoarthritis?

A

Total hip replacement

21
Q

Roughly how many hip replacements are performed in the UK each year and what is the average age?

A

about 100,000

Average age: 68yrs

22
Q

What is a fractured neck of femur (NOF#) defined as? (as in where fracture is classified as NOF#)

A
  • Fracture of proximal femur
  • Up to 5cm below lesser trochanter
23
Q

What are the 2 types of neck of femur fractures?

A

Intracapsular

Extracapsular

24
Q

What can the extracapsular fractures be divided into?

A
  1. Intertrochanteric
  2. Subtrochanteric
25
Q

Why is there a high risk of avascular necrosis with an intracapsular #NOF, particularly if the fracture is displaced?

A
  • Fracture=likely to disrupt: Medial femoral circumflex artery (MFCA)
  • Artery of ligamentum teres- unable to sustain metabolic demands of femoral head
26
Q

Which populations do intracapsular and extracapsular fractures commonly affect?

A

Intracapsular:

  • More common in elderly
  • (esp post-menopausal women w./ osteoporotic bone)

Extracapsular:

  • Young and middle aged
27
Q

What are the common mechanisms of injury for intracapsular and extracapsular fractures?

A

Intracapsular: Minor fall

Extracaspsular: Significant trauma eg road traffic collision

28
Q

Why is a displaced intracapsular fracture in an older person usually treated by surgical replacement of:

  • Hemiarthroplasty (Femoral head only)
  • Total hip replacement (Femoral head and acetabular cup)
A

High risk of avascular necrosis

29
Q

What is the prognosis like following a #NOF?

A
  • 20% one year mortality (many of patients=elderly and have co-morbidities)
  • 30% one-year post #NOF permanent disability
  • 40% unable to walk independently
  • 80% unable to carry out at least one independent activity of daily life
30
Q

What are the symptoms of a neck of femur fracture?

A
  • Reduced mobility
  • Pain (may be felt in hip, groin, knee)
31
Q

How will a patient with a neck of femur fracture present if the fracture is displaced? (position of leg)

A

Affected leg:

  • Shortened
  • Abducted
  • Externally rotated

Exacerbation of pain on:

  • Palpation of greater trochanter
  • Rotation of hip
32
Q

Why is the hip shortened, abducted and externally rotated in a displaced #NOF?

A
  • Shaft of femur can now move independently to hip joint
  • Short lateral rotators of hip: piriformis, obturator internus etc contract and laterally rotates femoral shaft
  • Iliopsoas pulls on lesser trochanter- laterally rotates femoral shaft
  • Strong abductors attach to greater trochanter abduct femur distal to fracture site
  • Rectus femoris, adductor magnus, hamstring muscles- pull distal fragment of femur upwards- shorten limb
33
Q

Define ‘dislocation of the hip’.

A

Head of femur- fully displaced out of cup-shaped acetabulum of pelvis

34
Q

What are the 2 main causes of hip dislocations?

A
  1. Congenital
  2. Traumatic
35
Q

What is DDH? (MSK)

A

Developmental dysplasia of the hip

(can be congenital/develop after birth)

36
Q

In what population is an acute traumatic hip dislocation most commonly seen?

A

16-40 year olds

(in high speed road traffic collision)

37
Q

What % of hip dislocations are posterior?

A

90%

38
Q

What is the most common cause of a posterior hip dislocation?

A

Knee impacting dashboard during road traffic collision

39
Q

How will the patients affected limb be held is they have experienced a posterior hip dislocation?

A
  1. Flexed
  2. Adducted
  3. Internal (medial) rotation

(Due to:

Femoral head lying on surface of ilium

Head of femur pulled up by strong extensors and adductors of hip

Anterior fibres of glut medius and minimus pull on greater trochanter- cause femur to rotate internally

40
Q

In what % of cases of posterior hip dislocations is sciatic nerve palsy present?

A

8-20% of cases

41
Q

What position is the limb held in in an anterior dislocation?

A

External rotation

Abduction

Slight flexion

42
Q

Why is a central dislocation of the hip a life threatening injury?

A
  • Head of femur driven into pelvis through acetabulum
  • Always= fracture dislocation
  • Femoral head=palpable on rectal examination
  • High risk- intrapelvic haemorrhage
    • disruption of pelvic venous plexuses

2 MSK Clinical Conditions (10 decks)

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