Pathologies Related to Pelvis and Hip I Flashcards
Pathological hip fracture overview:
________ femur fx; particularly the _____ due to what?
proximal
neck
disease
Pathological hip fracture
Etiology: Conditions with compromised ______
- Osteoporosis and _________
- _________ _______ : congenital and inherited brittle bone disease
- ________ disease- chronic bone disorder with abnormal bone turnover that results in bigger but softer bones
May or may not involve a _______
bone
osteomalacia
Osteogenesis imperfecta
Paget’s
fall
Risk factors for Pathological hip fracture: _____ based on etiologies
vary
Incidence/Prevalence with pathological hip fracture:
mostly ______
_____ Americans
older
European
Pathogenesis of Pathological hip fracture: ______ _____ of bone resulting in fx
gradual weakening
Pathological hip fracture
S&S:
- Painful ____ and possible _____ way
- _____ and possibly _______ thigh P! and to the knee and lateral ______
Increased pain in ________ and decreased in _______ WB
snap; giving
Groin; anteromedial
hip
WB; non
With a Pathological hip fracture, you may observe…
_______ and excessively ______ rotated LE due to displacement and pull of ER’s
_______ and _______ gait
Shortened; externally
antalgic; asymmetrical
With a Pathological hip fracture, ROM will be in ______ directions but specifically _____
several; IR
With a Pathological hip fracture, what special test will be positive?
Patellar-pubic percussion
With a Pathological hip fracture, there could be a sign of the _______
buttock
The sign of the buttock is a collection of _____ indicating a ______ pathology
signs; serious
What is the etiology for sign of the buttock? (4)
Fx
Tumor
Infection
Hematoma
S&S for sign of the buttock
Hx- possible ______, infection, or ______ S&S
cancer
fracture
What would you observe with sign of the buttock?
gluteal swelling
ROM S&S with the sign of the buttock:
Hip _____ limitation the same no matter the ______ position with _____ end feels
Same degree of trunk ______ limitation in relation to the _____ and trunk position
FLX
knee
empty
flexion
femur
With sign of the buttock resisted/MMT: they will have _____ and ______ glutes
weak; painful
Sign of the buttock referral?
Urgent referral to MD but emergent if there is fx present
*due to possible displacement and vascular compromise
With a pathological hip fracture:
PT Implications- significant _____, _____, and health ______ arise from resulting sedentary situation
Ensure patients with risk factors of Osteoporosis had a ______ scan
morbidity; mortality; issues
DEXA (DXA)
Age group for DEXA scan:
Biological women at ____ years old
Biological men at _____ years old
65
70
Pathological hip fracture is a “Do Not Want To Miss” condition
You want to ______ with _______ referral due to possible displacement and potential vascular compromise
immobilize; emergent
________ is aka avascular necrosis or AVN of the femoral head
Osteonecrosis
With osteonecrosis incidence/prevalence:
May be ______ in _____% of cases
______> younger individuals
bilateral; 60
older
With osteonecrosis etiology and risk factors:
Insufficient _______ supply to _______ head
arterial; femoral
Two risk factors associated with trauma and osteonecrosis?
Fx/dislocation
Slipped femoral epiphysis or growth plate
With osteonecrosis etilogy which ligament is involved?
ligamentum teres- intracapsular ligament
Pertaining to osteonecrosis:
The ligamentum teres attaches proximally in the ________ is distally in the _______ of the femoral head
acetabulum; fovea
Pertaining to osteonecrosis: The ligamentum teres contains the _____ _____ artery to supply the head of the femur
Also plays a ________ role
medial epiphyseal
supportive
With osteonecrosis, the femoral head is also supplied by the _____ and ______ circumflex aa.
medial; lateral
Osteonecrosis etology and risk factors:
Insufficient ______ supply to ______ head
arterial; femoral
Osteonecrosis etology and risk factors:
Gradual onset with…
_______ abnomalities
________ (ex. radiation, smoking, alcoholism)
_____ ______ disease with a shortage of healthy carrying oxygen RBCs
Chronic _______ and oral _________ use
Bone _______ pathology
_______ syndrome
Vascular
Toxicity
Sickle cell
corticosteroid; contraceptive
Marrow
Metabolic
Osteonecrosis pathogenesis:
______ leading to death of bony tissue
Rapid progression to ____-_____ _____ _____
May involve ______ tears
Ischemia
age-related joint changes
labral
Osteonecrosis S&S:
Hx of…
_____ and possibly _______ thigh P! and to the knee
_______ but worsening with _______ and unknown
Even occuring at rest due to ______
Groin; anteromedial
Intermittent; gradual
ischemia
With osteonecrosis, you may observe ______ and ______ gait
antalgic; asymmetrical
With osteonecrosis their ROM may be limited with _____, ______, and _______ due to greater contact
IR/ABD/FLX
With osteonecrosis, there could S&S with what condition that involves changes?
