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clin med - spring exam 2 > Pathologies Related to the Pelvis and Hip I > Flashcards

Pathologies Related to the Pelvis and Hip I Flashcards

1
Q

What is a pathological hip fx?

A

proximal femur fx, particularly the neck, due to disease

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2
Q

What is the etiology of a pathological hip fx?

A

Conditions with compromised bone
- Osteoporosis and Osteomalacia
- Osteogenesis Imperfecta- congenital and inherited brittle bone disease
- Paget’s disease- chronic bone disorder with abnormal bone turnover that results in bigger but softer bones
- Tumors

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3
Q

What is Paget’s disease?

A

chronic bone disorder with abnormal bone turnover that results in bigger but softer bones

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4
Q

What is Osteogenesis Imperfecta?

A

congenital and inherited brittle bone disease

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5
Q

What are risk factors for a pathological hip fx?

A

vary based on the above etiologies

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6
Q

What is the incidence/prevalence of pathogenic hip fx?

A

VARIES… but
- Mostly older
- European Americans

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7
Q

What is the pathogenesis of a pathological hip fx?

A

gradual weakening of bone resulting in fracture

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8
Q

What are some clinical manifestations of a pathological hip fx?

A

Fx S&S plus:
- Painful snap and possible giving way
- Groin and possibly anteromedial thigh P! and to the knee and lateral hip
- Increased: WBing
- Decreased: Non-WBing

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9
Q

What will we observe in a patient with a pathological hip fracture?

A

Shortened and excessively externally rotated LE due to displacement and pull of ERs, respectively
- Antalgic and asymmetrical gait

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10
Q

What will we find in ROM for a pathologcial hip fracture?

A

several limitations but particularly IR limitation

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11
Q

What special tests will be positive for a pathological hip fx?

A

(+) Patellar-pubic percussion
- Possible sign of the buttock

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12
Q

What is sign of the buttock?

A

collection of signs indicating a serious pathology

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13
Q

What is the etiology of sign of the buttock?

A
  • Fracture
  • Tumor
  • Infection
  • Hematoma
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14
Q

What will we find in the hx in someone with sign of the buttock?

A

possible cancer, infection, or fracture S&S

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15
Q

What will we observe with sign of the buttock?

A

gluteal swelling

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16
Q

What will we find with ROM in someone with sign of the buttock?

A
  • Hip flx limitation the same no matter knee position with empty end feels
  • Same degree of trunk flexion limitation in relation to femur and trunk position
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17
Q

What will we find with resisted testing with sign of the buttock?

A

weak and painful glutes

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18
Q

What kind of referral is sign of the buttock?

A

Urgent referral to MD but emergent if fracture due to possible displacement and
vascular compromise

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19
Q

What are the PT implications of a pathological hip fx?

A

Significant morbidity, mortality, and health issues arise from resulting sedentary
situation

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20
Q

When should people be having a DEXA scan?

A

 Biological women at 65 yrs.
 Biological men at 70 yrs

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21
Q

What kind of referral is a pathological hip fx?

A

Immobilize with emergent referral due to possible displacement and potential vascular compromise

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22
Q

What is osteonecrosis also known as?

A

aka avascular necrosis or AVN of the femoral head

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23
Q

What is the incidence/prevalence of osteonecrosis?

A
  • May be bilateral in 60% of cases
  • Older > younger individuals
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24
Q

What is the etiology and risk factors for osteonecrosis?

A

insufficient arterial supply to femoral head

associated with:
- Trauma
- Fx/dislocation
- Slipped femoral epiphysis or growth plate

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25
Q

Where does the ligamentum teres attach proximally and distally?

A
  • Proximally in acetabulum
  • Distally in fovea of the femoral head
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26
Q

What artery does the ligamentum teres contain to supply the head of the femur?

A

Medial epiphyseal a. to supply
head of femur

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27
Q

What other arteries aside from the medial epiphyseal artery supply the femoral head?

