The Hip Flashcards
What are the common red flags to look out for when doing a hip assessment
Loosening/infection of hip arthroplasty
Slipped capital femoral epiphysis
AVN of femoral head
Femoral aneurysm
Red flag: Loosening/infection of hip arthroplasty (s+s)
- Red, hot swollen joint/wound
- Feeling generally unwell- fever, chills, night sweats
- Pus/fluid from incision
- Signs of sepsis
- Fatigue
- New onset of hip pain/stiffness
- Feeling of instability
Red flag: Slipped Capital Femoral Epiphysis (children) (S+s)
- New onset hip/groin pain
- Deformity - shortening/externally rotated joint
- Decreased range of movement at joint
- Unable to stand on one leg
Red flag: AVN Femoral head (S+S)
- Pain which increases over time
- Stiffness in joint
Red flag: Femoral Aneurysm (S+S)
- Pulsatile mass in the groin
- Pale
- Pain
- Pallor
- Paraesthesia
- Pedal pulses (pulse of dorsum of foot)- reduced or absent
- Blue toes
OA of the hip: pathophysiology and risk factors
- Degenerative joint disease of inflammation of the hip joint. When cartilage or other tissues about the joint have been broken down or theres structural change.
It can be idiopathic or secondary
Risks:
Increasing age
Females >
Obesity
Genetics
Joint Dysplasia
Occupations (involving heavy manual work)
High impact sports
Signs and symptoms of hip OA
-Groin, hip, buttock and anterior thigh pain
-Gradual onset
-Worsen over time with pain, stiffness and restricted movement
-Locking or sticking within the hip joint
-Night pain
-Stiffness in morning and present after periods of rest and usually lasts for less than 30 mins
-Aggr: walking, putting shoes on, getting up after sitting, bending, prolonged inactivity, getting in and out of the car, prolonged physical activity
How would someone with OA hip present on physical examination?
- Antalgic gait
-Pain on hip joint movement
-Restricted hip joint ROM particularly in a capsular pattern (flexion, internal rotation and abduction)
-Reduced muscles strength surrounding the hip
-Positive trendelenberg in some cases
-Presence of crepitus but not always
Management of OA hip
- Education on OA, symptom management and self management
- Advise on life style modifications (avoid repetitive movements and ensure breaks between aggravating activities)
- Direct to GP for NSAID
- Physio: manual therapy, mobility, strengthening, gait re-education and proprioceptive exercise
- Consider provision of walking aids if required
- Possible Corticosteroid injection
If persistent and meeting CCG criteria (BMI <35) consider ortho referral for surgery
Greater trochanteric pain syndrome: pathophysiology and risk factors
Is a condition diagnosed with lateral hip pain including trochanteric bursitis associated with a tendinopathy of glute medius or minimus and tears of these tendons* mention cook and purnam continuum*
Risks:
- Female
- 40-60
- sedentary lifestyles and also athletic population
- runners
Signs and symptoms of GTPS
-Pain on palpation of greater trochanter
-Lateral hip, thigh and buttock pain
-Gradual onset, can progressively worsen over time
-Symptoms can follow a significant increase in activity
-Pain can radiate down the lateral thigh to knee
-Aggr: walking (antalgic gait), crossing legs, lying on affected hip, prolonged standing (leaning on affected leg)
- Potential positive Trendelenberg
Any special tests for GTPS?
No specific special tests but a collection of movements can increase suspicion
- Single leg stance
- Hip flexion, abduction, external rotation
- In adducted position, resist abduction
Management of GTPS
- Education of condition, symptom management and self management
- Advise lifestyle modifications (avoid leg crossing, sleeping on side with leg adducted, leaning on one hip, breaks from aggr factors)
- Direct to GP for NSAIDs
- Offer weight loss and smoking cessation advice, Offer walking aids
If no improvement: - Physio to strengthen (particularly glutes) and functional movements e.g gait
- Corticosteriod injections or shockwave therapy. Exercise is more beneficial for global improvement than CSI
- Worse case surgery
Research: science direct
Hip Labral Pathology and Femoroacetabular Impingement (FAI): Pathophysiology and risk factors
FAI Is a term used to described an abnormal contact between the femoral head/neck and the acetabular rim.
3 Types:
CAM, Pincer and Mixed
- Most common cause for labral pathology in the hip
Risks:
- Repetitive athletic activity
- Genetics
- Hip dysplasia
- Cam more common in men Pincer more common in women
Signs and symptoms of FAI and labral pathology:
- Movement or position related hip or groin pain particularly into flexion and adduction positions
- Pain pattern commonly follows a ‘C sign’ pattern (C-shaped pain pattern from the groin, around the lateral aspect of hip towards the buttock
- Patients will commonly describe a deep anterior groin pain
-Descriptions of: Clicking, Catching, Locking, Stiffness, Restricted ROM, Giving way
