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MSK 1 > Hip/Thigh > Flashcards

Hip/Thigh Flashcards

1
Q

OA of hip

A

articular cartilage of the femoral head and acetabulum degenerates over time (PRIMARY) or secondarily from disorder of hip during childhood or trauma

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2
Q

hx OA of hip

A

progressive and gradual onset of anterior thigh or groin pain

typically only pain with activity, but progresses to all the time

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3
Q

PE OA of Hip

A

limp when walking

decreased AROM and PROM with internal rotation

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4
Q

diagnostic w.u of OA of Hip

A

loss of joint space and osteophytes on XR

if XR –> MRI

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5
Q

prevention of OA of hip

A

activity modification

hip girdle strengthening program

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6
Q

sx tx OA of hip

A

young: femoral head resurfacing with acetabular resurfacing (RSA)
older: total hip replacement or bipolar replacement

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7
Q

rx tx OA of hip

A

NSAID rx of choice

AVOID narcotic analgesics

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8
Q

hip impingement syndrome

A

abnormal wearing and contact b/t ball and socket of hip joint

result in increased friction during hip movement

CAM and PINCER lesions

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9
Q

cause of hip impingement syndrome

A

hip bones do not form normally during childhood yrs

athletic people may experience pain earlier but exercise DOES NOT cause FAI

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10
Q

crossover sign

A

radiographic finding associated with acetabular retroversion = pincer type FAI in pt with hip pain

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11
Q

arterial blood supply to hip

A

via obturator and medial and lateral circumflex femoral arteries

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12
Q

osteonecrosis of hip

A

compromised of arterial blood supply cause death to cells of femoral head

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13
Q

osteonecrosis of hip hx

A

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

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14
Q

osteonecrosis of hip PE

A

antalgic gait
tenderness of groin

decreased AROM or PROM in IR of hip

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15
Q

osteonecrosis of hip dx studies

A

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

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16
Q

osteonecrosis of hip will look like ___ on XRAY (progression)

A

normal –> patchy sclerosis –> crescent sign –> change in shape of head and collapse of cortical bone

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17
Q

crescent sign

A

subchonral fracture of articulate surface

found in osteonecrosis of hip

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18
Q

prevention of osteonecrosis of hip

A

prior to collapse

avoid steroids, address EtOH use, control other dz

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19
Q

non rx tx osteonecrosis of hip

A

prior to head collapse: core decompression w/wo graft

after collapse: bipolar hemiarthroplasty (potential head resurfacing)

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20
Q

iliotibial band (ITB)

A

long tendon of tensor fascia late and gluteus Maximus

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21
Q

snapping hip

A

ITB band snaps over greater trochanter

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22
Q

what other tendons could cause snapping hip

A

iliopsoas tendon (snap over pectineal eminence)

labrum of femoral head (can tear and snap with motion)

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23
Q

hx of snapping hip ITB

A

pt points to greater trochanter area

MC occurs w/walking ration of hip

SNAP when affected side up, rotating leg

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24
Q

iliopsoas hx snapping hip

A

snap when risking from seated position

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25
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
26
snapping hip PE | ITB
INSPECT | motion of hip when recreate snap, should feel snap
27
iliopsoas snapping hip PE
inspect observe reaction during rise of the hand feel snap on extension of hip from flexed position
28
labrum snapping hip PE
inspect | shortening of leg, limp with walk
29
best diagnostic study snapping hip labral tear
MR arthrogram with gadolinium
30
snapping hip tx
non painful - reassure NSAID or corticosteroid injection
31
hip strain
muscles suddenly stressed to resistance
32
hip strain hx
sudden onset ("I pulled a muscle") although can be from over use or under condition
33
PE hip strain
stretch affected muscle or use muscle against resistance
34
dx studies hip strain
AP pelvis, frog leg MRI only indicated for possible torn muscle/tendon
35
ddx hip strain
fracture to ASIS or AIIS (get XR to rule this out)
36
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
37
thigh strain QUADS
direct blow (I.e. football or soccer)
38
thigh strain HAMSTRINGS
most often injured sudden onset (pain and pop while running)
39
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
40
trochanteric bursa
lie between greater trochanter of femur and ITB
41
trochanteric bursitis
inflamed from tight ITB or associated OA, leg length discrepancies, idiopathic
42
hx trochanteric bursitis
pain over lateral hip (greater trochanter) esp when standing from seated position or lying down
43
trochanteric bursitis PE
pain worse with abduction tenderness
44
trochanteric bursitis Dx studies
AP pelvis and frog leg (r/o boney pathology)
45
prevention and tx trochanteric bursitis
don't lie on that side NSAID, corticosteroid if tx fails
46
hip dislocation
strong ligaments surround hip so this is hard to do typically due to high energy trauma
47
hip dislocation mc
Posterior dislocation 90% of them
48
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
49
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
50
hip dislocation complications
orthopedic emergency loss of blood supply can cause osteonecrosis, post traumatic OA and femoral or sciatic n palsy
51
hip dislocation non rx tx
immediate reduction (w/in 3 hrs) surgical stabilization may be needed (acetabulum fracture)
52
femur shaft fx
high energy impact | Osteoporosis is more common in neck region
53
PE femur shaft fx
look for deformity, edema, open wounds inspect whole extremity gently feel for crepitus and NV status
54
tx femur shaft fx
long leg posterior splint or traction splint until sx if open - surgical debridement, tetanus prophylaxis and IV ABX
55
pelvis fracture
ring that supports the worse disruption = loss of function until fixed/healed
56
hx pelvis fracture
low energy (elderly) pain with motion of affects LE acetabular fas often associated with hip locations
57
dx studies pelvis fracture
low energy - AP pelvis high energy - AP pelves, inlet and outlet (judet) and oblique pelvis ENTIRE BODY (CT PAN SCAN)******
58
what do we use to classify the young burgess for?
classification of pelvis fracture
59
pelvis fracture compilations
abdominal organs and pelvic organs damaged SHOCK chest injuries, head injuries, neck injuries, fat emboli
60
pelvis fracture tx
WBAT and assist (low energy) high engird 0 hemodynamic stabilization with pelvic girdle, ORIF once stable IV morphine
61
proximal femur fx
neck fracture due to osteoporosis (elderly women)
62
risk factors proximal femur fx
``` smoking sedentery lifestyle alcohol abuse psych meds dementia ```
63
hx proximal femur fx
fall to side land on hip unable to stand or ambulate pain in groin/thigh
64
what classification do we use for a proximal femur fx
garden classification
65
proximal femur fx tx
surgical intervention admit NWB with external traction for comfort IM/IV narcotic (caution of respiratory depression)

MSK 1 (9 decks)

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