S3 (hip) Flashcards
Sup gluteal nerve injury
Glut med and min (hip abductors)
Hip surgeries, injections into bum,fracture of greater trochanter, hip dislocation
When standing on injured limb, pelvis on injured side drops down Trendelenburg’s sign (NOT TEST)
Pulled hamstring
During sudden stretch of post thigh muscles esp without warmup
Results in muscle sprain, partial or complete tear of origin of hamstring from ischia tub sometimes also with avulsion of a fragment of bone
OA of hip
Joint stiffness esp after per being stationary for a while
Hip, gluteal and groin pain can radiate to knee (obturator nerve)
Mechanical pain
Crepitus (grating/crunching/crackling souhd when move joint)
Reduced mobility /difficulty
Lose weight and modify activities, waking stick/frame, improve muscle strength, orthotic footwear, NSAIDs, nutritional supplements, steroid injections into joint (reduce swelling), hyaluronic injections into joint to increase lubrication and poss cart repair
Only cure is total hip replacement (one of most common and successful operations in orthopaedics
Fractures of neck of femur (#NOF)(2 types )
Up to 5cm below lesser trochanter
Intracapsular
Extracapsular-inter and subtrochanteric
Life changing and 10% mortality after one month, 20% after a year
Reduced mobility, sudden inability to weight bear on that limb, pain in hip groin and or knee
Limb shirtened, abducted, ext rotated
Pain exacerbated by palpation of greater troch and rotation of hip (see TB for which muscles pull what where)
NOF intracapsular
Likely to disrupt ascending cervical (retinacular)branches of the med fem circumflex art (MHA)- high risk of vasc necrosis
More in elderly esp post meno women (with osteoporotic bone) usually due to minor fall
Hemiarthroplasty (fem head replaced)
Total hip replacement (head and acetabular cup)
NOF extracapsular
Retinacular art supply to fem head remains intact
More in younger and middle aged, usually in sig traumatic force eg car crash
Traumatic discolaction of hip
Head fully displaced out of acetabulum ( if not fully out-subluxation )
May be congenital (dev dysplasia-(though this isn’t always congenital) not always dislocation, can develop after birth).
May be traumatic, these are usually severe, most common in 16-40yrs in high speed car crash (needs major force to dislocate healthy hip).-v painful, won’t want to move limb at all
90% of hip dislocations are posterior-most common hitting knee on dashboard in car crash-this limb will be shortened, flexed, addicted, medically rotated (see tb for muscles why), may have sciatic nerve palsy
Ant dislocation-ext rotated, abducted, slightly flexed, poss fem nerve palsy
Central dislocation- head pushed into pelvis through acetabulum, fem head felt on rectal exam, high risk of intrapelvic haemorrhage (pelvic venous plexus) can be life threatening
