Lumbopelvic hip region Flashcards
1
Q
What are LBP red flags?
A
- Age ≥ 50
- History of cancer
- Weight loss
- Failure of PT
- Fever, chills
- Recent infection
- Trauma
- night pain
- saddle anesthesia
- LE neuro deficit
- immunosuppression
- bladder dysfunction
2
Q
What are red flags for back related tumors?
A
- > 50 y/o
- PMH
- weight loss
- failure of conservative therapy
- ambiguous presentation
- constant pain
- band-like distribution of pain to the abdomen
- neuro LE signs
3
Q
What infection is most common in the upper lower back
A
spinal osteomyelitis
4
Q
When is spinal osteomyelitis most common?
A
30s
5
Q
Pain from spinal osteomyelitis increases within __-___.
A
1-3 weeks
6
Q
What is the most common type of infection of the vertebral body?
A
bacterial
7
Q
What are red flags of spinal osteomyelitis?
A
- recent infection
- IV drug use/abuse
- immunosuppression
8
Q
What vertebral levels are commonly affected by spinal osteomyelitis?
A
1st and 2nd vertebral levels
–> spinous process TTP w/ global pain
9
Q
(true/false) fever is common in both adults and children when they have spinal osteomyelitis
A
FALSE (common only in children)
10
Q
What are red flags associated with back related infections?
A
- deep constant pain that increases with WB and can radiate
- fever, malaise, sweating
- spinal rigidity
11
Q
What are red flags for cauda equina syndrome?
A
- 50 to 55 y/o
- b/b changes
- saddle paresthesia (L4-S2)
- LE weakness (L4-S1)
- sensory deficits of L4-S1
12
Q
What are aggs and eases for saddle paresthesia?
A
- Aggs: standing/walking
- relief: flexion
13
Q
What are red flags for spinal fx?
A
- > 70 y/o
- trauma
- prolonged steroid use
- loss of mobility/function
- TTP over site of fx
- increased pain with WB
- edema in local area
14
Q
What are red flags for abdominal aneurysm?
A
- back, abdominal, or groin pain
- PVD or CAD
- > 50 y/o
- smoker
- HTN
- DM
- pulsatile mass
- bruit w/ auscilation in the central epigastric area
15
Q
(true/false) symptoms related to an abdominal aneurysm are associated with movement
A
FALSE
16
Q
What are red flags for kidney disorders?
A
- UNILATERAL flank pain or LBP
- difficulty urinating
- painful urination
- hematuria
- recent UTI
- PMH of kidney stones
- (+) precussion test over the kidney
17
Q
What is pyelonephritis?
A
Infection of the kidney
18
Q
What causes infection of the kidney (pyelonephritis)?
A
infection of ascending urinating tract
19
Q
What is nephrolithesis?
A
kidney stones (excessive calcium, uric acid, or cysteine)
20
Q
What are s/s of nephrolithesis?
A
- back and abdominal pain
- N/V
- urinary frequency
21
Q
What are risk factors for renal cancer carcinoma?
A
- male
- smoker
- obese
- HTN
- genetics
22
Q
What are the 2 components of the “Rule of Thumb” to rule in a painful SIJ?
A
- unilateral pain below L5
- Pain with sit –> stand transfer
23
Q
(true/false) The SIJ moves.
A
True
Avg: 2-3 mm and < 4 degrees of ROT
24
Q
What is the stork/gillet test used for?
A
Palpating SIJ movement
25
What palpation tests are used for detection of SIJ dysfunction?
1. standing FLX test
2. sitting PSIS palpation
3. Supine-long sitting test
4. prone knee FLX test
| 3 of 4 (+) tests are idea for Dx
26
(true/false) Individual SIJ palpation tests are reliable for SIJ dysfunction
FALSE
| unreliable
27
What is a (+) Fortin's sign?
The patient identifies the area surrounding the PSIS is the area of pain
28
What tests are used to identify pain originating from the SIJ?
1. SIJ compression test
2. ASIS distraction test
3. Thigh thrust (femoral shear)
4. Sacral thrust (provocation)
5. R/L Gaenslen's Test (Torque test)
| If 3+ are positive, there is high specificity and sensitivity
## Footnote
Can replace the compression test with FABER (Patrick's) test
29
What are infectious/inflammatory Dx involving the Lumbopelvic region?
1. Spondyloarthropathy:
- ankylosing spondylitis
- Reiter's
- Psoriatic syndrome
- Inflammatory bowel disease
2. Vertebral osteomyelitis
3. endocarditis
4. TB
30
What is Paget's disease?
Unexplained acceleration of bone deposition and resorption
| Second most common metabolic bone disease
## Footnote
Common in males > 70 y/o
31
Symptoms:
- slowly progressing enlargement and deformity of multiple bones
- redness and warmth
Paget's disease
32
What are bowel disturbances seen in those with colon cancer?
- rectal bleeding
- red-streaked stools
- change of stool diameter
33
What are red flags for colon cancer?
- TTP of abdomen
- ascites
- metastases
34
Where is inguinal hernia pain?
groin and/or scrotum
35
symptoms:
- s/s exacerbated by coughing, sneezing, or resisted sit-ups
- TTP of inguinal canal
Inguinal hernia
36
Appendicitis can present as an ____ due to similar s/s
inguinal hernia
| appendicitis presents with flank pain. nausea, and anorexia
37
What are red flags for appendicitis?
