Hip/Thigh Flashcards
OA of hip
articular cartilage of the femoral head and acetabulum degenerates over time (PRIMARY) or secondarily from disorder of hip during childhood or trauma
hx OA of hip
progressive and gradual onset of anterior thigh or groin pain
typically only pain with activity, but progresses to all the time
PE OA of Hip
limp when walking
decreased AROM and PROM with internal rotation
diagnostic w.u of OA of Hip
loss of joint space and osteophytes on XR
if XR –> MRI
prevention of OA of hip
activity modification
hip girdle strengthening program
sx tx OA of hip
young: femoral head resurfacing with acetabular resurfacing (RSA)
older: total hip replacement or bipolar replacement
rx tx OA of hip
NSAID rx of choice
AVOID narcotic analgesics
hip impingement syndrome
abnormal wearing and contact b/t ball and socket of hip joint
result in increased friction during hip movement
CAM and PINCER lesions
cause of hip impingement syndrome
hip bones do not form normally during childhood yrs
athletic people may experience pain earlier but exercise DOES NOT cause FAI
crossover sign
radiographic finding associated with acetabular retroversion = pincer type FAI in pt with hip pain
arterial blood supply to hip
via obturator and medial and lateral circumflex femoral arteries
osteonecrosis of hip
compromised of arterial blood supply cause death to cells of femoral head
osteonecrosis of hip hx
trauma (dislocation or fracture) or inadequate blood Flow (I.e. sickle cells, alcohol abuse, steroid use, RA, SLE)
20s-40s
gradual onset of dull aching pain in groin, butt, hip
osteonecrosis of hip PE
antalgic gait
tenderness of groin
decreased AROM or PROM in IR of hip
osteonecrosis of hip dx studies
AP of pelvis and AP and Frog leg veins of hip
progressive patchy areas of sclerosis
crescent sign
change in shape of head that collapse of cortical bone
osteonecrosis of hip will look like ___ on XRAY (progression)
normal –> patchy sclerosis –> crescent sign –> change in shape of head and collapse of cortical bone
crescent sign
subchonral fracture of articulate surface
found in osteonecrosis of hip
prevention of osteonecrosis of hip
prior to collapse
avoid steroids, address EtOH use, control other dz
non rx tx osteonecrosis of hip
prior to head collapse: core decompression w/wo graft
after collapse: bipolar hemiarthroplasty (potential head resurfacing)
iliotibial band (ITB)
long tendon of tensor fascia late and gluteus Maximus
snapping hip
ITB band snaps over greater trochanter
what other tendons could cause snapping hip
iliopsoas tendon (snap over pectineal eminence)
labrum of femoral head (can tear and snap with motion)
hx of snapping hip ITB
pt points to greater trochanter area
MC occurs w/walking ration of hip
SNAP when affected side up, rotating leg
iliopsoas hx snapping hip
snap when risking from seated position
labral tears hx snapping hip
early warning side of OA
snap may be sudden when walking and cause patient to grab hold to keep from falling
snapping hip PE
ITB
INSPECT
motion of hip when recreate snap, should feel snap
iliopsoas snapping hip PE
inspect
observe reaction during rise of the hand
feel snap on extension of hip from flexed position
labrum snapping hip PE
inspect
shortening of leg, limp with walk
best diagnostic study snapping hip labral tear
MR arthrogram with gadolinium
snapping hip tx
non painful - reassure
NSAID or corticosteroid injection
hip strain
muscles suddenly stressed to resistance
hip strain hx
sudden onset (“I pulled a muscle”) although can be from over use or under condition
PE hip strain
stretch affected muscle or use muscle against resistance
dx studies hip strain
AP pelvis, frog leg
MRI only indicated for possible torn muscle/tendon
ddx hip strain
fracture to ASIS or AIIS (get XR to rule this out)
hip strain tx
phase 1: RICE 48-72 hrs
2: PROM exercise, heat 72 hrs -1 week
3: isometrics (week 1-3)
4: strength and condition 2-4
thigh strain QUADS
direct blow (I.e. football or soccer)
thigh strain HAMSTRINGS
most often injured
sudden onset (pain and pop while running)
Pe thigh strain
possible antalgic gait and ecchymosis (if torn(
hamstrings - flexion of hip and extension of knee cause pain
quads - flexion of knee causes pain
trochanteric bursa
lie between greater trochanter of femur and ITB
trochanteric bursitis
inflamed from tight ITB or associated OA, leg length discrepancies, idiopathic
hx trochanteric bursitis
pain over lateral hip (greater trochanter) esp when standing from seated position or lying down
trochanteric bursitis PE
pain worse with abduction
tenderness
trochanteric bursitis Dx studies
AP pelvis and frog leg (r/o boney pathology)
prevention and tx trochanteric bursitis
don’t lie on that side
NSAID, corticosteroid if tx fails
hip dislocation
strong ligaments surround hip so this is hard to do
typically due to high energy trauma
hip dislocation mc
Posterior dislocation 90% of them
hip dislocation PE
must check NV status
posterior will hold tight flexed, adducted, and internally rotated, NV STATUS
anterior: thigh minimally flexed, abducted, externally rotated
dx studies hip dislocation
AP pelvis, and AP/lateral femur (including knee)
posterior = head of femur appears smaller anterior = head of femur appears larger
CT may be needed
hip dislocation complications
orthopedic emergency
loss of blood supply can cause osteonecrosis, post traumatic OA and femoral or sciatic n palsy
hip dislocation non rx tx
immediate reduction (w/in 3 hrs)
surgical stabilization may be needed (acetabulum fracture)
femur shaft fx
high energy impact
Osteoporosis is more common in neck region
PE femur shaft fx
look for deformity, edema, open wounds
inspect whole extremity
gently feel for crepitus and NV status
tx femur shaft fx
long leg posterior splint or traction splint until sx
if open - surgical debridement, tetanus prophylaxis and IV ABX
pelvis fracture
ring that supports the worse
disruption = loss of function until fixed/healed
hx pelvis fracture
low energy (elderly)
pain with motion of affects LE
acetabular fas often associated with hip locations
dx studies pelvis fracture
low energy - AP pelvis
high energy - AP pelves, inlet and outlet (judet) and oblique pelvis
ENTIRE BODY (CT PAN SCAN)****
what do we use to classify the young burgess for?
classification of pelvis fracture
pelvis fracture compilations
abdominal organs and pelvic organs damaged
SHOCK
chest injuries, head injuries, neck injuries, fat emboli
pelvis fracture tx
WBAT and assist (low energy)
high engird 0 hemodynamic stabilization with pelvic girdle, ORIF once stable
IV morphine
proximal femur fx
neck fracture due to osteoporosis (elderly women)
risk factors proximal femur fx
smoking sedentery lifestyle alcohol abuse psych meds dementia
hx proximal femur fx
fall to side
land on hip
unable to stand or ambulate
pain in groin/thigh
what classification do we use for a proximal femur fx
garden classification
proximal femur fx tx
surgical intervention
admit NWB with external traction for comfort
IM/IV narcotic (caution of respiratory depression)
