Test 2: Pathologies related to Pelvis and Hip

Question 1

what area is most likely to have a pathological hip fx

Answer 1

proximal femur

particularly the neck

due to disease

Question 2

etiology of pathological hip fx

Answer 2

conditions with compromised bone (osteoporosis, osteopenia, osteogenesis imperecta, paget’s disease, tumors, etc)

may or may not involve fall

Question 3

what is osteogenesis Imperfecta

Answer 3

congenital and inherited brittle bone disease

Question 4

what is paget’s disease

Answer 4

chronic bone disorder

abnormal bone turn over that results in bigger but softer bones

Question 5

incidence/prevalence of pathological hip fx

Answer 5

varies based on etiology BUT mostly older and European Americans

Question 6

Hx of those with patgological hip fx

Answer 6

Fx S&S

painful snap

groin/anteromedial thigh pain to knee and lateral hip

pain increased in WB

Question 7

observation of those with pathological hip fx

Answer 7

shortened and excessively externally rotated LE due to displacement and pull of ERs

antalgic and asymmetrical gait

Question 8

ROM and special test findings for pathological hip fx

Answer 8

ROM: several limits but especially IR limits

special tests: + patellar pubic percussion

Question 9

what is sign of the buttock

Answer 9

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

Question 10

sign of buttock referral

Answer 10

urgent to MD BUT emergent if fx due to possible displacement and/or vascular compromise

Question 11

PT implications for pathological hip fx

Answer 11

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

Question 12

referral for pathological hip fx

Answer 12

immobilize with emergent referral due to possible placement and potential vascular compromise

Question 13

what is osteonecrosis, what % of cases are bilateral and what age group is most prone

Answer 13

aka avascular necrosis or AVN of femoral head

may be bilateral in 60% of cases

Older > younger individuals

Question 14

etiology and risk factors of AVN

Answer 14

insufficient arterial supply to femoral head associated with trauma, fx, dislocation, slipped epiphysis, etc

Question 15

how is ligamentum teres involved with AVN

Answer 15

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…

Question 16

osteonecrosis is insufficient arterial supply to femoral head associated with gradual onset with…

Answer 16

vascular abnormalities
toxicity
sickle cell disease (shortage of healthy oxygen +RBCs)
chronic corticosteroid and oral contraceptive use
bone marrow pathology
metabolic syndrome

Question 17

pathogenesis of osteonecrosis

Answer 17

ischemica leading to death of bony tissue

rapid progression to ARJC

may involve labral tears

Question 18

PT implications for osteonecrosis

Answer 18

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

Question 19

what is legg-calve-perthes

Answer 19

aka coxa plana or flat hip

AVN of femoral head in children

Question 20

referral for osteonecrosis

Answer 20

urgent

possibly emergent

Question 21

etiology of Legg Calve Perthes

Answer 21

trauma

exposure to 2nd hand smoke

prenatal factors such as genetics, endocrine, nutritional, or socioeconomic conditions

developmental dysfunction of bone or vasculature

Question 22

incidence/prevalence of Legg Calve Perthes

Answer 22

most common in 5-8 year old caucasian boys

Question 23

pathogenesis of Legg Calve Perthes

Answer 23

impaired vascular supply to epiphyses that changes the shape of the femoral head and acetabulum

Question 24

PT S&S/observation for Legg Calve Perthes

Answer 24

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

Question 25

PT referral for Legg Calve Perthes

Answer 25

long term problem

urgent MD referral

Question 26

if a pt with Legg Calve Perthes is referred to PT what should you keep in mind

Answer 26

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