A

Femoral head also supplied by
medial and lateral circumflex aa.

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28
Q

What is the etiology of osteonecrosis?

A

Insufficient arterial supply to femoral head

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29
Q

What are some risk factors of osteonecrosis?

A
  • Vascular abnormalities
  • Toxicity i.e., radiation, smoking, alcoholism
  • Sickle cell disease with a shortage of healthy oxygen carrying RBCs
  • Chronic corticosteroid and oral contraceptive use
  • Bone marrow pathology
  • Metabolic syndrome
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30
Q

Is osteonecrosis gradual or sudden onset?

A

gradual

31
Q

What is the pathogenesis of osteonecrosis?

A
  • Ischemia leading to death of bony tissue
  • Rapid progression to Age-related Joint Changes
  • May involve labral tears
32
Q

what will we find in the hx of patients with osteonecrosis?

A
  • Groin and possibly anteromedial thigh P! and to the knee
  • Intermittent but worsening with gradually and unknown
  • Even occurring at rest due to ischemia
33
Q

What will we observe with osteonecrosis?

A

antalgic and asymmetrical gait

34
Q

What will we find with ROM of those with osteonecrosis?

A

ROM- limited IR, abduction, and flexion due to greater bony contact

35
Q

What other condition S&S will be present with osteonecrosis?

A

Age-related Joint Change S&S

36
Q

What is the referral of osteonecrosis if gradual onset??

A

Urgent referral to MD if gradual onset

37
Q

If patient with osteonecrosis is referred to PT how do we proceed?

A

if referred for PT proceed with caution

38
Q

What kind of PT measures can we do with those with osteonecrosis?

A
  • Gait training with an assistive device is often necessary to protect the femur
  • PT directed primarily at protection motion, improving circulation, and for bone and cartilage integrity; like age-related joint change Rx
39
Q

What may happen with those with osteonecrosis?

A

May end up having a Hemi-arthroplasty or possibly a THA

40
Q

What is Legg-Calve-Perthes?

A
  • aka as coxa plana or flat hip
  • AVN of the femoral head in children
41
Q

What is the etiology of Legg-Calve-Perthes?

A
  • Trauma
  • Exposure to 2nd hand smoke
  • Prenatal factors, i.e., genetics, endocrine, nutritional, or socioeconomic conditions
  • Developmental dysfunction of bone or vasculature
42
Q

What population is Legg-Calve-Perthes MOST common in?

A

MOST common in 5-8 yr. old Caucasian biological boys

43
Q

What is the pathogenesis of Legg-Calve-Perthes?

A

impaired vascular supply to epiphyses (med/lat circumflex aa) that changes shape of the femoral head and acetabulum

44
Q

What are PT clinical manifestations of Legg-Calve-Pethes?

A
  • Vary in magnitude
  • Gradual and unknown onset primarily
  • If P!ful, groin and possibly anteromedial thigh P! and to the knee
  • Increased with activity
  • Decreased with rest
45
Q

Is Legg-Calve-Perthes gradual or sudden onset?

A

gradual and unknown

46
Q

What will we observe with Legg-Calve-Perthes?

A
  • Antalgic and asymmetrical gait
  • Muscle atrophy if long standing
47
Q

What will we find in ROM with Legg-Calve-Perthes?

A

limited IR and aBd due to greater bony
contact

48
Q

What is the referral with Legg-Calve-Perthes?

A

A long-term problem
- Urgent referral to MD if gradual
- Emergency referral to MD if trauma
- If referred for PT proceed with caution

49
Q

How can we treat Legg-Calve-Perthes with PT?

A
  • PT directed primarily at protected motion, improving circulation, and for bone and cartilage integrity
  • Periodically, splinted, braced, or casted in slight abducted position
  • Better femoral head contact with acetabulum
  • Maintain and help better form femoral head in acetabulum as healing can occur
50
Q

Why can we do gait training with Legg-Calve-Perthes?

