The Hip and Thigh

Question 1

name all the disorders of the hip

Answer 1

Osteoarthritis
Acetabular Labral Tears
Slipped Capital Femoral Epiphysis
Leg-Calve-Perthes Disease
Hip Dysplasia
 Avascular Necrosis (AVN at the hip)
“Snapping hip” syndrome
Trochanteric Bursitis
Hip “pointer”
Avulsion Fractures

Question 2

Hip Osteoarthritis
Population?
Causes?
Symptoms?

Answer 2

> 50 yrs

• trauma
• repetative stress
• bony abnormality
• inflammation/ infection

Symptoms:

• progressive stiffness
• AM stiffness which eases with movement
• exacerbated by weight bearing and cold weather
• presents with a capsular pattern: flexion (osseous) the Abduction (iliofemoral log) then internal rotation (ischiofemoral ligament)
• loss of flexion and IR are easiest to assess

Question 3

Acetabular labral tears 
Common in what population?
Causes?
Symptoms/ presentation?
Treatment?

Answer 3

• late childhood to adolescence
• Boys> girls

Causes
traum- ie planted foot and twisted on it
-can be gradual and progressive with hip OA

Presentation:

• sharp, deep catching pain in the groin after twisting/ slipping injury
• can be gradual and progressive
• groin pain
• audible click
• mild limitation of ROM

Treat:
-surgery if significant tear

Question 4

Slipped Capital Femoral Epiphysis
Population?
Cause?
presentation?

Answer 4

pop:
late childhood adolescence
-Boys> girls

Cause

• obesity is factor
• can occur bilaterally

presentation:
limp and decreased ROM

Question 5

Leg-Calve Perthe’s
Population?
Cause?

Answer 5

Pop:

• younger children
• Boys> girls

Cause:

• avascular necrosis of femoral head leading to collapse and fragmentation
• due to disruption of blood flow to the bony area (idiopathic-unknown)

Question 6

Hip Dysplasia
Population?
Cause?

Answer 6

-usually noted in first few months of life but can be diagnoses when they start walking

Cause: ligament laxity -from possible connective tissue disorder
-or secondary cause is that femur doesn’t have contact with acetabulum so there is no stress on bone for it to develop properly.

Question 7

Avascular Necrosis (AVN)
What is AVN?
Causes?
Presentation?
Treatment?

Answer 7

what is it?
-interruption of blood supply to bone. Femoral head schema results in death of marrow and osteocytes and usually results in collapse of the necrotic segment.

Causes:
-excessive corticosteroid use and alcohol abuse may account for 90% of new cases
-coagulation secondary to vessel wall injury (e.g. chemotherapy) or thromboembolic event
Traumatic causes:
-femoral neck fracture
-hip dislocation
-slipped capital epiphysis
-high incidence in pregnant women-cmpresses vascular structures

Presentation:

• AVN may present with nonspecific signs and symptoms
• early in disease process, the condition is painless; however, patient ultimately present with pain and limitation of motion.
• pain in localised groin area but manifest to butt, knee, greater trochanter
• exaccerbates with weight bearing and relieved by rest

How is it treated? Limit progression-cant do anything once its set in

• restrict weight bearing
• surgery to alter the collapse of the femoral head

Question 8

Snapping hip Syndrome

3 types

Answer 8

external 
internal 
intra-articular 
m.c in cycling sports
Tense TFL puts increased friction over greater trochanter
-snap may be palpable/audible/ both 
-trochanteric bursitis may occur 
treatment- get rid of trigger points ago avoid bursitis ad check for underlying tendonitis 

Internal:
-when iliopsoas tendon is flexed, abducted and externally rotated and hip moves to a position medial to the hip capsule during extension. - iliopsoas bursitis may ensue
treat- lengthen iliopsoas, clicking is inside