screening of the hip Flashcards

1
Q

Suspicious Examination Findings - Symptoms

A

acute hip pain with fever
night sweats
night pain
symptoms unchanged by movement or position
symptoms related to period

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2
Q

Suspicious Examination Findings - potential causes

A

tumor
infection
Septic arthritis
osteomyelitis
endometriosis

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3
Q

Corticosteroid use has been reported in cases of

A

avascular necrosis (AVN) and fracture occurring at the hip joint

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4
Q

AVA direct causes

A

fracture of dislocation
radiation
SCFE
sickle cell disease

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5
Q

AVA indirect causes

A

corticosteroid use
chronic alc
autoimmune disease
smoking history

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6
Q

AVN pathogenesis​ in the hip

A

decrease blood flow to the proximal femur which can lead to structural failure and collapse​

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7
Q

AVN clinical presentation

A

Primary pain distribution: groin > buttock > lateral thigh
Secondary/referred pain: knee > anterior thigh > lower leg

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8
Q

Clinical Testing for AVN

A

Lack of tests with high sensitivity

Tests with high specificity
<15 degrees hip extension (0.92)
< 60 degrees hip ER (0.73)
Pain with IR (0.86)

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9
Q

what is Breach birth

A

feet first position for birth

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10
Q

Breach birth issues

A

high association with dysplastic hips

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11
Q

Childhood Disorders for the hip

A

Developmental Dysplasia of the Hip
Legg Calve Perthes Disease
Slipped Capital Epiphysis

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12
Q

Legg Calve Perthes Disease

A

a childhood condition that occurs when the ​blood supply to femoral head of the hip joint is temporarily interrupted and the bone begins to die

the compromised bone may deform

4-10

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13
Q

Slipped Capital Epiphysis

A

occurs when there is a slippage of the proximal epi on the meta
treatment is often conservative

8- 15

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14
Q

hip dysplasia in younger adults

A

is often due to residue childhood and teenaged onset dysplasia

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15
Q

what we are looking for in a Pelvic Screen – History

A

Bowel issues
Bladder-related changes
Pregnancy and birth history.
Psychosocial and mood disorder history
Fear-avoidance characteristics

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16
Q

Fear-avoidance characteristics

A

avoidance of movements or activities based on the fear of increased pain or re-injury.

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17
Q

what is included in the Screening of the Lumbosacral Spine

A

Pelvic landmark palpation
Lumbar AROM Testing
Sensory
Motor exam
Special Tests

  • Determine if spine is primary or contributing factor
18
Q

Screening of the Lumbosacral Spine

A

Prone Instability Test
Thigh Thrust Test

19
Q

Prone Instability Test

A

Presence of lumbar instability

SN = 72%, SP = 58%

20
Q

Thigh Thrust Test

A

Sacroiliac joint irritability

Cluster of findings more useful for SIJ dysfunction

21
Q

Lumbosacral Spine - Neural Tension Tests

A

SLR
active slump
prone knee flexion

22
Q

Stress Fractures in the hip description

A

Mechanically induced fracture of the proximal femur or pelvis

Repetitive overload that overcomes normal structural properties
Example: overtraining, rapid volume increase

Loading that overcomes compromised structural properties
Example: fracture occurring with osteopenia

23
Q

Differential Diagnoses with stress fracture in the hip

A

Acetabular labral tear
Hip flexor strain
Hip adductor strain
Iliopsoas bursitis
Osteochondral lesion
Hip OA

24
Q

Osteochondral lesion

A

lesions are a tear or fracture in the cartilage covering one of the bones in a joint

25
types of stress fractures
Compression sided Tension sided
26
Compression sided stress fracture in the hip
Inferior region of femoral neck Conservative management
27
Tension sided stress fracture in the hip
Pulled apart – tension Superior region of femoral neck ORIF - surgery
28
Stress Fractures – Clinical Presentation pain
Groin & anterior thigh most common Potential for lateral thigh and more rarely in gluteal region Potential for medial knee pain Often reproducible with end-range IR and overpressure (motion more limited in proximal/neck region) May be reproducible with SLR or MMT for flexion and/or abduction
29
Stress Fractures – Clinical Presentation functional
Initially occurs as pain during or after strenuous activity (running) Progresses to affect lower level activity (walking) In acute stages, can be painful at rest or at night
30
Clinical Tests for a ​stress fracture
Patellar-pubic Percussion Test (femoral neck) - he has not had luck with this test
31
Patellar-Pubic Percussion Test procedure
Patient in supine position Stethoscope placed over pubic tubercle Clinician listens through stethoscope as they tap the ipsilateral patella
32
Patellar-Pubic Percussion Test interpretation
Lack of sound propagation may indicate fracture No noise: the fracture is stopping the sound from transmitting
33
Stress fracture​ diagnostic imaging
Plain Radiography (AP, frog-lateral) Bone scan MRI
34
stress fracture Plain Radiography (AP, frog-lateral)
Rule out other conditions (OA, tumor, etc.) Examine for displacement
35
Stress Fracture Bone scan
Demonstrates increased focal uptake of radiotracer at site of fracture (“hot spot”) May read negative for first 24 hours after occurrence development
36
Stress fracture MRI
Ideal in sensitive and specificity Yields information about surrounding tissue (differential diagnoses)
37
FABER Test Interpretation
felx, ABD, ER: joint screen Normal: equal ROM bilaterally with no symptom reproduction Abnormal: ask where the pain is Anterior/Inguinal pain: potential hip pathology Posterior pain: may indicate potential SI joint dysfunction
38
Scour Test
joint screen Normal: no interruption of motion, no pain Abnormal: pain/discomfort, grating sensation, crepitis-like sound. This may indicate degenerative changes
39
what is a screen test used for
Screening test – not that specific just testing to see if the pain is originating from the hip
40
what is a screen test used for
Screening test – not that specific just testing to see if the pain is originating from the hip