- abdominal rigidity
- (+) Mcburney's points
- (+) psoas and obturator signs
38
Who is at risk of developing an ovarian cyst?
Female at childbearing age
39
symptoms:
- sudden severe abdominal or pelvic pain
- gradual cycling of pain with menstrual irregularities
ovarian cyst
40
What is adnexal torsion?
Twisting of the ovary and sometimes the fallopian tube, interrupting the arterial supply and causing ischemia
| "Ovarian Torsion"
41
What is the primary cause of ovarian torsion?
benign tumor > malignant tumor
42
What are s/s of ovarian torsion?
- sudden severe pelvic pain
- nausea
- vomiting
43
(true/false) ovarian torsion is more common than testicular torsion
FALSE
44
What is varicosities?
Twisted, enlarged veins of the ovaries
| "Ovarian varicocele"
45
Endometriosis is a pathologic condition of (anterograde/retrograde) menstruation
retrograde
46
What is endometriosis?
Tissue resembling the normal lining of the uterus grows outside of the uterus
| Stays in the pelvic cavity
47
Up to _ % of women with endometriosis are infertile
50%
48
49
What is rectocele?
rectal prolapse
50
What is cystocele?
Bladder prolapse
51
Describe first degree uterine prolapse?
Uterus is dropped 1/3 of the way into the vaginal canal
52
What is pelvic congestion syndrome associated with?
Pelvic varicose veins
| Lower abdomen and groin
53
What population commonly experiences pelvic congestion syndrome?
Women 20-45 y/o
54
What is the cause of pelvic congestion syndrome?
idiopathic development of varicose veins during pregnancy
| continue to progress in size
55
symptoms:
- constant dull pelvic pain
- pelvic pressure
- pelvic heaviness
- aggs: prolonged standing
| worse: at the end of the day
Pelvic congestion syndrome
56
What is coccygodynia?
coccygeal pain
57
What aggravates coccygeal pain?
- direct pressure
- movement
58
What are treatment options for coccygeal pain?
- injections
- coccyx pillow
- manipulation
59
Definition: small tear in the lining of the anal canal caused by passing hard and/or large stools during bowel movements
Anal fissure
60
symptoms:
- burning pain and bright red blood with bowel movements
anal fissure
61
What are thrombosed hemorroids?
swelling of the veins in the anus or outside of the rectum
## Footnote
Restricted venous blood flow --> vessels split --> blood pools & clots subcutaneously
62
Definition: A cyst that develops along the coccyx near the cleft of the buttocks containing hair/skin
pilonidal cysts
## Footnote
Men 15-24 y/o
63
chracteristics:
- dimple
- opening in the skin
- pus
- redness and warmth
Pilonidal cyst
64
definition: infectious bone disease of the pubic symphysis
osteomyelitis pubis
## Footnote
Causes: pelvic surgery, childbirth, abdominal pathology, unknown
65
symptoms:
- painful hip ABD
- Fever
- TTP over pubis symphysis
- waddling gait
- elevated WBCs
- elevated sedimentation rate
osteomyelitis pubis
## Footnote
Treatments: antibiotics, NSAIDS, rest, surgery
66
What is the prognosis for osteomyelitis pubis?
Progressive without treatment
| widening of the symphysis and increased bone destruction
67
What is femoral head osteonecrosis associated with?
- long-term corticosteroid use
- sickle cell disease
- DM
- trauma
- contralateral hip AVN
68
presentation:
- Slow, progressive groin, greater trochanter, deep buttock pain
- pain can refer to the medial knee
- stiff hip joint
- FADIR restrictions
femoral head osteonecrosis
69
What is legg-calve perthes disease?
Idiopathic loss of blood supply from the lateral ascending cervical artery to the femoral head
| Affects 5-8 y/o
70
Characteristics:
- pain with WB
- antalgic gait
- Involved LE is shortened and held in ER
- Painful and limited hip IR and ABD
Legg-calve perthes disease
71
What is a slipped capital femoral epiphysis?
Progressive displacement of femoral head superiorly through the open growth plate
| Primarily in adolescent males with a Hx of growth spurt or trauma
72
Characteristics:
- diffuse groin/thigh/knee pain that is exacerbated with WB
- antalgic gait
- limb held in ER
- limited IR
- Hx of recent growth spurt or trauma
SCFE
73
Characteristics:
- child or older adult with vague hip ache who had a recent bacterial infection
- not willing to WB or move on the involved side
- fluid is seen around the femoral head and may be seen going into the bladder on MRI
Septic hip arthritis
74
What can a FAI cause?
## Footnote
definition: Decreased joint clearance between the femur and acetabulum especially when hip flexion is combined with adduction, and internal rotation (FADIR)
labral tear = progressive degeneration leading to osteoarthritis
75
symptoms:
- Locking, clicking or catching sensation in hip joint
- Pain in hip or groin
- Stiffness or limited hip jt ROM
## Footnote
Causes:
- trauma
- abnormal structure
- repetitive motions
- osteoarthritis
labral tear
76
Who is commonly seen with femoral neck Fx?
females > 70 y/o
77
Characteristics:
- hip, thigh, knee pain
- severe, acute, constant groin pain
- history of a fall from standing position
- involved LE: shortened, abducted, and ER
Femoral neck Fx
78
Meralgia paresthetica is the entrapment of what nerve?
Lateral Femoral Cutaneous nerve
79
What is the presentation of meralgia paresthetica?
- burning pain in the lateral thigh
- aggravated with sitting, squatting, and wearing wide belts
