Week 3- Hip Common Clinical Presentations Flashcards
What are the common clinical presentations at the hip? (15)
- 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
PART 1: OSTEOPOROSIS
PART 1: OSTEOPOROSIS
- Is osteoporosis more common in males or females?
- Is osteopenia more common in males or females?
- females
- females
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?
- 50 y/o
- females >/= 65 y/o & males >/= 70 y/o
- 1 major or 2 minor
- Yes
What are the major risk factors for osteoporosis? (10)
- 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)
PART 2: FRACTURES OF THE HIP
PART 2: FRACTURES OF THE HIP
> /= 90% of hip fractures are sustained by individuals >___ y/o.
-65
- What is the main positive prognostic indicator for patients who have sustained a hip fracture?
- What are the negative prognostic indicators? (5)
- Surgery within 48 hours
- Male gender, age > 86 y/o, >/= 2 comorbidities, anemia, and a mini mental (MMSE) test score ≤ 6/10
Patients who have sustained fractures at the proximal 1/3 of the femur are at risk for what?
-Thrombosis/embolism
What are the (3) categories of hip fractures?
- Intertrochanteric (between greater and lesser trochanter)
- Subtrochanteric
- Femoral Neck
- With femoral neck fractures we should monitor for _____ and ____-_______.
- Are compression fractures or tension fractures more stable?
- AVN and non-union
- compression
Who is at risk for fractures of the hip?
- Older adult
- Trauma vs spontaneous
As far as symptoms for a fracture go, is severe lateral hip pain or severe groin and anterior thigh pain more likely?
-Severe groin and anterior thigh pain. (deep pain)
Hip Fracture Physical Examination:
- __________ of the LE
- Limited/ painful _______ in LQS
- Painful/ limited hip AROM/ PROM
- Painful/ weakness with strength testing
- ________ & ______________ Tests
- Shortening
- squat
- Fulcrum and Pubic Percussion Tests
What are some common surgical procedures performed with fractures of the hip?
- Arthroplasty
- External Fixation
- ORIF
- Intramedullary Fixation
- Which surgical hip procedure is rare and temporary?
- ORIF has full w/b __-__ weeks post-op.
- External Fixation
- 8-12 weeks
PART 3: AVASCULAR NECROSIS OF FEMORAL HEAD (AVN)
PART 3: AVASCULAR NECROSIS OF FEMORAL HEAD (AVN)
- AVN is progressive _______ with secondary bone cell death.
- It leads to collapsing of bone and degenerative __________.
- Are they usually managed conservatively or surgically?
- ischemia
- arthropathy
- surgically
-AVN is common in what decades?
-3rd-5th decade
What are the risk factors for AVN?
- Trauma
- Corticosteroid use
- Excessive alcohol consumption
- Coagulation disorders
- Hemoglobinopathies
- Dysbaric phenomena
- Autoimmune diseases
- Storage diseases
- Smoking
- Hyperlipidemia
- Where is pain felt with AVN? (3)
- __________ onset but can have sudden decline.
- Deep groin, buttock, knee
- Progressive
AVN Physical Examination:
-Limited _______ LQS
Limited/ painful AROM & PROM (especially ______)
-Pain/ weakness with resistive testing
- squat
- especially IR
What are the (3) prognostic indicators for AVN?
- Extent of lesion
- Location
- Bone marrow edema presence
PART 4: OSTEOARTHROPATHY (OA)
PART 4: OSTEOARTHROPATHY (OA)
- 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?
- 7-25% of individuals >55 y/o and 40% of individuals >65 y/o.
- Joint space loss, osteophytes, sclerosis
What may be found during a patient interview/Hx with Osteoarthropathy? (8)
- Insidious onset
- Hx trauma
- Family Hx
- Obesity
- Hypermobility
- Joint shape abnormality
- Physical activity levels
- Age >50
OA Symptomology:
- Dull vs. sharp _______. ______. ______. _____ pain
- “__-Sign”
- Hip stiffness (greater following prolonged sitting/ inactivity)
- Difficulty with donning pants/ socks/ shoes
- ______ ambulation limitations
- buttock, groin, thigh, knee
- “C-sign”
- Stair ambulation limitations
OA Physical Examination:
- ____________ AROM/PROM limitations/pain >1 plane (greatest IR, flexion, abduction)
- _______ test
- +/- weakness/ pain with resistive testing
- Joint _____mobility
- multidirectional
- Scower Test
- hypomobility
What are the (5) CPR for ruling in Hip OA?
- 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)
PART 5: ACETABULAR LABRAL TEAR
PART 5: ACETABULAR LABRAL TEAR
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.
- degenerative vs traumatic
- 38 y/o
- chondral
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.
- Dull pain generally and sharp with activity.
- asymptomatic
- Groin, anterior thigh/knee, lateral hip, buttock
- Insidious, acute, trauma
PART 6: FEMORAL-ACETABULAR IMPINGEMENT (FAI)
PART 6: FEMORAL-ACETABULAR IMPINGEMENT (FAI)
What is FAI?
Bony abnormality with decreased femoral-acetabular clearance.
- What are the 2 types of FAI?
- Which is more common?
- 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.
What population is at risk for FAI?
Hockey players, golfers, dancers, football, soccer players.
FAI Symptomology:
-_______, ____ _________ hip pain.
Pain/ limitation with deep squat, cutting, lateral movements, painful ER.
