O: Adult Spine & Hip Disorders Flashcards
what is an acute disc tear
tear in the outer annulus fibrosis of intervertebral disc
aetiology of acute disc tear?
heavy lifting
s/s of acute disc tear?
pain worse on coughing
mx of acute disc tear
resolves within 2-3months + analgesia and physio
what is a disc prolapse?
if an intervertebral disc tears, nucleus pulpous can prolapse through tear
main risk of disc prolapse?
material can impinge on an exiting nerve root
common sites for disc prolapse?
L4-S1, cervical spine
which nerve is commonly affected by an L4-S1 disc prolapse?
sciatic nerve and often causes sciatica
s/s of disc prolapse?
burning/tingling in dermatomal distribution, reduced power in myotomal (muscles) distribution
ix for disc prolapse
clinical findings and MRI
tx for disc prolapse?
analgesia and physio, discectomy
what happens as a result of spinal stenosis and claudication
nerve root is compressed
s/s of spinal stenosis claudication (as opposed to PVD claudication)?
distance is inconsistent, burning pain, pain is less when walking uphill, pedal pulses preserved
mx for spinal stenosis & claudication
physio, wt loss, surgery (decompression)
what is femeroacetbular impingement syndrome (FAI)
extra bone of femoral neck and acetabulum causes abatement of femoral neck on edge of acetabulum during movement
what are the 3 types of FAI?
- CAM: femoral head defamed so cannot rotate smoothly in acetabulum
- Pincer: extra bone extends over normal rim of acetabulum
- mixed
epi of CAM FAI?
young athletic males
epi of pincer FAI?
F>M
s/s of FAI?
activity related pain in groin, difficulty sitting, C-sign +ve, stiffness, limping
with which particular movement is FAI exacerbated?
flexion and rotation
ix for FAI?
FADIR provocative test +ve, MR arthrogram, x-rays
what is a FADIR +ve result?
pain on internal rotation of knee at 90º
mx of FAI?
asymptomatic: observe, activity changes, physio
symptomatic: surgery to deride CAM + arthroplasty later in life
what is avascular necrosis of hip?
failure of blood supply to femoral head
epi of AVN of hip?
M>F, 30-50yo, bilateral in 80%
aetiology of AVN of hip?
trauma, long term steroids, alcohol excess, blood cancers, haematological disease
pathophysiology of idiopathic AVN of hip?
coagulation of interosseous circulation causing interosseous stasis
s/s of AVN of hip?
low energy hip, insidious onset of severe groin/buttock/ hip pain
ix for AVN of hip?
x-ray (after a few weeks), MRI
what would be seen on MRI of AVN of hip?
patchy sclerosis, subchondral fracturing, incongruent femoral head, bone marrow oedema
mx for reversible AVN of hip?
core decompression & bone grafting
T/F: irreversible AVN of hip requires amputation of whole leg
F: requires total hip replacement
idiopathic transient osteonecrosis of hip (ITOH) is…
transient loss of blood supply to femoral head resulting in inc pressure on femoral neck
epi of ITOH
middle aged men, women in 3rd trimester of pregnancy
s/s of ITOH?
progressive groin pain over several weeks, no weight bare
MRI is gold standard ix for ITOH, what would be the findings?
osteopenia of head and neck, thinning cortices, preserved jt space, bone marrow oedema*
mx for ITOH?
self limiting (6-9months), analgesia, crutches
epi of trochanteric bursitis
young fit females
aetiology of trochanteric bursitis?
repeated trauma to iliotibial band, unaccustomed exercise, inflammatory arthritis
s/s of trochanteric bursitis?
pain at greater trochanter, worse going up stairs/ lying on affected side, pain on rested abduction
T/F: mx for trochanteric bursitis is surgery
F: self limiting so conservative mx
how to differentiate between trochanteric bursitis and gluteus medium tendinopathy?
gluteus medius tendiinopathy doesn’t get better with injections
