lower extremity Flashcards
most stable ball and socket joint
hip
hip dislocations require how much energy
high energy
clinical presentation of posterior hip dislocation
hip pain, limb length discrepancy on physical exam - shorted and internally rotated AE PI anterior - externally rotated posterior - internally rotated
blood supply to femoral head
median circumflex - dee profunda artery
after trauma, femoral head is at risk for
osteonecrosis
types of hip fractures
Intracapsular (Femoral neck)
Extracapsular (intertrochanteric)
classic presentation of hip fracture
limb shortened, externally rotated on exam
radiograph of right intertrochanteric hip fracture
intertrochanteric hip fracture characteristics
typical age > 70
often associated with osteopenia or osteoporosis
Often a low-energy mechanism (fall from standing height)
limb shortened and externally rotated
radiograph of left femoral nexk fracture
greater risk of nonunion osteonecrosis in this type of hip fracture
femoral neck fractures
treatment for hip fractures
almost always surgical
atypical femoral fractures
”Classic” bisphosphonate complication is jaw osteonecrosis
and proximal femoral stress and fractures
hip pain location can give clue to cause
articular pain
trochanteric pain
low back pain
Articular pain:
-Typically anterior/groin pain
Trochanteric pain:
-Typically lateral
Low back pain:
-Often bilateral
trochanteric bursitis
Tenderness; pain with activity
Patients will present with “hip pain” but all the pain will be lateral
x rays are normal
anterior hip pain (groin pain) is more likely to be
arthritis - rheumatoid or osteonecrosis
How to tell articular pain from bursitis pain?
Tenderness–more common with bursitis
limited range of motion—more common with joint issues
will have x ray deformities
common risk from cardiac catheterization
femoral nerve/quad deficit
pelvic sag away from affected side when walking
trendelenburg gait - superior gluteal nerve injury (compensation for weak hip abductors)
causes of trendelenburg gait
polio
superior gluteal nerve injury
emobolization to prevent hemmorhage after trauma
Femoral shaft fracture
Usually high energy injury (MVC)
Operative treatment (cast in children under 5 or so, internal fixation otherwise)
Clinically common
knee pain types
Articular
-OA/RA, Meniscus, Chondral, Ligamentous
Peri-articular
-Bursitic, Referred
articular pain vs bursitic pain
articular - decreased ROM
bursitis - normal ROM but focal tenderness over bursa
common type of bursitis in knee
pes anserine bursitis
