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Semester 2 PM Exam 6 > Nonsurgical Hip > Flashcards

Nonsurgical Hip Flashcards

1
Q

Slipped Femoral Capital Epiphysis

A

Displacement of the femoral head on the femoral neck
30% are bilateral
11-13 y/o
Male > Female (3:2)

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2
Q

Goal of tx with slipped femoral capital epiphysis

A

movement of femoral head on neck creates abnormal biomechanics and pain
Would want to prevent osteonecrosis of femoral head

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3
Q

Usual tx for slipped femoral capital epiphysis

A

Sometimes casting is done for 12-24 weeks with limited success so Usual tx is surgical with single pin fixation or if severe internal fixation with traction

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4
Q

Cause of Slipped Femoral Capital Epiphysis

A

Idiopathic
Possible that a hormonal abnormalilty causes inc fibrous tissue in the growth plate
Often pt is overweight but not always

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5
Q

What movements are most impacted by slipped femoral capital epiphysis

A

Hip IR, Abduction, and Flexion are most affected ROM

Gait is antalgic or with a Trendelenberg gait pattern

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6
Q

Prognosis with slipped femoral capital epiphysis

A

Prognosis is for high likelihood of DJD

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7
Q

Congenital Hip Dislocation

A

Spontaneous dislocation before, during, or shortly after birth
Females > Males
Femoral head dislocates superiorly and laterally
33% of cases are bilateral

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8
Q

Cause of congenital hip dislocation

A

Usually delayed acetabulum development causing developmental dysplasia of the hip (DDH)
Pathology also includes femoral neck anteversion
Joint laxity, hormonal joint laxity, hip dysplasia or a breech position during pregnancy

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9
Q

Tests done immediately after birth

A

Ortolani test and Barlow maneuver

Earlier the dx the better the prognosis for normal gait and avoidance of DJD

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10
Q 
Tx of congenital hip dislocation
First 6 weeks
6 months - 6 years
7-10
After 11
A

For the first 6 weeks of life - positioning the hip in abduction, ER, and flexion through a double diaper or Pavlik Harness
From 6 months - 6 years - closed or open reduction is necessary and LE is immobilized
7-10 = if bilateral patient may be functionally OK or else surgical tx occurs
After 11 not surgical tx occurs unless they have degenerative changes

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11
Q

Legg Calve Perthes

A

Osteochondritis of the femoral capital epiphysis with eventual ossfication center necrosis
Flattening of the femoral head within the acetabulum occurs
Ages 2-12
Males > Females usually between 2-12 yrs
Caucasians 10 x more likely

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12
Q

Goals of tx with legg calve perthes

A

Prevent damage to femoral head, keep it as round as possible, let ossification center heal

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13
Q

Cause of Legg Calve Perthes

A

Unknown and deformities occur over a period of 2-5 years

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14
Q

Tx of legg calve perthes

A

Conservative tx ncludes traction during sleep time, casting for three months and bracing for 6-15 months
Surgical tx is used if conservative tx fails

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15
Q

Impact of legg calve perthes

A

Avasular necrosis of the femoral head occurs secondary to a subchondral fracture or occluded blood supply
Eventually the necrotic ossification tissue is replaced by normal disuse but the shape of the femoral head is not correct

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16
Q

To test for legg calve perthes

A

radiographs

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17
Q

Prognosis for legg calve perthes

A

if caught early the prognosis is good for no future hip problems

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18
Q

Transient Synovitis

A

An idiopathic, nonbacterial inflammation of synovial membrane
Not serious and needs no tx
Affects children before puberty - usually boys
Children demonstrate limping, hip pain, possible low grade temp
Most common cause of hip pain in children

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19
Q

Tx for transient synovitis

A

NSAIDS - usually children will be painfree within two weeks

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20
Q

How diagnose Transient Synovitis

A

radiographs done to rule out other pathology

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21
Q

Avascular necrosis

A

lack of blood circulation to the head of the femur causing breakdown of tissue and bone
Not a disease but occurs over time

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22
Q

Avascular necrosis is common with

A

prolonged steroid use and may be result of slipped femoral capital epiphysis
Also occurs with trauma

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23
Q

Patients with avascular necrosis are usually

A

asymmptomatic in early necrosis with slow developing pain in the groin and thigh and eventual loss of ROM and muscle spasm
Eventually they develop DJD and femoral degeneration

