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S6- MSK 2 > Week 3- Hip Common Clinical Presentations > Flashcards

Week 3- Hip Common Clinical Presentations Flashcards

1
Q

What are the common clinical presentations at the hip? (15)

A
  • Osteoporosis
  • Fractures of the Hip
  • AVN
  • Osteoarthropathy
  • Labral Tear
  • FAI
  • Loose Bodies
  • Snapping Hip Syndrome
  • Tendinopathy
  • Muscle Strain
  • Bursitis
  • Greater Trochanteric Pain Syndrome (GTPS)
  • Nerve Entrapments
  • Avulsion Fractures
  • Stress Fractures
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2
Q

PART 1: OSTEOPOROSIS

A

PART 1: OSTEOPOROSIS

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3
Q
  • Is osteoporosis more common in males or females?

- Is osteopenia more common in males or females?

A
  • females

- females

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4
Q

Osteoporosis Recommendations:

  • Screening for risk factors among individuals >___ y/o.
  • BMD testing for females >/= ___ y/o & males >/= ____y/o.
  • Younger post-menopausal women & men aged 50-69 y/o with __ major or __ minor risk factors.
  • Is exercise early in life beneficial for increased BMD?
A
  • 50 y/o
  • females >/= 65 y/o & males >/= 70 y/o
  • 1 major or 2 minor
  • Yes
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5
Q

What are the major risk factors for osteoporosis? (10)

A
  • Vertebral compression fracture
  • Fragility fracture after age 40
  • Family hx of osteoporotic fracture
  • Systemic glucocorticoid therapy lasting >3 months
  • Malabsorption syndrome
  • Primary hyperparathyroidism
  • Propensity to fall
  • Osteopenia apparent on x-ray
  • Hypogonadism
  • Early menopause (before 45)
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6
Q

PART 2: FRACTURES OF THE HIP

A

PART 2: FRACTURES OF THE HIP

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7
Q

> /= 90% of hip fractures are sustained by individuals >___ y/o.

A

-65

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8
Q
  • What is the main positive prognostic indicator for patients who have sustained a hip fracture?
  • What are the negative prognostic indicators? (5)
A
  • Surgery within 48 hours

- Male gender, age > 86 y/o, >/= 2 comorbidities, anemia, and a mini mental (MMSE) test score ≤ 6/10

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9
Q

Patients who have sustained fractures at the proximal 1/3 of the femur are at risk for what?

A

-Thrombosis/embolism

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10
Q

What are the (3) categories of hip fractures?

A
  • Intertrochanteric (between greater and lesser trochanter)
  • Subtrochanteric
  • Femoral Neck
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11
Q
  • With femoral neck fractures we should monitor for _____ and ____-_______.
  • Are compression fractures or tension fractures more stable?
A
  • AVN and non-union

- compression

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12
Q

Who is at risk for fractures of the hip?

A
  • Older adult

- Trauma vs spontaneous

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13
Q

As far as symptoms for a fracture go, is severe lateral hip pain or severe groin and anterior thigh pain more likely?

A

-Severe groin and anterior thigh pain. (deep pain)

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14
Q

Hip Fracture Physical Examination:

  • __________ of the LE
  • Limited/ painful _______ in LQS
  • Painful/ limited hip AROM/ PROM
  • Painful/ weakness with strength testing
    • ________ & ______________ Tests
A
  • Shortening
  • squat
  • Fulcrum and Pubic Percussion Tests
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15
Q

What are some common surgical procedures performed with fractures of the hip?

A
  • Arthroplasty
  • External Fixation
  • ORIF
  • Intramedullary Fixation
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16
Q
  • Which surgical hip procedure is rare and temporary?

- ORIF has full w/b __-__ weeks post-op.

A
  • External Fixation

- 8-12 weeks

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17
Q

PART 3: AVASCULAR NECROSIS OF FEMORAL HEAD (AVN)

A

PART 3: AVASCULAR NECROSIS OF FEMORAL HEAD (AVN)

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18
Q
  • AVN is progressive _______ with secondary bone cell death.
  • It leads to collapsing of bone and degenerative __________.
  • Are they usually managed conservatively or surgically?
A
  • ischemia
  • arthropathy
  • surgically
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19
Q

-AVN is common in what decades?

