Lower Extremity Disorders Flashcards
Which nerves create the sciatic nerve?
L4-S3
Which nerves create the femoral nerve?
L2-4
Which nerve create the lateral femoral cutaneous nerve?
L3-4
Blood Supply to the Hip
Circumflex
Profunda femoris
Posterior division of the obturator artery
Femoral head
Possible Reasons for AVN
Fracture Dislocation Slipped capital femoral epiphysis Steroids ETOH Perthes Coagulopathy Sickle cell
Hip Imaging
X-rays: weight bearing if possible Bone scan CT MRI MRI arthrogram
Differential Diagnosis for Anterior Hip Pain
Osteoarthritis Inflammatory arthritis Muscle/tendon strain Tendinitis Femoral neck stress fracture Obturator/ilioinguinal nerve entrapment Osteitis pubis Acetabular labral tear
Differential for Pre-Pubescent Individuals
Legg Calve Perthes disease
Slipped capital femoral epiphysis (SCFE)
Differential for Hip Pain of Adolescence
Avulsion fracture Hip pointer Contusion Myositis ossificans Femoral neck stress fracture
Differential of Hip Pain for Older Individuals
Femoracetabular impingement (FAI) Osteoid osteoma ITB syndrome Trochanteric bursitis Piriformis syndrome Iliopsoas bursitis Meralgia paresthetica Osteoarthritis
Clinical Presentation of Iliopsoas Bursitis or Tendinosis
Pain & snapping in groin & anterior hip with hip flexion & crunches
Evaluation of Iliopsoas Bursitis or Tendinosis
H&P
X-ray
MRI
R/o other diseases
Treatment of Iliopsoas Bursitis or Tendinosis
Relative rest Stretch NSAIDs PT Injection, surgery??
Clinical Presentation of Acetabular Labrum Tear
Hip pain Deep click Catching sensation Worse with deep flexion & raising from seated position Decreased ROM
Evaluation of an Acetabular Labrum Tear
H&P
Pain with hip flexion, add, and axial load
X-rays
MRI arthrogram
Treatment for Acetabular Labrum Tear
PT to maximize ROM & strength
Corticosteroid injection?
Surgery?
Clinical Presentation of Trochanteric Bursitis
Lateral hip pain
Gradual onset
Can’t lie on side
Evaluation of Trochanteric Bursitis
H&P
Tender to palpation over lateral thigh
Pain with Ober test
X-ray??
Treatment of Trochanteric Bursitis
Ice NSAIDs briefly PT: stretch IT band, strengthen hip muscles Evaluate biomechanics Corticosteroid injection
Clinical Presentation of Osteoarthritis of the Hip
Progressive hip & groin pain
Decreased ROM
Evaluation of Osteoarthritis of the Hip
H&P
Weight bearing x-rays
Treatment of Osteoarthritis of the Hip
PT
Tylenol > NSAIDs
US guided hip injection
Surgery
Clinical Presentation of Pubic Ramus Stress Fracture
Pain with jumping, running, stretching, & landing
Increased pain with activity
Evaluation of Pubic Ramus Stress Fracture
Point-tender superior pubic ramus Non-tender adductors Normal physical exam X-ray Bone scan MRI
Treatment of Pubic Ramus Stress Fracture
Relative rest
Non-painful activity
Slowly increase
Address other fractures
Other Problems Associated with Stress Fractures Besides Overuse
Estrogen deficiency
Hormonal abnormalities
Nutritional deficiencies
Metabolic disorders
Presentation of a Stress Fracture
Gradual onset
Increased intensity/duration of activity
Change in footwear
Change in surface
Evaluation of Stress Fractures
H&P
X-rays
Bone scan
MRI
Key to Treatment of Stress Fractures
Pain free activity
Treatment of Inferior Hip, Pelvis, or Thigh Stress Fractures
Non-painful activity
Gradual return to activity
Treatment of Superior Hip, Pelvis, or Thigh Stress Fractures
Refer to ortho
Address Causation of Hip, Pelvis, or Thigh Stress Fractures
Diet
Activity level
Maturity
Clinical Presentation of Adductor Tendonopathy
Chronic groin pain
Increased training
Worse with resisted adduction
Evaluation of Adductor Tendonopathy
H&P
Pain with resisted adduction
Tender to palpation medial groin at tendon insertion
Treatment of Adductor Tendonopathy
Relative rest
Ice
Isometric & eccentric strengthening
PT
Clinical Presentation of Athletic Pubalgia or Sports Hernia
Groin pain
Progressive symptoms
Worse with hip motion
Evaluation of Athletic Pubalgia or Sports Hernia
Pain in hernia region without hernia
Possible dilated superficial ring
Etiology of Athletic Pubalgia or Sports Hernia
Injury to conjoined tendon, internal oblique, external oblique, transversalis fascia, inguinal ligament, etc.
Treatment of Athletic Pubalgia or Sports Hernia
Surgery
Only some surgeons do these
Clinical Presentation of Piriformis Strain or Syndrome
Buttocks pain Insidious onset Pain to sit Increase after a run Annoying
Evaluation of Piriformis Strain or Syndrome
Painful resisted external rotation
Painful passive internal rotation
Difference Between Piriformis Strain & Syndrome
Strain: no sciatica
Syndrome: sciatica
Treatment of Piriformis Strain/Syndrome
Rule out other things
NSAIDs
Stretch/strengthen
PT: core strength program
Evaluation of Femur Fractures
H&P
R/O other injuries
Shortened & external rotated
Internal rotation elicits pain
Treatment of Femur Fracture
Pins
ORIF
Total hip
Hemi hip
Things to Consider with Femur Fractures
DVT
Young: AVN
Etiology of Femur Shaft Fractures
High energy
Treatment of Femur Shaft Fractures
Surgery
Something to Consider with Femur Shaft Fractures
Compartment syndrome
Causes of Compartment Syndrome
Fractures Crush Envenomation Immobilization Constrictive dressing Infection Burns Tourniquets Chronic exertional compartment syndrome (CECS)
Treatment of Compartment Syndrome
Release of pressure
Anterior Hip Dislocation
Dashboard with thigh abducted
Externally rotated position
Posterior Hip Dislocation
Internally rotated position
Treatment of Hip Dislocations
Reduction ASAP
Watch for s/s of AVN & sciatica
What should one always think of with hip fracture or dislocation?
Concomitant injuries
