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Sem 2 - MSK > The Hip > Flashcards

The Hip Flashcards

1
Q

What does the hip joint consist of?

A

Ball (femoral head)

Socket (acetabulum hip bone)

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2
Q

What are some properties of the hip joint?

A
  • Late range of movement
  • Strong joint
    • takes a lot to disrupt
    • very stable joint
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3
Q

What bones is the hip bone formed from?

A

It is formed by the fusion of three bones.

  • Ilium
  • Ischium
  • Pubis

These are separated by a tri-radiate cartilage.

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4
Q

When do the hip bones fuse?

A

The Ilium, Ishium and the Pubis start to fuse at 15-17 years old.

Fusion is complete by 20-25 years old.

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5
Q

What is the acetabulum?

A

This is the socket of the joint.

It is where the hip bones converge.

The margin of the acetabulum is incomplete inferiorly resulting the acetabular notch.

This notch is covered in the transverse acetabular ligament (continuous with the acetabular labrum) which serves to deepen the socket in which the acetabulum articulates.

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6
Q

What strengthens the hip joint?

A
  • Labrum
  • Joint capsule
  • Ligaments
  • Muscles
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7
Q

What is the acetabular labrum?

A

It is a fibrocartilaginous rim attatched to margin of acetabulum.

It increases the articular contact area by 10%

-This means that more than 50% of the head of the femur fits in.

The transverse acetabular ligament strengthens inferior portion of acetabulum. This is where the acetabulular notch is.

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8
Q

What is the joint capsule (fibrous)?

A
  • It attatches anteriorly at the intertrochanteric line.
  • Capsular fibres take a spiral course.
    • In extension capsule helps pull femoral head into acetabulum.
  • The lateral part of neck is extra-capsular on the posterior side.
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9
Q

What are the joint ligaments?

A

The capsule is strengthened by three strong ligaments:

  • Illiofemorral
  • Pubofemoral
  • Ischiofemoral

Accessory ligaments:

  • Ligament of head of femur
  • Transverse acetabulum ligaments
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10
Q

What is the IlIiofemoral ligament?

A
  • Y shapes ligament
  • Bodies strongest ligament
  • Protects hip joint superiorly and anteriorly
  • Prevents hyperextension
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11
Q

What is the pubofemoral ligament?

A
  • Protects anteriorly and inferiorly
  • Prevents over abduction
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12
Q

What is the ischiofemoral ligament?

A
  • Weakest of the three
  • Positioned posteriorly (attached to greater trochanter)
  • Limits extension
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13
Q

What muscles flex the joint-Hip?

A

Need to cross the joint to move it!!

Flexors:

  • iliopsoas (two muses with common insertion)
  • Rectus femorus (one of quads)
  • Sartorius
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14
Q

What muscles adduct the hip joint?

A
  • Adductor Magnus
  • Adductor Brevis
  • Adductor Longus
  • Pettineus
  • Gracilius
  • Obturator externus
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15
Q

What muscles extend the hip?

A
  • Gluteus maximus
  • Long head of the bicep femoris
  • Semimebranosus
  • Senitendinosus (3 last ones are hamstrings)
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16
Q

What muscles are the hip abductors?

A
  • Gluteus medius
  • Gluteus minimus
  • Tensor fascia latae
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17
Q

Rope of the hip abductors?

A

Ensure pelvis doesn’t droop down

Keep you standing on one leg

18
Q

What muscles laterally rotate the leg?

A
  • Piriformis
  • Superior gemellus
  • Obturator internus
  • Inferior gemellus
  • Quadratus femoris
19
Q

What nerves supply the hip?

A
  • Femoral nerve (anterior)
  • Obturator nerve (inferior)
  • Superior Gluteal nerve (superior)
  • Nerve to Quadratus femoris (posterior)
20
Q

What is the blood supply to the hip joint?

A

Major source (deep femoral artery):

  • Medial circumflex femoral artery
  • Lateral circumflex femoral artery.

Minor source (adults)

  • Obturator artery (via ligament of head of femur)
21
Q

What is the Perfunder femorus?

A

A Deep branch of the femoral artery

22
Q

What occurs if theres only blood supply from ligament of the head of the femur?

A

Blood supply from ligament of the head of the femur is often not adequate if only supply.

If you get a femoral neck fracture you can tear the retinacula artery.

Results can be avascular neucrosis of the femoral head.

23
Q

What is superior gluteal nerve damage?

A

Supplies hip abductors

Damage to SGN leads to:

  • weakened abduction
  • Changes to stance phase of gait cycle
  • Trendelenburg sign.
24
Q

What is Tendelenburgs sign?

A

This is when there is damage to the superior gluteal nerve.

This results in the pelvis drooping on the unaffected side.

25
Q

What are the causes of osteoarthritis?

A

Primary:

  • Cause unknown

Secondary:

  • Obesity
  • Trauma (inc. sports and accupational risk factors)
  • Malalignment (e.g. developmental displasia)
  • Infection (e.g. septic arthritis, TB)
  • Inflammatory arthritis (e.g. RA)
  • Metabolic disorders affecting the joints (e.g. gout)
  • Haemotalogical disorders (e.g. haemophilia with bleeding into the joints)
  • Endocrine abnormalities (e.g. diabetes with neurovascular impairment)
26
Q

What are the risk factors of osteoarthritis?