A

-3rd-5th decade

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20
Q

What are the risk factors for AVN?

A
  • Trauma
  • Corticosteroid use
  • Excessive alcohol consumption
  • Coagulation disorders
  • Hemoglobinopathies
  • Dysbaric phenomena
  • Autoimmune diseases
  • Storage diseases
  • Smoking
  • Hyperlipidemia
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21
Q
  • Where is pain felt with AVN? (3)

- __________ onset but can have sudden decline.

A
  • Deep groin, buttock, knee

- Progressive

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22
Q

AVN Physical Examination:
-Limited _______ LQS
Limited/ painful AROM & PROM (especially ______)
-Pain/ weakness with resistive testing

A
  • squat

- especially IR

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23
Q

What are the (3) prognostic indicators for AVN?

A
  • Extent of lesion
  • Location
  • Bone marrow edema presence
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24
Q

PART 4: OSTEOARTHROPATHY (OA)

A

PART 4: OSTEOARTHROPATHY (OA)

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25
Q
  • OA is present in 7-25% of individuals >___ y/o and 40% of individuals >___ y/o.
  • What do we see with radiographic imaging of OA?
A
  • 7-25% of individuals >55 y/o and 40% of individuals >65 y/o.
  • Joint space loss, osteophytes, sclerosis
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26
Q

What may be found during a patient interview/Hx with Osteoarthropathy? (8)

A
  • Insidious onset
  • Hx trauma
  • Family Hx
  • Obesity
  • Hypermobility
  • Joint shape abnormality
  • Physical activity levels
  • Age >50
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27
Q

OA Symptomology:

  • Dull vs. sharp _______. ______. ______. _____ pain
  • “__-Sign”
  • Hip stiffness (greater following prolonged sitting/ inactivity)
  • Difficulty with donning pants/ socks/ shoes
  • ______ ambulation limitations
A
  • buttock, groin, thigh, knee
  • “C-sign”
  • Stair ambulation limitations
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28
Q

OA Physical Examination:

  • ____________ AROM/PROM limitations/pain >1 plane (greatest IR, flexion, abduction)
    • _______ test
  • +/- weakness/ pain with resistive testing
  • Joint _____mobility
A
  • multidirectional
    • Scower Test
  • hypomobility
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29
Q

What are the (5) CPR for ruling in Hip OA?

A
  • Self-report squatting as aggravating activity
  • Lateral pain with active hip flexion
  • Passive hip IR = 25 deg
  • Pain with active hip extension
    • Scower test with adduction

(4/5)

30
Q

PART 5: ACETABULAR LABRAL TEAR

A

PART 5: ACETABULAR LABRAL TEAR

31
Q

Labral Tear Hx:

  • _______ vs _________
  • Average age ___ y/o (18-66 y/o)
  • 73% had an observable abnormality
  • Prevalence among individuals with hip pain estimated to be 22–55%
  • High likelihood of _______ injury in area of lesion.
A
  • degenerative vs traumatic
  • 38 y/o
  • chondral
32
Q

Labral Tear Symptomology:

  • _____ pain generally and ______ with activity.
  • Large % of pop walking around with hip pathology that’s __________.
  • What are the pain locations in order from most to least common?
  • List the onset of symptoms in order from most to least common?insidious, acute, trauma.
A
  • Dull pain generally and sharp with activity.
  • asymptomatic
  • Groin, anterior thigh/knee, lateral hip, buttock
  • Insidious, acute, trauma
33
Q

PART 6: FEMORAL-ACETABULAR IMPINGEMENT (FAI)

A

PART 6: FEMORAL-ACETABULAR IMPINGEMENT (FAI)

34
Q

What is FAI?

A

Bony abnormality with decreased femoral-acetabular clearance.

