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Year 2- MSK > Orthopaedic Hip Conditions > Flashcards

Orthopaedic Hip Conditions Flashcards

1
Q

Femur fractures may lead to what clinical observation?

A

Hypotension, especially in cases of major trauma- the femur has a large blood supply and if damaged can bleed significantly

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2
Q

Define osteoarthritis.

A

Degenerative change of synovial joints

->progressive loss of articular cartilage and secondary bony changes as a result

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3
Q

What is osteoarthritis characterised by?

A

Worsening pain and stiffness of the affected joint affecting day to day life

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4
Q

Trochanteric burtsitis?

A

Inflammation of the bursa found between the trochanter and the iliotibial band

F>M

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5
Q

What characterises bursitis?

A

Swelling

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6
Q

What are some of the causes of trochanteric bursitis?

A

Trauma
Over-use e.g. athletes or runners
Abnormal movements e.g. after surgery, muscle wasting, hip replacements, scoliosis

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7
Q

Presentation of trochanteric bursitis?

A

Pain- lateral hip
Swelling

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8
Q

What may be seen during MSK examination of someone with trochanteric bursitis?

A

LOOK- muscle wasting, previous surgery scars
FEEL- tenderness at greater tuberosity
MOVE- worst pain in active abduction, passive adduction painful too (crossing leg over)

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9
Q

Investigations for trochanteric bursitis?

A

X-ray- usually to exclude arthritis diagnosis
MRI- helps to confirm if not sure
Ultrasound- useful at localising it, sometimes used as US guided steroid injection

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10
Q

Treatment of trochanteric bursitis?

A

NSAIDs- topical and oral
Relative rest/activity modification
Physio
Corticosteroid injection

->sometimes surgery of bursectomy but rarely required

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11
Q

Avascular necrosis?

A

Death of bone due to loss of blood supply

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12
Q

Who is more likely to get avascular necrosis?

A

M>F
Average age 35-50 yrs

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13
Q

Risk factors which can lead to avascular necrosis?

A

Trauma; fracture, dislocation
Systemic; steroids, alcoholism, hypercoagulable states
Other conditions; lymphoma, sickle cell disease, leukaemia, Caisson’s disease

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14
Q

Which trauma related incident can lead to avascular necrosis?

A

Femoral head injury e.g. fracture
More displaced the fracture, the higher risk of avascular necrosis

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15
Q

How does intravascular coagulation lead to avascular necrosis?

A

Coagulation of blood, leading to venous thrombosis, increased pressure which reduces blood supply to bone and cells die

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16
Q

Symptoms of avascular necrosis?

A

Insidious onset of pain- gradual but with serious effects
Pain usually in groin, associated with stairs, walking uphill
Limp

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17
Q

Examination of a patient with avascular necrosis may be fairly normal but what may the symptoms replicate?

A

Early arthritis as reduced range of motion and stiff joints

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18
Q

Which investigation is best to confirm diagnosis of avascular necrosis?

A

MRI

->more sensitive and picks up 99%. X-ray only helpful if condition has progressed to the stage where the bone has started to collapse or become arthritic

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19
Q

Non-operative treatment of avascular necrosis?

A

Reduce weight bearing
NSAIDs
Bisphosphonates
Anticoagulants
Physio

20
Q

Which cells remove dead bone?

A

Osteoclasts

21
Q

Surgical treatments for avascular necrosis are in the early stages and can be controversial…
What can be done?

A

Restoration of blood supply
Move lesion away from weight-bearing area
Total hip replacement

22
Q

What is impringement?

A

Two surfaces hitting together

23
Q

Femoroacetabular impingement can be the common cause of which other conditions?

A

Hip pathologies in younger patients
Hip osteoarthritis

24
Q

What are the two categories of femoroacetabular impingement?

A

Cam lesion impingement
Pincer impingement

25
Q

Cam lesions are primarily a problem of which bone?

A

Femur

26
Q

Femoral-based impingement is seen most in which type of person?

A

Young athletic males, often rowers

27
Q

In cam lesions, there is excess bone, often around the femoral head. What happens anatomically?

A

Decreased head to neck ratio
Aspherical head

28
Q

Pincer impingement is usually based with which bone?

A

Acetabulum

29
Q

Who is more likely to get acetabulum based pincer impingement?

A

Active females

30
Q

What other injuries are associated with femoroacetabular impingement?

A

Labral degeneration
Cartilage damage and flap tears
Secondary hip osteoarthritis

31
Q

How does femoroacetabular impingement present?

A

Groin pain, worse with flexion
Pain with movements such as squatting, lunging, getting out a chair

->apparently Andy Murray has femoroacetabular impingement, think of him doing these movements in tennis trying to get to the bal

32
Q

What are the test for both cam and pincer femoroacetabular impingement?

A

FADIR test
-flexion, adduction, internal rotation all of hip at once and reproduces the pain

33
Q

Which investigations can be useful for femoroacetabular impingement?

A

X-ray to identify bony pathology
MRI useful for assessing associated conditions like labral tears and articular cartilage damage

34
Q

Treatment of femoroacetabular impingement?

A

Activity modification
NSAIDs
Physio- correct posture and strengthen muscles around the joint

35
Q

What are some potential operative treatments for femoroacetabular impingement?

A

Arthroscopy- shave down defect, deal with labral tears and resect articular cartilage flaps
Open surgery- resection, periacetabular osteotomy, hip replacement or resurfacing

36
Q

Most common anterosuperior tear?

A

Labral tear

37
Q

Who is more likely to get a labral tear?

A

Active females
Can affect all age groups

38
Q

What are some of the causes of labral tears?

A

Femoroacetabular impingement
Trauma
Old age
Dysplasia
Collagen disease e.g. Ehlers-Danlos

39
Q

Presentation of a labral tear?

A

Groin or hip pain, usually intermittent and comes on with certain movements
Snapping sensation
Jamming or a locking feeling

40
Q

What may be seen in examination in someone with a labral tear?

A

Can be normal
Often positive FABER test (flexion, abduction and external rotation of hip)

41
Q

Okayyyy so there’s FABER and FADIR

When is FABER positive?

A

Labral tears

->FABER sounds more like labral

42
Q

Okayyyy so there’s FABER and FADIR

When is FADIR positive?

A

Femoroacetabular impingement

43
Q

Investigation of choice for labral tears?

A

MRI Arthrogram

44
Q

Non-operative management for labral tears?

A

Activity modification
NSAIDs
Physio

45
Q

Operative management for labral tears?

A

Arthroscopy for repair and resection of the labrum

46
Q
A

Year 2- MSK (36 decks)

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