ORTHO-HIP KNEE Flashcards
Pt c/o of Hip pain what is systematic step?
Consider Anatomy- Proximal to Distal 1. Low back-DISC 2. Hip-SI Jt 3. Femur, Internal vs External: 1. Infx/Arthritis 1. Organ Referral Appendix 2. DVT, PAD 3. Labrum, Bursa 4. Ligament 5. MSK. EMErgent 1. INfx/Arthris 2. DVT 3. PAD
What Q/A is concerning?
Onset Location Duration C Associate sx Radiation Trauma Severity
This DDX is pain and tenderness over greater trochanteric bursa. Pain is worse with initial movement, better with ROM. Pt will state cannot lie on affected side.
Trochanteric Bursitis PE- TTP Pain w/ ER of hip DX- X Ray? TX- NSAIDs PT, Kenalog 40/0.5 Marcaine/1% Lidocaine- 1-2 ml cs+local anesthetic. Pt expectation will fill great, then wears off 2-3w Expectations
Where should CS be injected?
Local to Pt TTP- 1. Move needle around until Pt feels pain-$ 2. Slowly inject 3. Repeat in other hotspot. PT expec
What is this HIP ddx where Pt will hear snap over hips with walking and flexing?
Snapping Hips Syndrome. Likely IT/TFL irritated tight hip, weak glutes/rotators
What is the work up for Snapping Hip?
PE- Palpate has Pt ADD and Rotates hip DX- XR? TX- NSAIDS, PT, INJ?
What DDX is detrimental and is loss of articular cartilage in hip from trauma, overuse, infection, genetic?
Osteoarthritis
What is c/c of OA in the hip?
NIght pain. Gradual onset of groin pain. DEC ROM and Antalgic Gait, hard to put on shoes
What is the work up for OA?
PE- Early sign- DEC IR of hip, to loss of FLX and EXT. DX-XR- narrow space, osteophytes, cyst, sclerosis-white bone) TX- NSAIDs, PT, Ambulatory device, THR-10-15yr lifespan.
Is injection ideal for hip OA?
YES- But guided Arthrogram (under fluoroscopy). NOT FOR SEVERE cases
What is the DDX for hip when Medial circumflex artery acetabular branch of obturator aa. are compromised d/t narrow jt. Pain is gradual or acute.
Osteonecrosis AVN- Death of trabecular bone in femoral head- Idiopathic. WHO?-30-50y. RISK-trauma, alcohol abuse, corticosteroid use, rheumatoid arthritis or lupus
What is work up for Osteonecrosis of hip?
PE- Pain IR/ER and ABD. DX XR sclerosis, mothy, femur head is not smooth, TX- THR
This DDX of hips is classic pain radiate down leg from low back to glute?
LBP/Sciatica. Sciatic nerve irritation, glute stiff. TX- NSAIDs, PT
What are systematic approach for Knee pain?
- OLD CARTS and age, PMH 2. OA, Soft tissue, Fx, dislocation
What is MC form of knee arthritis?
Osteoarthritis- wear and tear cartilage WHO- >40y, FH, Obese, PMH trauma ACL
What is work up for Osteoarthritis of Knee?
CP- Joint line pain, unstable feeling, night pain, swelling, gradual PE-Alignment, Varus, Valgus, Crepitus w/ EXT PFP DX- XR-standing, sunrise merchant, AP, Lateral- MED, LAT, Patellofemoral compartments. JT space narrowed. MRI- if XR looks ok, meniscus ligament
What is non op TX for OA of knee?
MAX 3200 600 TID,- Motrin, Naprosyn MAX 1250, Relafen, Indomethacin MAX 50 mg TID.
Cortisone Injection-check A1C
Can give months of pain relief QO3-4MO
Strict sterile technique
Depo Medrol, Kenalog mixed LIDo, marcaine. Hyaluronic Acid- avoid sulfa allergy, natural in synovial fluid, lubricant and shock absorb. From bacteria and rooster combs. Synvisc or Supartz
RICE
What can PT and bracing do for OA?
Brace unload jt to create more space PT- Strength surround muscle, movement, wt loss, Re-education
When is operation considered for OA?
When all other fail. Severe. Arthroscopy- cleaning frayed meniscus tissue. DO NOT TAKE OUT-cushion. FOR mild changes and pain not relieved with conservative TX
Who get TKR?
Mod-Severe. Replace with metal prosthesis. Restore Pt QOL. Pt driven
What DDX for knee pain is d/t jt line pain, catching, popping or locking of knee, swelling, pain w/ activity?
Meniscal Tears- Medial MC d/t limited mobility attached to MCL, larger, WB. Occurs with twisting mech w/ ACL, MCL. WHO- 13-40y. >50 2/2 d/t arthritis.
Who get Degenerative meniscal injury?
30-50y OBese, Inactive
What is work up for meniscus tears?
PE- TTP along jt line, +McMurray’s-pain and click, Deep squat pain limited-catch, EROM pain DX- XR obligues to r/o FX w/ trauma, >40 standing AP and sunrise/merchant joint space. MRI**- T1 H2O BLK.
Why do meniscus tear hurt?
Meniscal tissue becomes caught or stuck in the joint- Bucket handle tear, flap tear, radial tear, complex tear, degenerative tear
1. Locked knee from meniscal tear- MAY knee same day/ week surgery.- Arthroscopy MC
