The Hip: Red Flag Considerations

Question 1

What System should be considered when doing a system review?

Answer 1

Urogenitial
- The Kidneys can refer to the lateral hip
- We may need to perform Kidney percussion test

Question 2

When screening the hip, what vascular conditions should we look out for?

Answer 2

Avascular Necrosis / Osteonecrosis
- They may complain of a dull ache or throbbing pain in the groin, lateral hip or buttock
- Pain with ambulation, abduction and IR/ER

Question 3

Pediatric Disorders

What is Legg-Calve-Perthes Disease?

Answer 3

When the Femoral Head temporarily loses blood supply
- This is idiopathic
- More common in overweight adolescents
- Hx of recent growth spurt or trauma

Question 4

Legg-Calve-Perthes Disease, what can be observed and what may we find objectively?

Answer 4

• Limp is observed
• Pain in Hip, Groin, Thigh or Knee that worsens with activity
• Limited flexion, abduction and IR

Question 5

What is Slipped Capital Femoral Epiphysis?

Answer 5

• Anterior displacement of the Femoral Neck
• Male > Females; 2-13 years old
• Gradual onset of groin, medial thigh and knee pain

Question 6

With Slipped Capital Femoral Epiphysis, what can be observed?

Answer 6

• Limited abduction and extension ROM
• Short limb, antalgic gait

Question 7

What is Congenital Hip Dysplasia?

Answer 7

• Hips that are “unstable”, malformed, subluxated, or dislocated
• Infants, Female > Male
• Short limb
• Associated with torticollis
• Hip position flexed and abducted
• May be a breech birth
• Galeazzi, Ortolani and Barlow signs

Question 8

What types of infections should be considered with Red Flag considerations?

Answer 8

• Septic Arthritis
• Osteomyelitis, espeically those patients who’ve had an acute trauma or who are post-op

Question 9

Which Cancers are local to the hip?

Answer 9

• Osteoid Osteoma
• Colon Cancer

Question 10

What are the Red Flags associated with Colon Cancer?

Answer 10

• Age > 50
• Bowel Disturbances (e.g., rectal bleeding or black stools)
• Unexplained weight loss
• Hx of colon cancer in the family
• P! unchanged by positions or movement

Question 11

What are the Red Flags with Osteonecrosis/Avascular Necrosis of the Hip?

Answer 11

• Hx of long-term corticosteroid use
• Hx of avascular necrosis of the contralateral hip
• Trauma

Question 12

Which Neurologic conditions should be considered with Hip red flags?

Answer 12

• Cauda Equina Syndrome
• Guillain-Barre Syndrome
• MS
• ALS