Lecture 5B Flashcards
AVN (Legg Perthes) mainly affects what age?
2-8
“there will be Q on final about this” - Dr. A”
What hip problem commonly affects newborns
congenital dislocation
slipped capital epiphysis and osteochrondritis dissecans commonly affects what age
10-14
Glute medius tendinopathy/tears commonly affects what age
Females 50+
Stress fractures and FAI commonly affect what age
14-25
How will the hip present with congenital hip dislocation
More females, L > R
Shortened limb, hip flexed and abducted
Limited Abd range of motion
Galeazzi sign and ortolani sign
Pt presents with ache in hip, thigh, knee
observation: Shorter limb, higher greater trochanter, quad atrophy, adductor spasm
ROM: limited into abd and ext
gait: antalgic
legg calve perthes
Gradual onset vague pain in knee, hip, and thigh. Pain with extreme motion
observaton: Shortened limb, obese, quad atrophy, adductor spasm, hip abducted and ER
ROM: limited IR, abd, and flexion
gait: antalgic during acute, tendelenberg sign w/ ER in chronic
slipped femoral capital epiphysis
Urgent or emergent: Slipped Capital Epiphysis
Urgent: They can drive to ER or have someone drive them. Don’t need an ambulance
Pt is 30-50, more likely male than female
Sharp pain or intermittent pain with extreme motion
ROM decreased
limping
avascular necrosis
Pt is over 40, female
insidious onset, pain w/ weight bearing
often obese, joint crepitus
atrophy of gluteal muscles
limping
Degenerative joint disease
Altman’s clinical criteria for hip OA
Dr A: This will be on final exam
Hip Pain
IR less than 15
Morning stiffness up to 60 mins
Age 50+
Sutlive CPR for hip OA
4/5 present = 91% probability
- Self- Reported Squatting is aggravating
- Scour test w/ adduction causes groin or lateral hip pain
- Active hip flexion causes lateral pain
- Active hip ext causes lateral pain
- Passive hip IR less or equal to 25 degrees
Gradual onset (overuse)
Lateral hip, thigh,knee pain
snapping over greater trochanter
positive Ober’s test
ITB syndrome
Pain over greater trochanter with resisted abduction
pain upon palpation
Trochanteric Bursitis
Gradual onset, obese/pregnant
pain or paresthesia of anterior/lateral groin and thigh
Dx: Meralgia Paresthesia
Abnormal sensory exam of lateral femoral cutaneous nerve
post-menopausal females, 50+
Aggravated by sleeping on side, stair climibng
Can occur after hip/knee surgery
Gluteal, quad, gastroc wasting
gluteus medius tendinopathy/tear
Gluteus medius tendinopathy/tear pain is ____________
localized & load dependent
diffuse pain with low load is not tendinosis
Acetabular/labral pathologies are common in ___________
highly active people 20-40
Cam impingement vs Pincer impingement
Cam impingement - related to head/neck morphology
pincer impingement - acetabular overcoverage
Pincer impingement usually presents with acetabular _____version
retroversion
FAI w/ anterior-medial pain will have pain with:
flexion + IR
FAI with posterior pain will have pain with:
Flexion, abduction, ER
Military trainee with inability to passively rotate hip, history of increasing pain
mistaken for psoas tendonitis or adductor strain/hernia
Femoral stress fx
The long axis manipulation happens in what hip position
What is the target
Open packed
Flexion, ER, Abd
target: overall capsule “Reset button”
may require 1+ to acheive goal
The prone PA mobilization is for
anterior capsule: decreased ext
Lateral hip mob is for:
lateral capsule, lack of horizontal ADD
Inferior capsule mob with patient supine with hip flexed to painfree range is for…
loss of flexion
When is the highest occurrence of re-straining a hamstring strain
Within the first 2 weeks of return to activities
