Pelvis Hip and Thigh Injuries Flashcards
what is a leg-calve-perthes
AVN of the femoral head
MOI of leg-calve perthes
unknown etiology
history of leg-calve-perthes
-usually children ages 4-10 with 4:1 males, 20% bio -pain in groin, thigh or knee -insidious onset usually with a limp
what will be found on physical examination of a leg-calve-perthes
- no internal or external hip rotation
- pain with motion
- hip or knee/thigh pain
what type of gait will be seen with a leg-calve-perthes
Trendelenburg gait
radiographs of a leg-calve-perthes will show what
-increased radio density (sclerotic changes)
what is the treatment of leg-calves perthes
- conservative with rest, crutches, PT
- containment of head in acetabulum with casting or bracing
- surgery in severe cases of Ped. Ortho
what is the history of a slipped capital femoral epiphysis (SCFE)
- children usually male ages 10-14, rapidly growing -bilateral 50% of the time
- insidious onset with hip, groin, thigh, knee pain
- obese male, delayed development usually
what will be found on physical exam of a slipped capital femoral epiphysis
- spasms, synovitis, reduced ROM
- observe external rotation with hip flexion
what is the treatment for a slipped capital femoral epiphysis
surgical reduction
- major difference btwn LCP
what history is common with Trochanteric Bursitis
- tight IT band
- runner with trochanteric pain during flexion and extension (increased with coxa varum)
what is the MOI of Trochanteric Bursitis
- commonly the result of overuse rather than direct trauma
- pain may radiate to the groin or in approximately 1/3 of patients, pain will radiate into the lateral thigh
what is evident upon PE of trochanteric bursitis
- while lying down on the unaffected side, leg extended have pt flex hip
- produces an aching pain over the lateral hip that is exacerbated by activity such as prolonged standing lying on the ipsilateral side, stair climbing, or running
- pain is reproduced w/ external rotation and abduction and by resisted abduction
- ITB tightness may be present
what test is positive in a trochanteric bursitis
ober test
what is the ober test
- the patient lies in the decubitus position with the affected leg up
- the examiner lowers the knee to the table to assess for IT band tightness
what is the treatment of Trochanteric Bursitis
- modify activity: do not flex/extend hip and less varus tension
- IT band stretching
- steroid injection
- evaluate for other causes if conservative tx fails
Paulska states that bursitis is due to
repetitive activity or acute trauma, may affect the trochanteric, ischial or iliopectineal bursar
who does avulsion hip fractures occur in
-rapidly growing adolescent males -mm. stronger than growth plates
injury to the iliac crest is what type of fracture
avulsion fracture
what muscles originate off the ASIS
TFL
Sartorius
what muscles originate off the AIIS
rectus femoris
what type of contracture can cause an avulsion fracture
ballistic loading with eccentric contracture
what is the cause/diagnosis of avulsion hip fracture
muscle strain or contusion
what is the treatment of avulsion hip fractures
- PRICE -crutch ambulation
- stretch and strengthening after 2 weeks
- return to activity with return of strength and function
what is a common history found in avulsion fractures (ASIS)
- a sudden contraction of the sartorius
- forced contraction with knee flexed and hip extended (eg. before a kick-falls)
- anterior lateral thigh parasthesias
what will be found during PE of Avulsion Hip Fracture at ASIS
- P.O.P @ ASIS
- localized tenderness and/or swelling is noted and flexion and abduction of the tigh provokes symptoms
- pain against hip flexion with knee extension
what do radiographs reveal for an avulsion hip fracture (ASIS)
- displacement of the ASIS is note
- marked displacement is rare
what history is common for an avulsion hip fracture at the AIIS
-forced contraction “kicking” -groin pain
what is found on PE for an avulsion fracture at the AIIS
-P.O.P -pain against hip flexion with knee extension
what is the MOI of an avulsion hip fractures at the AIIS
- occurs after contraction of the rectus femoris with vigorous kicking
- examination reveals local tenderness and swelling in the region of the AIIS and exacerbation with active flexion
ischial tuberosity fracture is common in what type of athlete
hurdlers
what history is common in an ischial tuberosity fracture
-stron hamstring contraction with hip flexed and knee extended
*suddent pain in buttocks “can’t go on”
-common in hurdlers
the ischial apophysis is the origin of the
-hamstrings and adductor magnus
what is the MOI for an ischial tuberosity fracture
- is a vigorous hamstring contraction with the hip flexed and the knee extended
- in runners, this injury occurs most often in hurdlers
what is found upon PE on an ischial tuberosity fracture
- hip flexion with the knee extended will reproduce symptoms; thus, the presentation and examination are similar to a hamstring strain in an adult
- P.O.P
- pain with straight leg raise and resisted knee flexion
what history is present with hamstring strain
- occurs often in baseball and track -tight, poor warm-up, fatigue
- fast contraction, extension of the knee
what is found upon PE of a hamstring strain
- pain with resisted knee flexion (use of hams against resistance)
- P.O.P muscle belly
- visible or palpable knot
what is the treatment for hamstring strain
- NSAIDS
- PRICE
- weight bearing so tolerated (bc can’t sit so they use crutch)
- E-stim
- stretching bilateral
- pool running
- strengthening
- isokinetic
what history is present with piriformis syndrome
- Benchwarmer’s syndrome
- trauma, prolong sitting, overuse
- dull ache in mid-buttocks -pain walking up stairs
- pain from either swelling or compression sciatic
piriformis syndrome may have what type of gait
Trendelenburg gait
what is a major cause of iliopsoas tendonitis/bursitis
-acute trauma and overuse resulting from repetitive hip flexion
what history is present in iliopsoas tendonitis/bursitis
- groin pain worse with activity
- “snapping” with hip flexion
what is found on PE of iliopsoas tendonitis/bursitis
- pain with resisted hip flexion
- P.O.P over pubic ramus lateral to neuro vascular bundle (NVB)
what is the treatment for iliopsoas tendonitis/bursitis
- steroids - injection, oral steroids
- NSAIDs: naproxin, Naprosin, anaprox, ibuprofen, Lodine -modify activities -strengthening and stretching exersisess
- E stim: galvanics, NNMS, MMES
