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Year 3 MSK > Ortho hip conditions > Flashcards

Ortho hip conditions Flashcards

1
Q

What are the key pathologies of the (adult) hip?

A

OA of hip

Bursitis

AVN

Impingement (FAI)

Labral tear

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2
Q

Describe the structure of the pelvis

A

Hemipelvis made up of 3 bones - ischium, ileum & pubis

Hemipelvis joined together by the pubic symphysis (anteriorly) and the sacrum (posteriorly)

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3
Q

What type of joint is the hip joint?

A

Synovial ball & socket

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4
Q

What anatomical features does the acetabulum (socket of hip bone) have to add stability?

Describe the structure of these

A

1) Acetabular labrum - fibrocartilagious lining of acetabulum. Deepens socket & adds stability.
2) Ligaments (x2)

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5
Q

What are the ligaments of the hip?

A

1) Ligamentum teres - HoF to acetabular notch
2) Transverse ligament - completes the circle of the labrum (note it is not shown in the photo)

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6
Q

Identify the bits

A

yis

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7
Q

Give an overview of the blood supply to the hip joint

A

Blood supply from 2 main arteries…

MFCA - Medial femoral circumflex artery

LFCA - Lateral femoral circumfelx artery

These are branches of the Profunda femoris (deep femoral artery)

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8
Q

Describe the distribution of the MFCA

A

Medial femoral circumflex artery

Major contributor to the femoral head blood supply

Has 2 branches:

  • one ascends to head
  • one transverses to cruciate anastomosis
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9
Q

Describe the distribution of the LFCA

A

Lateral femoral circumflex artery

Less important to hip joint…

Has 3 branches:

  • ascending branch to joint capsule
  • transverse branch to cruciate anastomosis
  • descending branch
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10
Q

Aside from the LFCA & MFCA - what other arteries supply the head of femur?

A

Artery of ligamentum teres - theres an artery inside the ligament

Nutrient arteries of the bone

Heres a nice wee diagram

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11
Q

What is the clinical relevance of the blood supply to the neck & head of the femur?

A

Fractures risk disrupting blood supply (and causing AVN)

As a general rule:

  • Intracapsular fractures = blood supply disruption
  • Extracapsular = all good
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12
Q

What is the typical presentation for osteoarthritis of the Hip?

A

Chronic history of groin pain & stiffness - worsened by exercise & relieved by rest

Pain may radiate down to knee on affected side

(see lecture on OA)

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13
Q

What is trochanteric bursitis?

Describe the relevant anatomy

A

Trochanteric bursitis (aka Greater T pain syndrome)

Inflammation of the Bursa located over the greater trochanter of the femur

The trochanteric bursa is sandwiched between the insertions of the gluteus medius & minimus (hip abductors) - and is overran by the IT band of Tensor fasciae latae

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14
Q

What are the risk factors for Trochanteric bursitis?

A

Female

Over-use (athletes etc)

Abnormal movments due to other problem:

  • distant problem eg scoliosis
  • muscle wasting following surgery
  • THR
  • OA of hip
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15
Q

Describe the presentation and specific exam findings for trochanteric bursitis

A

Well localised, lateral hip pain

On examination:

  • tenderness over greater trochanter
  • painful active abduction
  • +/- scars from surgery, gluteal muscle wasting etc
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16
Q

How can trochanteric bursitis be investigated?

A

Think it can be diagnosed clinically but:

X-ray

MRI

US

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17
Q

How is trochanteric bursitis treated?

A

First order:

  • activity modifcation / rest
  • NSAIDs
  • physiotherapy

If above fails:

  • US guided steroid injections

If all else fails:

  • Bursectomy
18
Q

What is AVN?

A

Avascular necrosis - death of bone due to disruption in blood supply

19
Q

What are the risk factors/causes of AVN?

A

Trauma:

  • irradiation
  • fractures (intracapsular)
  • dislocations
  • iatrogenic

Systemic:

  • idiopathic
  • hypercoagulability
  • haematological
  • steroids
  • Caisson’s disease
  • alcoholism
20
Q

What haematological conditions predispose someone to AVN?

A

Hypercoagulable states

Sickle cell disease

Lymphoma

Leukaemia

21
Q

What is Caisson’s disease?

A

Decompression sickness - aka The bends

Happens to divers

22
Q

Describe the epidemiology of AVN

A

Males > females

35-50 y/o

80% bilateral

23
Q

Describe the typical presentation of AVN

A

Insidious onset of groin pain

Pain especially on exercise/impact activities

Limp

(similar to OA)

24
Q

What features on examination could you see with AVN

A

Largely normal

May have reduced ROM - especially on internal rotation

25
Q

How is AVN investigated?

A

MRI is best

X-ray

26
Q

Describe the treatment of early AVN

A

Non-operative:

  • reduce weight bearing
  • NSAIDs
  • bisphosphonates?
  • anticoagulants
  • physio
27
Q

Describe the treatment of bad AVN

A

If serious enough - surgery is indicated:

  • Core decompression +/- vascularised graft
  • Rotational osteotomy
  • THR if above fail/not possible
28
Q

What happens in Femoroacetabular impingement (FAI)?

Who does it affect?

What condition does it predispose to?

A

Impingement of femoral neck against anterior edge of acetabulum

Affects younger patients

Causes secondary OA of hip

29
Q

What causes FAI?

What are the 2 categories of FAI related to this?

A

Anatomical phenomenon - in which there is reduced space between the femoral neck & anterior edge of acetabulum

2 causes of this:

Cam lesion - typically males, bulged femoral neck

Pincer - typically females, abnormally deep acetabulum (kinda)

30
Q

What injuries are associated with FAI?

A

Labral degeneration & tears

Cartilage damage & flap tears

Secondary OA of hip

31
Q

Describe the presentation of FAI?

A

Groin pain - worse on flexion

32
Q

What findings on examination may indicate FAI?

A

Reduced flexion & internal rotation

Positive FADIR test - pain on:

  • Flexion
  • ADduction
  • Internal Rotation
33
Q

What investigations can you do for FAI?

A

X-ray - identifies bony pathology

MRI - identifies any associated labral tears & cartilage damage

34
Q

Give an overview of the treatment of FAI

A

Non-operative - NSAIDs, activity mod, physio

Operative:

  • Arthroscopy
  • Open surgery
    • resection
    • periacetabular osteotomy
    • hip arthroplasty
35
Q

What is the most common type of labral tear?

A

Anterosuperior

36
Q

What are risk factors for labral tears?

A

FAI (esp pincer)

Trauma

OA

Dysplasia (I assume DDH)

Collagen diseases (eg Ehlers-danlos)

37
Q

Describe the presentation of a labral tear

A

“Snapping sensation” - followed by:

Hip/groin pain

Locking/jamming of hip

38
Q

What would you find on examination of someone with a labral tear?

A

May be normal…

Positive FABER test - pain on:

  • Flexion
  • ABduction
  • External Rotation
39
Q

Compare the FADIR & FABER test…

A

FADIR - flexion, adduction, internal rotation - +ve indicates FAI

FABER - flexion, abduction, ext rotation - +ve indicates anterior labral tears

40
Q

What investigations can you do for Labral tears

A

MRI arthrogram

Diagnostic injection of local anaesthetic

X-ray - will identify causes such as OA, dysplasia

41
Q

How are labral tears treated?

A

Non-operative:

  • usual shite - NSAIDs, physio, activity modification
  • steroid injections

Operative:

  • arthroscopic repair / resection

Year 3 MSK (42 decks)

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