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24
Q

Tx for avascular necrosis

A

Conservative tx is NWB for 2-3 yrs in young patients
Most patients opt for surgical internal fixation of femoral head and grafts to revascularize the bone
Total hip arthroplasty is an option too

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25
Q

All patients with avascular necrosis develop -

Tests to diagnose

A

OA

Radiographs

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26
Q

Septic Hip/Arthritis

A

Medical emergency and needs immediate treatment

Can occur at any age but usually occurs in adults

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27
Q

If not treated for septic hip…

A

hip joint will be destroyed - pathogens include

Gonorrhea, H influenza, Staphylococcus, Steptococcus

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28
Q

Septic hip is divided into

A

gonococcal arthritis and non-gonococcal arthritis

Most common non- gonoccoal pathogens are H influenza, Stph and Strep

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29
Q

Degenerative Joint Disease

A

Breakdown of cartilage on the femur or acetabulum
Can be idiopathic or in response to injury or disease
Females > Males
Over age of 40

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30
Q

Subjective Complaints with DJD

A

Groin or trochanteric pain

Morning stiffness less than 30 min

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31
Q

Objective findings with DJD

A 
Antalgic gait
Loss of hip motion
Weak abductors 
Crepitus
Muscle spasm
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32
Q

Dx is confirmed with (DJD)

A

radiographs

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33
Q

Treatment for DJD

A

Conservative tx is symptom relief and stress control via medications, joint mobilization and stretching, assistive and adaptive equipment, and hip strneghtening

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34
Q

Surgical tx for DJD

A

Birminghman procedure for younger patients and total hip arthroplasty

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35
Q

Prognosis for DJD

A

Pain will increase as degeneration continues

36
Q

Hip Pointers or Iliac Crest Contusion

A

Contusion of the iliac crest, ASIS, or both
Caused by trauma and can cause soft tissue damage to surrounding mm (RF, Sart, TFL, E/IO)
Avulsion needs to be ruled out

37
Q

Tx for Hip pointer or iliac crest contusion

Prognosis

A

initial rest with gradual return to function

Prognosis is full recovery

38
Q

Hip fractures

A
  1. Avulsion
  2. Subcapital
  3. Femoral neck
  4. Intertrochanteric
  5. Subtrochanteric
  6. Stress
39
Q

Stress fracture

A

Insidious and often happen in individuals with osteoporosis, runners, elderly, patients with cancer, individuals with compromised nutrition

40
Q

When do stress fractures occur

A

When osteoclastic activity outweights osteoblastic activity

41
Q

Patient will complain of (stress fracture)

A

pain with weightbearing

42
Q

Tx for stress fracture

A

rest but if fracture is through a major weight bearing area, ORIF might be necessary

43
Q

Prognosis for stress fracture

A

good for return to activity but not if nutrition and training do not change

44
Q

Subtrochanteric Fracture

A

Occur with major trauma primarily in elderly from falls and from other traumas in young people
Fractures are classified by degree of displacement and number of fragments of bone

45
Q

Subejctive info Subtrochanteric Fracture

A

pt will show an acute onset of pain, inability to weightbear and a shortened and externally rotated LE

46
Q

Tx for subtrochanteric fracture

A

ORIF

47
Q

Prognosis for subtrochanteric fracture

A

poor for elderly to get to full function

mortality up to 80% within 2 years of the fracture

48
Q

Intertrochanteric Fracture

A

Caused by falls and trauma

Classified by degree of displacement and location

49
Q

Tx of Intertrochanteric fracture

A

ORIF

50
Q

Prognosis of intertrochanteric fracture

A

Poor prognosis for return to function in elderly

51
Q

Femoral neck (subcapital) fracture

A

More likley to have a sequelae of avascular necrosis secondary to the femoral circumflex artery

52
Q

Classification of fractures (femoral neck)

A

Grade 1 = Incomplete
Grade 2 = Nondisplaced
Grade 3 = Partial Displacement
Grade 4 = Total displacement

53
Q

Tx for femoral neck fracture

A

Most hip fractures are treated with ORIF but type of fixation depends on kind of fracture and its classification
Weightbearing status also depends on type of fracture, classification, and bone integrity

54
Q

Avulsion Fracture

A

Caused by a strong muscle contraction resulting in pulling the muscle attachment and small amount of bone off a larger bone
Most common in athletes who still have open epiphyseal plates
Pain is localized to the muscle attachment and action with swelling, redness, and bruising