A
  • Age
  • Sex (female > males)
  • Ethnicity
  • Nutrition
  • Genetics (OA runs in families)
27
Q

What is the pathology of osteoarthritis?

A

The hyaline cartilage covering the articular surface becomes swollen due to increased proteoglycan synthesis by chondrocytes. This is an attempt to repair the cartilage damage and can last for several years.

As the disease progresses, the level of proteoglycans falls, causing the cartilage to soften and lose elasticity.

Microscopically, flaking and fibrillations (vertical clefts) develop along the normally smooth articular surface.

Over time, the cartilage becomes eroded down to the subchondral bone, resulting in loss of joint space.

28
Q

What do altered joint biomechanics lead to?

A

-Vascular invasion and increased cellurarity of subchondral bone causes it to become thickened and dense at areas of pressure.

(subchondral sclerosis). This process is known as eburnation.

  • Cystic degeneration of bone (subchondral bone cysts)
  • Osseous metaplasia of connective tissue (osteophytes)
29
Q

What are the symptoms of osteoarthritis of the hip?

A
  • Joint stiffness that occurs getting out of bed or when sitting for a long time.
  • PAIN, swelling or tenderness in the hip joint
  • Crepitus: a sound or feeling (crunching) of bone rubbing against bone
  • Reduced ability to move the hip performing routine activities such as putting on socks, getting in and out of car / bath ect..
  • Pain in the hip, gluteal and groin regions radiating to the knee (via the obturator nerve)
  • Mechanical pain (pain accentuated by mobilisation or weight bearing)

OA hip is diagnosed on clinical presentation (symptoms and signs) supported by radiography (x-rays)

30
Q

What are the four signs cardinal signs of osteoarthritis on an x-ray?

A
  • Reduced joint space
  • Subchondral sclerosis
  • Bone cysts
  • Osteophytes
31
Q

How could you manage osteoarthritis without an operation?

A
  • Activity modification
  • Weight loss (6 times their weight goes through their hip joint)
  • Stick / walker
  • Physiotherapy
  • Medications:
    • NSAIDs (naproxen, ibuprofen)
    • COX-2 inhibitors (celecoxib)
    • Nutritional supplements (glucosamine) - works for 1 in 3
    • Normal painkillers
  • Injections:
    • Corticosteroids
    • Viscosupplementation
32
Q

Give an overview of treatment for osteoarthritis

A
33
Q

What is a total hip peplacement?

A

Replace the damaged cartilage of the hip.

It helps relive pain and restore mobility.

34
Q

Why are hip fractures serious?

A

The number of hip fractures is increasing year on year and consequences are serious.

35
Q

What are the classifications of hip fracture? Why is this important?

A

NOF are classified as:

Intracapsular (which is further divided into subcapital and transcervical)

Extracapsular (which is further divided into intertrochanteric and subtrochanteric)

This classification is extremely important as the site of the fracture has implications for remaining blood supply, and therefore the viability, of the femoral head.

Intracapsular fractures are likely to disrupt the ascending cervical (retinacular) branches of the MFCA. Due to the inability of the artery of the ligamentum teres to sustain the metabolic demand of the femoral head, there is a high risk of avascular necrosis of the bone. This risk is increased if the fracture is displaced.

With extracapsular fractures, the retinacular arterial supply to the femoral head is likely to remain intact.

36
Q

Upon examination, what will be seen if there is a fractured neck of the femur?

A

On examination, the affected leg is shortened, abducted, and externally rotated. There is exacerbation of pain on palpation of the greater trochanter and pain is exacerbated by rotation of the hip.

Patient safety: If you have a suspicion that the hip is fractured, you should avoid vigorous examination as there is a risk of displacing the fracture.

37
Q

What are the symptoms of the fracture of neck of femur?

A

Reduced mobility / sudden innability to bear weight on the limb.

Pain which may be felt in the hip, groin and/or knee.

38
Q

When does avascular neurcrosis of hip occcur?

A
  • Mechanical disruption (Fractured neck of femur - Intracapsular)
  • Alcoholism
  • Excessive steroid use
  • Post trauma injury
  • Thrombosis
  • Hypertension
39
Q

What type of hip dislocation is most common? What is shown upon phyical examination?

A

Posterior dislocation in 90% of cases.

Physical examination:

  • Shortened (gluteus maximum, hamstrings, adductors)
  • Internally rotated (anterior fibres of gluteus medius and minimus)
  • Adducted
  • Flexed

Sciatic nerve paralysis in 8-20% of cases

40
Q

What would be seen in anterior dislocation of thr hip?

A
  • Externally rotated
  • Abducted
  • Slightly flexed

Rarely causes damage to the femoral nerve

41
Q

What is a central dislocation of the hip?

A
  • Always a fracture dislocation
  • Femoral head palpable per rectum
  • Intrapelvic is haemorrhage.

Sem 2 - MSK (22 decks)

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