Lecture 10: Hip Complaint Flashcards
What are the main symptoms of hip disease?
Pain
Stiffness
Deformity
Limp
What is an early symptom of hip diease?
Why?
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
Trochanteric Bursitis
What is it indiciative of?
Lateral hip pain aggrevated by direct pressure. IT IS UNLIKLEY TO BE DUE TO HIP JOINT DISEASE.
What causes hip joint or intra atricular problems?
Progressive lateral hip pain that is aggrevated by direct pressure and weight bearing.
What is Mearalgia Paresthetica?
Which nerve causes this?
What is it not influenced by.
How do you test this?
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
What is lumbar radiculopathy?
What nerves are normally invovled?
Lateral hip pain that can radiate down the leg into the foot
Involves L4-L5
What is Trochanteric Bursitis?
Inflammation of bursa (fluid-filled sac near a joint) at greater trochanter
What does anterior hip or groin pain suggest?
Several differentials
- Possible issue with hip joint itself
- Osteoarthritis
- Osteonecrosis
- Ocult Fracture
- Acute Synovitis
- Septic Arthritis
- Inguinal Hernia
- Lower Abdominal Pathology
- Referred pain (rare)
What does posterior hip pain suggest?
- Sacroiliac Joint Disease
- Lumbar Radiculopathy
- Herpes Zoster
Least Common Pain Pattern of Hip
Which part of the hip poses greatest clinical challenge?
Why?
Lower Anterior Thigh
- Different diseases and fractures can refer pain to this area
- Requires specfic radiographic procedures to define precise cause for pain
How would you inspect patient to note any hip abnormalities?
- Evaluate patient’s gait
- Evaluate tolerance of squatting
- General ability to move in examination room
What are some sources of referred pain to the hip?
Lumbar Spinal Nerves
Sacroilialc Join
Lateral Femoral Cutaneous Nerve
Lower Abdominal Vascular Structures
What is the Trendelenburg Gait?
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.
What can asymmetric iliac crests suggest?
- 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
What does a Faber test assess for?
What can a positive test indicate?
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
What can a positive Straigh Leg Raise Test indicate?
< 30o: Acute spondyloithesis, gluteal abscess, disc protrusion or extrusion, etc
30-70o: Lumbar Disc Herniation at L4-S1 nerve roots
>70o: Tightness of hamstrings, gluteus maximus or hip capsule
What has minimal impact upon ambulation?
-meralgia paresteica, mild hip arthritis and most caes of burisits
antalgic gait
- 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
short leg limp
–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
What would a gradual onset of anterior hip or groin pain with variable degrees of impaired movement suggest?
osteoarthritis
