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

Trochanteric Bursitis

What is it indiciative of?

Answer 3

Lateral hip pain aggrevated by direct pressure. IT IS UNLIKLEY TO BE DUE TO HIP JOINT DISEASE.

Question 4

What causes hip joint or intra atricular problems?

Answer 4

Progressive lateral hip pain that is aggrevated by direct pressure and weight bearing.

Question 5

What is Mearalgia Paresthetica?

Which nerve causes this?

What is it not influenced by.

How do you test this?

Answer 5

Tingling and numbness of anterolateral 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

IT IS NOT ALWAYS ASSOCIATED WITH HIP PAIN

-The skin is tested for light touch, pin prick and deep pain sensation: if they have loss of sensastion or heightened sensation they have it

Question 6

What is lumbar radiculopathy?

What nerves are normally invovled?

Answer 6

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

Involves L4-L5

Question 7

What is Trochanteric Bursitis?

Answer 7

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

Question 8

What does anterior hip or groin pain suggest?

Several differentials

Answer 8

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

Question 9

What does posterior hip pain suggest?

Answer 9

• Sacroiliac Joint Disease
• Lumbar Radiculopathy
• Herpes Zoster

Least Common Pain Pattern of Hip

Question 10

Which part of the hip poses greatest clinical challenge?

Why?

Answer 10

Lower Anterior Thigh

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

Question 11

How would you inspect patient to note any hip abnormalities?

Answer 11

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

Question 12

What are some sources of referred pain to the hip?

Answer 12

Lumbar Spinal Nerves

Sacroilialc Join

Lateral Femoral Cutaneous Nerve

Lower Abdominal Vascular Structures

Question 13

What is the Trendelenburg Gait?

Answer 13

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 14

What can asymmetric iliac crests suggest?

Answer 14

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

To check for thie pelvic obliquity: place hand on top of the iliac crest and look at the level of the pelvis

Question 15

What does a Faber test assess for?

What can a positive test indicate?

Answer 15

Assessment of HIp and Sacroiliac Joint

• Hip Disease
• Iliopsoas Spasm
• Sacroiliac Disease

+ positive test: occurs when the affected leg reamins above the oppsitie leg

• test: occurs when the test leg falls at least parallel to the opp leg

Question 16

What can a positive Straigh Leg Raise Test indicate?

Answer 16

< 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

Question 17

What has minimal impact upon ambulation?

Answer 17

-meralgia paresteica, mild hip arthritis and most caes of burisits

Question 18

antalgic gait

Answer 18

• It is a form of gait abnormality where the stance phase of gait is abnormally shortened relative to the swing phase.
• people with this spend a shorter time weight bearing on the affecte d side because of pain

Question 19

short leg limp

Answer 19

–due to leg length discrepancy

-characterized by an increase in up and down movement of the head and shoulders as the body falls onto the short leg and then rises up on the long leg

Question 21

What would a gradual onset of anterior hip or groin pain with variable degrees of impaired movement suggest?

Answer 21

osteoarthritis