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MSK Conditions > MOD 4 Hip Pathology > Flashcards

MOD 4 Hip Pathology Flashcards

1
Q

What is avascular necrosis?

A

pathology where blood supply to femoral head is compromised and the bone degenerates and dies

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2
Q

What are the risk factors of avascular necrosis?

A
  • alcohol use
  • steroid ue
  • hip BMI
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3
Q

How does avascular necrosis present?

A
  • limited ROM (full range in all directions rules out)
  • pain with weight bearing and even at rest
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4
Q

How do you treat avascular necrosis?

A

refer

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5
Q

What is a fatigue stress fracture?

A

normal bone subject to abnormal stress

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6
Q

What is an insufficiency stress fracture?

A
  • abnormal bone subject to normal stress
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7
Q

What are the common stress fracture locations of the hip?

A
  • femoral neck
  • pubic rami
  • acetabulum
  • femoral head
  • sacrum
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8
Q

What is the location of a stress fracture if it occurs on the tension or compression side of the femoral neck?

A
  • tension: superior, unstable
  • compression: inferior, stable
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9
Q

What are the risk factors of hip stress fracture?

A
  • female
  • low fitness starting intense exercise
  • overuse
  • smoking
  • steroid use
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10
Q

How do patients with a hip stress fracture present?

A
  • pain during exercise, poorly localized in deep hip, groin, and thigh pain
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11
Q

What are the common objective findings for a patient with hip stress fractures?

A
  • pain t extreme range of hip IR
  • palpation tenderness of inguinal area
  • positive active leg raise
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12
Q

How should a hip stress fracture be managed?

A
  • cease weight bearing and obtain imaging
  • tension: NWB 6 weeks, partial WB 6 weeks, return 3-6 months
    compression: 6-8 weeks of limited WB
  • return 12-28 weeks
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13
Q

What is the mechanism of hip fracture?

A

compression trauma, direct lateral impact (fall or collision)

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14
Q

What are the common hip fracture locations?

A
  • neck
  • intertrochanteric
  • subtrochanteric
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15
Q

What type of injury (intra-capsular vs extra-capsular) is a hip fracture?

A
  • intracapsular
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16
Q

What are the implications since a hip fracture is intra-capsular?

A
  • healing less certain due to blood supply being damaged
  • high mortality risk
  • high risk for avascular necrosis
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17
Q

How do you treat hip fracture?

A

ORIF, hemiarthoroplasty, and total hip replacement

rehab early

18
Q

What are the guidelines for a hip fracture rehabilitation?

A
  • early mobilization (24-48)
  • high intensity PT with 3 daily session
  • functional mobility and endurance

post acute:
- gait and balance 6-9 months
- muscle strength
- HEP

19
Q

What are the risk factors of a hip dislocation?

A
  • falling, chronic instability, laxity, structural abnormalities, reduced muscle mass
20
Q

What is the mechanism of hip dislocation?

A

compression trauma: blunt force to bent knee and flexed hip

rotational trauma: extreme IR with hip flexed (skiing)

21
Q

What is the most common site of hip dislocation?

A

posterior

22
Q

How does hip dislocation present?

A
  • pain
  • swelling
  • deformity
  • immobility
  • inability to WB
23
Q

How do you manage a hip dislocation?

A
  • surgical: open reduction
  • conservative: closed reduction

after immobilization 2-3 months, impairment driven

24
Q

What are avulsion fractures?

A

violent contraction of muscle, pulling boney attachment from bone

25
Q

What are the common sites of hip avulsion fractures?

A

ASIS, AIIS, lesser trochanter, ischial tuberosity

26
Q

How do hip avulsion fractures present?

A
  • pain at injury
  • boney tenderness
  • muscle bulging away from attachment
  • swelling
27
Q

How do you manage hip avulsion fractures?

A
  • early: immobilization, PROM, atrophy prevention
  • later: functional movement retraining, strength, proprioception
28
Q

What is the most common cause of hip pain in people over 50?

A

osteoarthritis

29
Q

What is osteoarthritis?

A

progressive deterioration of articular cartilage which leads to narrow joint space

30
Q

How will people with osteoarthritis present?

A

anterior groin or lateral groin pain (C sign)

anterior thigh pain (L3 dermatome)

stiffness after prolonged rest

31
Q

What are some related impairments with osteoarthritis?

A
  • loss of quad strength
  • gait asymmetry, slow speeds
32
Q

What are the CPG diagnosis for hip osteoarthritis?

A
  • older than 50
  • moderate anterior or lateral hip pain in WB
  • morning stiffness for longer than an hour
  • hip IR < 24 deg or hip IR and flexion < 15 compared to other limb
    and/or hip pain with passive IR
33
Q

What is cluster 1 in Altman’s criteria for hip OA?

A
  • hip pain
  • hip IR < 15 deg
  • flexion < 115 deg
34
Q

What is Altman’s cluster 2 for hip OA diagnosis?

A
  • painful hip IR
  • older than 50 y.o
  • morning hip stiffness <60 min
35
Q

What would direct you to use Altman’s cluster 2 over Altman’s cluster 1?

A

if hip IR is greater than or equal to 15 deg

36
Q

What is the clinical prediction rule for hip OA diagnosis?

A

if 4 or more present
- squating aggravates symptoms
- active hip flexion = lateral hip pain
- scour test: lateral hip or groin pain
- active hip extension causing pain
- passive IR less than or equal to 25 deg

37
Q

What is conservative management for hip OA?

A
  • NSAIDs and corticosteroid injections
  • modalities: heat and ultrasound
38
Q

What is the rehab management of hip OA?

A
  • manual therapy 1-3x week, 6-12 weeks
  • exercise 1-5x week, 6-12 weeks
  • working strength, balance, flexibility, coordination
39
Q

What is surgical management for hip OA?

A
  • total hip
  • partial hip
  • joint resurfacing
40
Q

What are the predictors someone will respond well to PT with hip OA?

A

if 3 or more present
- unilateral vs bilateral hip pain
- younger or equal to 58 y.o
- pain more or equal to 6/10
- 40m SPWT of less or equal to 25.9 sec
- symptoms less than a year

41
Q

What provides better outcomes with hip OA?

A

manual therapy is better than exercise alone

42
Q

What are the PT management strategies to be used for hip pain?

A
  • manual therapy + exercise
  • impairment driven
  • adequate challenge for strength gains
  • strength linked to functional tasks
  • CV and physical activity counseling

MSK Conditions (12 decks)

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