Test 2: Pathologies related to Pelvis and Hip Flashcards
what area is most likely to have a pathological hip fx
proximal femur
particularly the neck
due to disease
etiology of pathological hip fx
conditions with compromised bone (osteoporosis, osteopenia, osteogenesis imperecta, paget’s disease, tumors, etc)
may or may not involve fall
what is osteogenesis Imperfecta
congenital and inherited brittle bone disease
what is paget’s disease
chronic bone disorder
abnormal bone turn over that results in bigger but softer bones
incidence/prevalence of pathological hip fx
varies based on etiology BUT mostly older and European Americans
Hx of those with patgological hip fx
Fx S&S
painful snap
groin/anteromedial thigh pain to knee and lateral hip
pain increased in WB
observation of those with pathological hip fx
shortened and excessively externally rotated LE due to displacement and pull of ERs
antalgic and asymmetrical gait
ROM and special test findings for pathological hip fx
ROM: several limits but especially IR limits
special tests: + patellar pubic percussion
what is sign of the buttock
collection of signs indicating a serious pathology
etiology (hx of) = fracture, tumor, infection, hematoma
obs = gluteal swelling
Rst= weak/painful glutes
ROM= hip flex limitation same no matter knee position with empty end feels; same degree of trunk limit in relation to femur and trunk position
sign of buttock referral
urgent to MD BUT emergent if fx due to possible displacement and/or vascular compromise
PT implications for pathological hip fx
significant morbidity, mortality, and health issues arise form resulting sedentary situation
ensure pts have had DEXA scan (F 65, M 70)
don’t want to miss
referral for pathological hip fx
immobilize with emergent referral due to possible placement and potential vascular compromise
what is osteonecrosis, what % of cases are bilateral and what age group is most prone
aka avascular necrosis or AVN of femoral head
may be bilateral in 60% of cases
Older > younger individuals
etiology and risk factors of AVN
insufficient arterial supply to femoral head associated with trauma, fx, dislocation, slipped epiphysis, etc
how is ligamentum teres involved with AVN
intracapsular ligament
attaches to the acetabulum and distally to the fovea of the femoral head
contains medial epiphyseal a supply to head of femur as well as plays a support role
femoral head also supplied by medial and lateral circumflex arteries…
osteonecrosis is insufficient arterial supply to femoral head associated with gradual onset with…
vascular abnormalities
toxicity
sickle cell disease (shortage of healthy oxygen +RBCs)
chronic corticosteroid and oral contraceptive use
bone marrow pathology
metabolic syndrome
pathogenesis of osteonecrosis
ischemica leading to death of bony tissue
rapid progression to ARJC
may involve labral tears
PT implications for osteonecrosis
Hx to note:
-groin/anteromedial thigh pain to thigh/knee
-sudden with trauma
-possible sign of buttock
-intermittent/worsening with gradual/unknown onset
observation: antalgic/asymmetrical gait
possible ARJC S&S; however hx has different components to pay attention to
what is legg-calve-perthes
aka coxa plana or flat hip
AVN of femoral head in children
referral for osteonecrosis
urgent
possibly emergent
etiology of Legg Calve Perthes
trauma
exposure to 2nd hand smoke
prenatal factors such as genetics, endocrine, nutritional, or socioeconomic conditions
developmental dysfunction of bone or vasculature
incidence/prevalence of Legg Calve Perthes
most common in 5-8 year old caucasian boys
pathogenesis of Legg Calve Perthes
impaired vascular supply to epiphyses that changes the shape of the femoral head and acetabulum
PT S&S/observation for Legg Calve Perthes
S&S vary in magnitude
gradual/unknown onset
antalgic and symmetrical gait
pain increased with activity (usually in groin, anteromedial thigh, to the knee)
possibly hip muscle atrophy
limited IR and ABD
PT referral for Legg Calve Perthes
long term problem
urgent MD referral
if a pt with Legg Calve Perthes is referred to PT what should you keep in mind
proceed with caution
gait training with assisted devices is often necessary to protect femoral neck
PT directed primarily at protected motion, or casted in ABD position
periodically splinted, braced or casted in abducted position to allow better femoral head contact and or maintain/help form femoral head
casting makes pt prone to contractures