A

Gait training with an assistive device is often necessary to protect the femoral neck

51
Q

What is a complication with Legg-Calve-Perthes?

A

Complication: prone to contractures

52
Q

What should we know about Legg-Calve-Pethes and Age related Joint changes?

A

Possible age-related joint change in early adulthood and 50% will develop age
related joint disease before 50 yrs. of age

53
Q

What will MOST with Legg-Calve-Perthes need? What can happen earlier due to gait dysfunction?

A

MOST will need corrective surgery and/or early total hip arthroplasty
- Earlier LB and knee P! development in life due to gait dysfunction
- Kids tend to keep moving
- Adults tend to reduce activity

54
Q

What is slipped capital epiphysis?

A

Anterior displacement of femoral neck on femoral head
- aka adolescent coxa vara
- MOST significant epiphyseal plate disorder of the LE

55
Q

What is the etiology of slipped capital epiphysis?

A
  • Mostly idiopathic
  • Association with endocrine and renal disorders and Down Syndrome
  • Hypothyroidism is MOST common
56
Q

What do the risk factors for slipped capital epiphysis?

A
  • create increased shear forces across epiphyseal plate
  • Single MOST significant risk factor is obesity
  • Biological male, rapid growth, radiation therapy, and femoral torsion
57
Q

What is the incidence/prevalence of slipped capital epiphysis?

A

create increased shear forces across epiphyseal plate
- Single MOST significant risk factor is obesity
- Biological male, rapid growth, radiation therapy, and femoral torsion

58
Q

What is the pathogenesis of slipped capital epiphysis?

A
  • progressive displacement of femoral neck relative to the head through
    the growth plate due to shear forces and/or weakened epiphyseal plate
59
Q

How does slipped capital epiphysis come on?

A
  • more likely gradual and unknown onset than trauma, but may seem benign like rolling in bed
60
Q

What is the main complaint with slipped capital epiphysis?

A

groin and possibly anterolateral thigh pain and to the knee

61
Q

What will we observe with slipped capital epiphysis?

A
  • antalgic and asymmetrical
  • externally rotated hip
  • muscle atrophy if long standing
62
Q

What will we find in ROM with slipped capital epiphysis?

A
  • limited IR, abduction and flexion
  • obligatory ER during flexion
63
Q

What else can come along with slipped capital epiphysis? (other condition)

A

Possible sign of the buttock

64
Q

When should a slipped capital epiphysis always be considered?

A

in peri-adolescent with atraumatic hip pain, particularly if associated with antalgic gait

65
Q

What kind of referral is slipped capital epiphysis?

A

urgent referral to MD

66
Q

What should we do if a patient with slipped capital epiphysis is referred to pt?

A

proceed with caution

67
Q

How big can the slip be with a slipped capital epiphysis to still be referred to PT?

A

< 1 cm

68
Q

What will the patient be doing when non WB when referred to PT with slipped capital epiphysis?

A

splinted in an abducted position with non-WB

69
Q

What can we do with a patient referred to PT with slipped capital epiphysis do post -splinting?

A
  • gait training with an AD is often necessary to protect the femoral neck
  • PT directed primarily at protected motion, improving circulation and for bone and cartilage integrity
70
Q

When is surgery required with a slipped capital epiphysis?

A

if slip > 1 cm

71
Q

Why do we need surgery with a larger slipped capital epiphysis?

A

to avoid AVN or chrondrolysis (rapid loss of articular cartilage)

72
Q

What are S&S of vascular insufficiency?

A
  • coldness
  • pale, blueish discoloration
  • diminished pulses
  • impaired capillary refill with nail bed recovery
  • shiny skin
  • hair loss
73
Q

What are PT implications of a vascular insufficiency? How is it different with different types of onset?

A
  • urgent referral with gradual onset
  • emergency referral with acute onset

clin med - spring exam 2 (4 decks)

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