35
Q
  • What are the 2 types of FAI?

- Which is more common?

A
  • Cam = Increased size of femoral head, irregular junction with the neck.
  • Pincer = Increased protrusion of acetabular rim.

-Neither is more common, rather a mix of both.

36
Q

What population is at risk for FAI?

A

Hockey players, golfers, dancers, football, soccer players.

37
Q

FAI Symptomology:
-_______, ____ _________ hip pain.
Pain/ limitation with deep squat, cutting, lateral movements, painful ER.

A

-Sharp, deep anterior hip pain.

38
Q

FAI Physical Examination:

  • Cam: hip _____/_____/_____ ROM painful/ limited (potentially bony end-feel)
    • ________ Test described
A
  • hip flexion/ADD/IR

- + FABER Test

39
Q

PART 7: LOOSE BODIES

A

PART 7: LOOSE BODIES

40
Q
  • What are loose bodies?

- They are often secondary to ________ changes in the hip and may cause muscle _______.

A
  • Free-floating body within joint

- Secondary to degenerative changes and may cause muscle inhibition.

41
Q

What may be found during a patient interview/Hx with Loose Bodies? (4)

A
  • Chronic hip pain
  • Advanced OA
  • Prior traumatic hip dislocation
  • Prior AVN
42
Q

Loose Bodies Symptomology:

  • Anterior hip/groin pain.
  • _______, _______, _______, giving way of LE.
  • Sudden pain with w/b activities.
A

-Catching, locking, clicking

43
Q

Loose Bodies Physical Examination:

  • Limited AROM/PROM with ______/______.
  • _______ end-feel with PROM.
A
  • catching/grinding

- Springy end-feel

44
Q

How are loose bodies managed?

A

-Arthroscopically

45
Q

PART 8: SNAPPING HIP SYNDROME

A

PART 8: SNAPPING HIP SYNDROME

46
Q

What are the 3 types of Snapping Hip Syndrome?

A
  • Intra-articular
  • Internal
  • External
47
Q

___________ Snapping Hip Syndrome involves loose bodies, labral tears, long head of biceps over ischium & iliofemoral ligament over femoral head.

A

-Intra-articular

48
Q
  • __________ Snapping Hip Syndrome involves iliopsoas over femoral head, lesser trochanter, pectineus fascia, iliopectineal eminence.
  • These patients have snapping/pain at the ________ hip (especially extending from flexed position).
  • Also have pain/snap with movement from _______ position to extension, adduction, IR.
A
  • Internal Snapping Hip Syndrome
  • anterior hip
  • FABER position
49
Q
  • _________ Snapping Hip Syndrome involves ITB/ glut max over greater trochanter.
  • These patients have snapping/pain at the _______ hip.
  • Also have a painful _____ Test.
  • Aggravated by running on slanting surfaces, directional change on planted LE.
A
  • External
  • lateral hip
  • Ober Test
50
Q

PART 9: TENDINOPATHY

A

PART 9: TENDINOPATHY

51
Q

What are the most commonly involved structures with tendinopathy? (3)

A
  • Rectus Femoris
  • Iliopsoas
  • Gluts
52
Q

What Hx puts patients at risk for tendinopathy of the iliopsoas?

A

-Internal Snapping Hip Syndrome

53
Q

Tendinopathy Symptomology:

-_______ thigh/groin pain

A

-anterior

54
Q

Iliopsoas Tendinopathy Physical Examination:

  • Painful/ weak resisted hip ________
  • Painful/ limited hip _______ and ___ ROM (guarded or empty endfeel).
A
  • flexion

- extension and IR

55
Q

PART 10: MUSCLE STRAIN

A

PART 10: MUSCLE STRAIN

56
Q

Muscle Strain General Physical Examination:

  • TTP muscle bellies with possibly palpable defect
  • Antalgic gait
  • On-going _______/______ several days
  • Painful/weak/limited ________ testing and _________ of the involved musculotendinous unit.
A
  • ecchymosis/ edema

