Orthopaedics cases Flashcards
65 year old man referred from GP with 2 year history of ongoing right hip pain. XR shows mild arthritic changes in the right hip. Has currently active prostate Ca, watch and wait management.
- O/E (right hip): normal gait, painful flexion, positive impingement test, good degree of rotation (90 degrees)
a) What is the most likely cause of this man’s pain?
b) What is a positive impingement test?
c) What other test can show weakness in the hip ABductors?
d) How is range of hip rotation best assessed?
Also has pain in both shoulders ongoing for 3-4 years.
-O/E: painful and limited ROM on flexion, abduction, external and internal rotation.
e) What is the likely cause of his shoulder pain?
f) What important questions should you ask about any joint pain to determine severity (and need for surgery)
a) OA. Also some femoroacetabular impingement, which is commonly coexistent in this population.
b) Sudden onset of pain in the groin when hip is moved into flexion, ADDuction and internal rotation (in one fell swoop).
c) Trendelenburg. Superior gluteal nerve supplies these muscles. Also may be positive in dysplastic hips (secondary to DDH, SCFE, Perthes, ball/socket deformity etc.)
d) Prone - use tibia as angle and assess internal and external rotation. Total angle should be roughly 90 degrees. Good measure of hip stiffness and general joint health.
e) Rotator cuff arthropathy
f) Pain at rest, pain at night, pain despite optimal conservative management, severe functional limitation
