Lecture 10: Hip Complaint

Question 1

What are the main symptoms of hip disease?

Answer 1

Pain

Stiffness

Deformity

Limp

Question 2

What is an early symptom of hip diease?

Why?

Answer 2

Difficulty putting on shoes

• Requires external rotation of hip, which is normally first motion to be lost with degenerative disease of the hip
• Followed by loss of abduction and adduction
• Hip flexion is last to be lost

Question 3

Is lateral hip pain an indicator of hip joint disease?

If it’s not, what is it an indicator of?

Answer 3

No, it is an indicator of Trochanteric Bursitis

-due to direct pressure

Progressive lateral hip pain: Due to direct pressure and weight bearing

Question 4

What is Mearalgia Paresthetica?

Which nerve causes this?

Answer 4

Tingling and numbness of lateral thigh (l**ocalized area of burning or uncomfortable pain)

• Impingment of Lateral Femoral Cutaneous Nerve
• Not influenced by direct pressure, hip movement, or lower back movemement

Question 5

What is lumbar radiculopathy?

What nerves are normally invovled?

Answer 5

Lateral hip pain that can radiate down the leg into the foot

Involves L4-L5

Question 6

What is Trochanteric Bursitis?

Answer 6

Inflammation of bursa (fluid-filled sac near a joint) at greater trochanter

Question 7

What does anterior hip or groin pain suggest?

Several differentials

Answer 7

• Possible issue with hip joint itself
  
  • Osteoarthritis
  • Osteonecrosis
  • Ocult Fracture
  • Acute Synovitis
  • Septic Arthritis
• Inguinal Hernia
• Lower Abdominal Pathology
• Referred pain (rare)

Question 8

What does posterior hip pain suggest?

Answer 8

• Sacroiliac Joint Disease
• Lumbar Radiculopathy
• Herpes Zoster

Least Common Pain Pattern of Hip

Question 9

Which part of the hip poses greatest clinical challenge?

Why?

Answer 9

Lower Anterior Thigh

• Different diseases and fractures can refer pain to this area
• Requires specfic radiographic procedures to define precise cause for pain

Question 10

How would you inspect patient to note any hip abnormalities?

Answer 10

1. Evaluate patient’s gait
2. Evaluate tolerance of squatting
3. General ability to move in examination room

Question 11

What are some sources of referred pain to the hip?

Answer 11

Lumbar Spinal Nerves

Sacroiliac Joint

Lateral Femoral Cutaneous Nerve

Lower Abdominal Vascular Structures

Question 12

What is the Trendelenburg Gait?

Answer 12

Abnormal gait due to weakness to in gluteus medius muscle and other abductor hip muscles

-If Trendelenburg sign positive, pelvis drops on the side opposite to the stance leg. The muscle weakness is present on the side of the stance leg.

Question 13

What can asymmetric iliac crests suggest?

Answer 13

• Leg Length Disparity
• Pelvic Fractures
• Scoliosis
• Unilateral Paraspinal Muscle Spasms

Question 14

What does a Faber test assess for?

What can a positive test indicate?

Answer 14

Assessment of HIp and Sacroiliac Joint

• Hip Disease
• Iliopsoas Spasm
• Sacroiliac Disease

Question 15

What can a positive Straight Leg Raise Test indicate?

Answer 15

< 30^o: Acute spondyloithesis, gluteal abscess, disc protrusion or extrusion, etc

30-70^o: Lumbar Disc Herniation at L4-S1 nerve roots

>70^o: Tightness of hamstrings, gluteus maximus or hip capsule