- resistance testing and stretching

57
Q

Muscle Strain - Hamstring:

  • Biceps femoris has a relatively ________ recovery time and risk for recurrence.
  • What are the risk factors? (3)
  • What are the (2) proposed RTS criteria?
A
  • greater
  • prior Hx, hamstring weakness, older athletes
  • jogging at 70% of baseline, RTS at 90-95% baseline
58
Q

What may be found during a patient interview/Hx of a patient with a Hamstring Strain? (2)

A
  • Distinct injury/audible “pop”

- Common MOI: sprinting with trunk flexion and fast running

59
Q

Muscle Strain - Adductors:

  • What are the risk factors? (2)
  • What is a common MOI?
  • Main symptom is ______ pain that is worse with quick _____/_______.
A
  • prior Hx, decreased ROM for hip abduction
  • directional change while running
  • groin pain (worse with quick stops/starts)
60
Q

Muscle Strain - Iliopsoas:

  • What is a common MOI?
  • _________/_______ pain and pain with ____-stepping.
A
  • forced hip extension during active hip flexion

- Anterior hip/groin pain and pain with high-stepping.

61
Q

Muscle Strain - Quads:

  • __________ strains have worse prognosis and longer recovery duration.
  • What are the risk factors? (4)
  • What are some common MOI?
A
  • rectus femoris
  • older athletes, dry playing field, shorter height, dominant LE strength/flexibility
  • kicking while running, sprinting
62
Q

Muscle Strain - Glut Med/Min:

  • What may be found during patient interview/Hx?
  • Symptoms include ________/_________/______ pain.
A
  • fall, increased duration/frequency of loading, sports-related injury, middle-aged women
  • buttock/lateral hip/groin pain
63
Q

PART 11: BURSITIS

A

PART 11: BURSITIS

64
Q

What are the 2 main bursitis locations at the hip?

A
  • Trochanteric (greater)

- Iliopsoas/Iliopectineal

65
Q

Trochanteric Bursitis:

  • Greater risk ___-___ y/o
  • ________ > _________
A
  • 40-60

- females>males

66
Q

What are the (6) criteria for diagnosis of trochanteric bursitis?

A
  • Lateral hip pain
  • Distinct tenderness at greater trochanter
  • Pain at extreme of rotation, abduction, or adduction
  • Pain on hip abduction resistance testing
  • Pseudoradiculopathy
    • FABER
67
Q

Iliopsoas/Iliopectineal Bursitis:

  • Frequently __________
  • _______ hip pain
  • Painful/limited hip _______, ________, and _____.
  • Local TTP
A
  • frequently unrecognized
  • anterior hip pain
  • painful/limited hip flexion, extension, and ER
68
Q

PART 12: GREATER TROCHANTERIC PAIN SYNDROME (GTPS)

A

PART 12: GREATER TROCHANTERIC PAIN SYNDROME (GTPS)

69
Q

What may be found during a patient interview/Hx with GTPS? (4)

A
  • Female
  • Obesity
  • LBP/chronic arthropathy of hip/knee
  • middle-aged/older adults
70
Q

GTPS Symptomology:

  • Pain greater at ______
  • Aggravated with ________ >/= ___m
  • ____________ symptoms
  • Limitation/pain with donning/doffing shoes and socks
  • Symptoms may radiate where?
A
  • night
  • standing >/= 15m
  • radiating symptoms
  • may radiate to/below knee
71
Q

GTPS Physical Exam:

  • Excessive hip _________/________ during gait
  • TTP lateral hip
  • IT band tightness
    • ________ and _____________ Tests
  • Pain/limitations with hip ________ ROM (possibly hip IR as well)
  • Pain/weakness with hip _________ and _____ resistive/AROM testing
A
  • abduction/adduction
    • FABER and Resisted External Derotation Tests
  • hip adduction ROM
  • hip abduction and ER resistive/AROM
72
Q

PART 13: NERVE ENTRAPMENTS

A

PART 13: NERVE ENTRAPMENTS

S6- MSK 2 (21 decks)

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