-Sharp, deep anterior hip pain.
FAI Physical Examination:
- Cam: hip _____/_____/_____ ROM painful/ limited (potentially bony end-feel)
- ________ Test described
- hip flexion/ADD/IR
- + FABER Test
PART 7: LOOSE BODIES
PART 7: LOOSE BODIES
- What are loose bodies?
- They are often secondary to ________ changes in the hip and may cause muscle _______.
- Free-floating body within joint
- Secondary to degenerative changes and may cause muscle inhibition.
What may be found during a patient interview/Hx with Loose Bodies? (4)
- Chronic hip pain
- Advanced OA
- Prior traumatic hip dislocation
- Prior AVN
Loose Bodies Symptomology:
- Anterior hip/groin pain.
- _______, _______, _______, giving way of LE.
- Sudden pain with w/b activities.
-Catching, locking, clicking
Loose Bodies Physical Examination:
- Limited AROM/PROM with ______/______.
- _______ end-feel with PROM.
- catching/grinding
- Springy end-feel
How are loose bodies managed?
-Arthroscopically
PART 8: SNAPPING HIP SYNDROME
PART 8: SNAPPING HIP SYNDROME
What are the 3 types of Snapping Hip Syndrome?
- Intra-articular
- Internal
- External
___________ Snapping Hip Syndrome involves loose bodies, labral tears, long head of biceps over ischium & iliofemoral ligament over femoral head.
-Intra-articular
- __________ 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.
- Internal Snapping Hip Syndrome
- anterior hip
- FABER position
- _________ 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.
- External
- lateral hip
- Ober Test
PART 9: TENDINOPATHY
PART 9: TENDINOPATHY
What are the most commonly involved structures with tendinopathy? (3)
- Rectus Femoris
- Iliopsoas
- Gluts
What Hx puts patients at risk for tendinopathy of the iliopsoas?
-Internal Snapping Hip Syndrome
Tendinopathy Symptomology:
-_______ thigh/groin pain
-anterior
Iliopsoas Tendinopathy Physical Examination:
- Painful/ weak resisted hip ________
- Painful/ limited hip _______ and ___ ROM (guarded or empty endfeel).
- flexion
- extension and IR
PART 10: MUSCLE STRAIN
PART 10: MUSCLE STRAIN
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.
- ecchymosis/ edema
- resistance testing and stretching
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?
- greater
- prior Hx, hamstring weakness, older athletes
- jogging at 70% of baseline, RTS at 90-95% baseline
What may be found during a patient interview/Hx of a patient with a Hamstring Strain? (2)
- Distinct injury/audible “pop”
- Common MOI: sprinting with trunk flexion and fast running
Muscle Strain - Adductors:
- What are the risk factors? (2)
- What is a common MOI?
- Main symptom is ______ pain that is worse with quick _____/_______.
- prior Hx, decreased ROM for hip abduction
- directional change while running
- groin pain (worse with quick stops/starts)
Muscle Strain - Iliopsoas:
- What is a common MOI?
- _________/_______ pain and pain with ____-stepping.
- forced hip extension during active hip flexion
- Anterior hip/groin pain and pain with high-stepping.
Muscle Strain - Quads:
- __________ strains have worse prognosis and longer recovery duration.
- What are the risk factors? (4)
- What are some common MOI?
- rectus femoris
- older athletes, dry playing field, shorter height, dominant LE strength/flexibility
- kicking while running, sprinting
Muscle Strain - Glut Med/Min:
- What may be found during patient interview/Hx?
- Symptoms include ________/_________/______ pain.
- fall, increased duration/frequency of loading, sports-related injury, middle-aged women
- buttock/lateral hip/groin pain
PART 11: BURSITIS
PART 11: BURSITIS
What are the 2 main bursitis locations at the hip?
- Trochanteric (greater)
- Iliopsoas/Iliopectineal
Trochanteric Bursitis:
- Greater risk ___-___ y/o
- ________ > _________
- 40-60
- females>males
What are the (6) criteria for diagnosis of trochanteric bursitis?
- Lateral hip pain
- Distinct tenderness at greater trochanter
- Pain at extreme of rotation, abduction, or adduction
- Pain on hip abduction resistance testing
- Pseudoradiculopathy
- FABER
Iliopsoas/Iliopectineal Bursitis:
- Frequently __________
- _______ hip pain
- Painful/limited hip _______, ________, and _____.
- Local TTP
- frequently unrecognized
- anterior hip pain
- painful/limited hip flexion, extension, and ER
PART 12: GREATER TROCHANTERIC PAIN SYNDROME (GTPS)
PART 12: GREATER TROCHANTERIC PAIN SYNDROME (GTPS)
What may be found during a patient interview/Hx with GTPS? (4)
- Female
- Obesity
- LBP/chronic arthropathy of hip/knee
- middle-aged/older adults
GTPS Symptomology:
- Pain greater at ______
- Aggravated with ________ >/= ___m
- ____________ symptoms
- Limitation/pain with donning/doffing shoes and socks
- Symptoms may radiate where?
- night
- standing >/= 15m
- radiating symptoms
- may radiate to/below knee
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
- abduction/adduction
- FABER and Resisted External Derotation Tests
- hip adduction ROM
- hip abduction and ER resistive/AROM
PART 13: NERVE ENTRAPMENTS
PART 13: NERVE ENTRAPMENTS