55
Q

Diagnosis avulsion fracture

A

Radiographs are diagnositc choice to differentially diagnose an avulsion fracture versus muscle or tendon strain

56
Q

Tx goals for avulsion fracture

A

Focus on proper healing with initial rest and gradual return to activity

57
Q

Prognosis for avulsion fracture

A

Excellent for return to function and better than someone who had sustained a tendon tear or muscle tear

58
Q

Hip dislocations - Anterior or Posterior

A

Can be ant or post depending on force direction
Considered a medical emergency secondary to structures that may be damaged by the force needed to dislocate
Not very common because of stability of hip but can occur with large trauma like MVA

59
Q

Hip dislocations almost always damage

A

the labrum

Complications can occur like avascular necrosis or nerve damage

60
Q

Posterior hip dislocation can impact the

Anterior can impact the

A

sciatic nerve

Femoral nerve

61
Q

Tx for hip dislocation

A

Closed reduction under anesthesia if no fracture has occured and ORIF if fractures occur

62
Q

Prognosis for hip dislocation

A

Full recovery is good if avascular necrosis does not occur

63
Q

Femoral Acetabular Impingement

A

Syndrome of painful hip motion (usually flexion, adduction) that results from underlying bony abnormalities in the hip joint
Labral tears, DJD my be a result

64
Q

2 deformities with femoral acetabular impingmeent

A

Cam Impingement = femoral head/neck protrusion
Pincer Impingement = acetabular coverage on the femoral head
When hip is flexed and adducted like when cross legs, acetabulum may pinch the bone and joint capsule and labrum causing pain
FAI can also be caused by muscle imbalances and capsular tightness

65
Q

FAI is leading cause of

A

labral tears

66
Q

Labral Tears

A

Usually caused by microtrauma or FAI, capsular laxity or hip dysplasia
Occur in highly active people ages 20-40

67
Q

Subjective complaints

A

Generalized ant groin pain or clicking, locking or giving way

68
Q

Diagnosis labral tear

A

No clincial exams with high validity

Radiographs, MRI, bone scan, intraarticular injectiosn might be used to rule out other problems

69
Q

Tx for labral tear

A

Intraarticular injections to dec inflammation, PT for hip mobiliztaion, muscle balancing, lifestyle changes, and arthroscopic repair

70
Q

If untreated, labral tears are thoguht to lead to

A

DJD

71
Q

Hip bursitis

A

Inflammation of the bursa usually the greather troch, iliopectineal, or ischiogluteal
F > M

72
Q

GT bursitis occurs most frequently in

A

30-40 y/o and is most common cause of hip pain

73
Q

Subjective findings with hip bursitis

A

Tenderness is usually achy and diffuse in GT area with radiation to groin, glutes or thigh
Pain occurs with resisted abduction
With IP, IG, pain is at the site and area of bursa

74
Q

Objective findings with hip bursitis

A

Gait is antalgic

75
Q

Tx for hip bursitis

A

Rest, stress reduction, normalizing movement or postures, stretching and strnegthing are PT txs
Medical tx = injections and NSAIDS (non steroidal anti inflammatory drugs)

76
Q

Greater Trochanteric Bursitis

A

Fairly common

May be caused by trauma, weak abductors, forceful adduction

77
Q

ischial gluteal bursitis

A

Can be caused by over use of hamstrings, onto ischial tub, prolonged sitting

78
Q

Iliopectineal bursitsi

A

can be caused by tight iliopsoas rubbing against bursa, an abnormal hip joint from RA or OA that causes irritation to bursa

79
Q

Hip tendinopathy

A

Usually occurs in the tendons of greater troch or proximal hamstring
Cause = usually overuse
Pelvic obliquities and leg length discrepency can irritate GT tendons

80
Q

Diagnosis of tendinopathy

A

Via palpaton and resisted contraction with occasional MRI

81
Q

TX of tendinopathy

A

Depends on if it is tendonitits but usually always includes eccentric exercise

82
Q

Muscle Strain

A

Tearing of a muscle
Usually ecchymosis occurs
Palpation to muscle would be painful

83
Q

Common hip muscles to strain

A

Adductors, RF, Hamstrings

Two joint muscles are strained more commonly

84
Q

Mechanism of muscle strain

A

Mechanism is usually forceful contraction as the muscle is lengthening or trauma

85
Q

Inflammatory problem - best tx

A

Ice, STM, Painfree AROM, gait training

Semester 2 PM Exam 6 (10 decks)

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