Age-Related Joint Changes
Osteonecrosis is a _______ referral to MD if _______ onset
urgent; gradual
With osteonecrosis, if referred for PT proceed with ________
Should focus on _______ training with an _______ device to help protect the femur
PT directed primarily at ______ motion, improving ______, and for _____/______ integrity; like age-realted joint changes Rx
caution
gait; assistive
protection; circulation; bone; cartilage
With osteonecrosis, the patient may end up having a ____-_______ or possibly a _____
Hemi- arthroplasty
THA
______-_____-______ is aka as coxa plana or flat hip
Legg-Calve-Perthes
Legg-Calve-Perthes is the AVN of the femoral head in _______
children
Etiology for Legg-Calve-Perthes:
_______
Exposure to ______ ______ ______
_______ factors (ex. genetics, endocrine, nutritional, or socioeconomic conditions)
________ dysfunction of bone and vasculature
trauma
2nd hand smoke
Prenatal
Developmental
With Legg-Calve-Perthes incidence/prevalence: it is MOST common in ____-_____ year old caucasian biological ______
5; 8
boys
With Legg-Calve-Perthes pathogenesis- there is impaired vascular supply to ________ (med/lat _______ aa.) that changes the shape of the femoral _____ and ________
epiphyses; circumflex; head; acetabulum
Legg-Calve-Perthes S&S:
Vary in _______
_______ and ______ onset primarily
If p!ful, ____ and possible ________ thigh p! and to the knee
magnitude
gradual; unknown
groin; anteromedial
With Legg-Calve-Perthes S&S:
If p!ful, groin and possible anteromedial thigh p! and to the knee
it could _____ with activity
decrease with ______
increase
rest
What might you observe with Legg-Calve-Perthes?
_______ and _______ gait
Muscle _______ if ______ standing
antalgic; asymmetrical
atrophy; long
With Legg-Calve-Perthes, ROM will be limited with ______ and ______ due to greater bony contact
IR; ABD
Legg-Calve-Perthes is a ____-_____ problem
long term
Legg-Calve-Perthes is a _______ referral to MD if gradual; ______ referral to MD if trauma
urgent
emergent
With Legg-Calve-Perthes, if referred for PT proceed with caution:
Should focus on _______ training with an _______ device to help protect the femur
PT directed primarily at ______ motion, improving ______, and for _____/______ integrity
gait; assistive
protected; circulation; bone; cartilage
With Legg-Calve-Perthes, they present to the clinic periodically in a _______, ______, or ____ in a slight abducted position
splinted
braced
casted
With Legg-Calve-Perthes, they present to the clinic periodically in a splinted, braced, or casted in a slight abducted position:
It allows better _______ head contact with acetabulum
Maintain and help better ______ femoral head in the acetabulum as ______ can occur
Complication: prone to _______
femoral
form
contractures
With Legg-Calve-Perthes, possible age-related _____ changes in early _____ and ____% will develop age-related ______ disease before 50 yrs. old
joint; adulthood; 50; joint
With Legg-Calve-Perthes, MOST will need ______ surgery and or early ______
corrective; THA
With Legg-Calve-Perthes, there could be earlier ______ and _____ P! development in life due to ______ dysfunction
*kids tend to keep _____
*adults tend to _____ activity
LBP; knee
gait
moving
reduce
_____ ______ ______ is the anterior displacement of femoral neck on femoral head
Slipped capital epiphysis
Slipped capital epiphysis is aka as adolescent ____ ______
coxa vara
_______ _______ ______ is the MOST significant epiphyseal plate disorder of the LE
Slipped capital epiphysis
What is the etiology of slipped capital epiphysis?
Mostly _______
Association with _____ and _______ disorders and _____ _______
idiopathic
endocrine; renal
Down Syndrome
What is the MOST common etiology for slipped capital epiphysis?
Hypothyroidism
With slipped capital epiphysis, risk factors create increased _____ force across the _______ plate
shear; epiphyseal
The single MOST common risk factor for slipped capital epiphysis is?
obesity
Risk factors for slipped capital epiphysis:
Biological _____
Rapid _______
______ therapy
Femoral ______
males
growth
radiation
torsion
With slipped capital epiphysis: Incidence/prevalence
MOST common in early _______
______ Americans and biological _____
Typically higher _____ in 75% of cases
Bilateral in up to ___/___ of patients
adolescence
African; boys
BMI
1/3
The pathogenesis of _______ _______ _______- progressive displacement of femoral neck relative to the head through the growth plate due to shear forces and/or weakened epiphyseal plate
Slipped capital epiphysis
Slipped capital epiphysis S&S
More likely ______ and ______ onset than trauma but could be sudden with ______ activity like rolling in bed
_______ and possibly _______ thigh P! and to the knee
gradual; unknown
benign
Groin; anteromedial
With slipped capital epiphysis, you may observe it to be ______ and _________, ______ rotated hip, and muscle ______ if long standing
antalgic; asymmetrical
externally
atrophy
With slipped capital epiphysis: ROM may be limited with
______/______/and ________ due to greater bony contact
Obligatory ______ during flexion
Possible sign of ______
IR/ABD/FLX
ER
buttock
With slipped capital epiphysis: PT implications- should always be considered in ___-_______ with atraumatic ____ pain; particularly if associated with _____ gait
peri-adolescent
hip
antalgic
Slipped capital epiphysis is a ______ referral to MD
urgent
PT implications of slipped capital epiphysis:
If referred for PT proceed with caution-
If slip is __ 1 cm.
~ Splinted in an _____ position with non-WBing
<
ABDUCTED
PT implications of slipped capital epiphysis:
Post-splinting
Should focus on _______ training with an _______ device to help protect the femur
PT directed primarily at ______ motion, improving ______, and for _____/______ integrity
gait; assistive
protected; circulation; bone; cartilage
With slipped capital epiphysis:
Surgery is required if slip is ___ 1 cm.
>
With slipped capital epiphysis: you need to avoid _____ or _______ (rapid loss of articular cartilage)
AVN; chondrolysis
Vascular insufficiency S&S
_______
_______ or ______ discoloration
________ pulses
Impaired ______ refill with nail bed recovery
____ skin
____ loss
COLDNESS
blueish; pale
diminished
capillary
shiny
hair
With vascular insufficiency: it is at least an ______ but possibly ______ referral depending on severity and if _______
urgent; emergent; traumatic
