The Hip, Pelvis, and Thigh Lecture Powerpoint

Question 1

When a normal person stands on one foot, the pelvis tilts ___ on the opposite side (the side on which the foot is held off the ground, in trendelenberg patients, the pelvis tilts ___ on the opposite side

Answer 1

upwards, downwards

Question 2

The classic test for sacroilitis

Answer 2

Faber test

Question 3

Osteitis pubis

Answer 3

Idiopathic inflammatory diz involving the pubic symphysis and surrounding tissue, common in athletes but can also occur post pregnancy or pelvic surgery, usually insidious onset of pelvic pain in absence of systemic symptoms (ruling out osteomyelitis typically), tender over pubic symphysis

Question 4

Adduction maneuver for osteitis pubis

Answer 4

Have patients lying supine squeeze flexed thighs together (adduction) into the examiners hand

Question 5

Osteitis pubis treatment options (2)

Answer 5

• conservative treatment

- steroid injection

Question 6

Coccydynia definition

Answer 6

Pain in the coccyx, typically self limiting, usually related to direct trauma, can be reproduced with direct pressure on the coccyx, can see pain with sex or defecation

Question 7

Coccydynia treatment options (3)

Answer 7

• analgesics
• wedge pillow
• heat or cold applications, imaging typically not used as kind of useless

Question 8

Hip osteoarthritis

Answer 8

Loss of cartilage of femoral head and acetabulum, see groin, thigh, buttock, knee pain, stiffness, clicking, limp gait, decreased ROM

Question 9

Femoacetabular impingement (FAI) definition

Answer 9

Developmental abnormality that may be responsible for progression to arthritis, see groin pain, pain with turning twisting squatting and prolonged sitting

Question 10

Trochanteric bursitis definition

Answer 10

Inflammation of the trochanteric bursa often caused by exaggerated movement of the gluteus medius tendon and the extensor fascia over the outer femur, repetitive flexing of the hip and direct pressure aggrivate, caused by gait disturbance usually, typically presents as lateral hip pain over the outer thigh or difficulty with walking*

Question 11

Trochanteric bursitis treatment options (2)

Answer 11

• regional anesthetic block

- rest, correct gait disturbance, NSAIDS, heat, stretching, PT

Question 12

Osteonecrosis of hip presentation (4)

Answer 12

• <40 years in age
• groin pain
• deep throbbing pain
• trendelenberg gait

Question 13

Osteonecrosis of the hip treatment options (3)

Answer 13

• conservative management
• Joint preserving procedures
• joint replacement

Question 14

Most sensitive diagnostic exam of osteonecrosis of the hip

Answer 14

MRI

Question 15

Legg calve perthes disease definition***

Answer 15

Ischemia with subsequent necrosis of femoral head, avascular necrosis of epiphysis, abnormal growth at physis, remodeling of bone, most often in 4-10 y/o males, can be bilateral, can lead to osteoarthritis later in life

Question 16

Perthes disease signs and symptoms (4)***

Answer 16

• pain in the groin or thigh
• possible knee pain
• limp gait (parents will typically have noticed)
• limited abduction and internal rotation

Question 17

Perthes disease diagnostic studies (1)***

Answer 17

-x rays

Question 18

Perthes disease treatment options** (5)

Answer 18

• NSAIDS
• crutches
• PT
• casting/bracing of progressive deformity
• surgery if not caught

Question 19

Slipped capital femoral epiphysis (SCFE) definition***

Answer 19

Posterior inferior displacement of femoral epiphysis thru the growth plate, ost common in early teenage males 11-15 often obese, sometimes with endocrine disorders, gradual process but may be due to minor trauma

Question 20

Slipped capital femoral epiphysis (SCFE) signs and symptoms (4)***

Answer 20

• hip or knee pain
• externally rotated leg at rest when comfortable
• limp or pain walking
• stiffness of hip

Question 21

Slipped capital femoral epiphysis (SCFE) diagnostic studies (1)***

Answer 21

-x rays, AP pelvis and bilateral frog leg lateral views to rule out opposite hip involvement

Question 22

Slipped capital femoral epiphysis (SCFE) treatment options (2)***

Answer 22

• surgery

- watch for it to happen on other side

Question 23

Snapping hip syndrome

Answer 23

Snapping with flexion/extension of hip caused by tendon catching on bony prominance, x ray usually normal but usually need to rule out pathology, treated with reassurance

Question 24

IT band syndrome definition and management

Answer 24

Aching or burning pain at the site where the ITB coursres over the lateral femoral condyle, occasionally pain radiates up the thigh toward the hip, clinical diagnosis with no imaging

-treated with ice, NSAIDS, rest, PT

Question 25

Main cause of lateral knee pain in runners

Answer 25

IT band syndrome