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Flashcards in Hip Pain Deck (28)
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1
Q

Hip joint anatomy

A

Ilium, ischium, and pubis = acetabulum

Multiu-axial ball and socket joint

2
Q

Groin
Lateral pain
Posterior
C-sign

A

Think intra-articular

Generally not the hip joint,,think soft tissue

Could by hip, but probably SI< buttock, or lumbosacral spine

C-sign is suspicious for hip joint…if they cup their hand around the side of the hi

3
Q

Passive ROM

Gait

A

Log rolling is one of the best ways to assess femoroacetabular motion

Antalgic (limping where stance phase is shortened) or tendelenberg gait (normally due to muscle weakness…sag one side of the hip)

4
Q

SI joint anatomy

A

Join with sacrum posteriorly and meet anteriorly

Partially synovial…no muscles that control movements but infleucned by lumbar spine and hip joints

5
Q

DDH patho and risk factors

A

ABnormal contact of femoral head with acetabulum leading to abnormal development

Female, breech, genetics, swaddling

6
Q

Exam of DDH

A

Ortolani test - flex hip 90 degrees…gently abduct while fingers lift the greater trochanter…positive if femoral head relocates into acetabulum

Barlow - adduct and flex the hip…hold distal and push posteriorly…positive test is femoral head slides posterioloy…dislocated femoral head

Galexazzi - flex hips and knees…affected knee lower

7
Q

Tx for DDH

A

Harness that puts hips into correct position…urgent ortho evaluation

8
Q

SCFE

Clinical manifesation and patho

A

Inferior and posterior slpipage of proximal femoral epiphysis

Chronic is most common

Acute if fall from height

Dull, nonradiating groin, thigh, or knee pain worse with activatu

Decreased internal rotation

Bilateral in 25%

Place in a non-bearing state immediately

Most obese and prepubertal

9
Q

Hx and exam of SCFE

A

Insidious onset

Dull and worse with moving

Groin to medial aspect of knee with painful limp

Obese adolescent male

Hold lower extremity in exteneral rotation

Decreased internal and increased external rotation

10
Q

Management of SCFE

A

Non-weight bearing and strict bed rest

Surgical fixtion

Close follow-up especially of contralteral hip

11
Q

LCP patho and clinical

A

Idiopathic avascular necrosis of femroal epiphysis

4-8 y/o

Persistent hip or knee pain with a limp

12
Q

Pathophys, characteristics of LCP

A

Self-limiting

Blood flow to femorla head interrupted….tip dies over 1-3 weeks…new blood supply causes new bone supply to appear over -12 months…new bone then replaces old bone within 2-3 years

Tend to be shorter

13
Q

Hx of LCP and PE

A

Insidious onset with painless limp (maybe mild pain in the knee)

Shortening of the limp

Decreased internal rotation and abduction of the hip

Atrophy of muscles in upper thigh

14
Q

Tx of LCP

A

Avoid impact activities and containment

15
Q

Transeint synovities

A

Benign and self limited

Unknown cause but think preceding URI

Boys 3-8 (most under 5)

Transient joint effusions for 7-10 days

Limp

ESR<40 and WBC<12000

16
Q

Septic exam

A

Acute, monoarticular

Knee mostly

Erythema and warmth not in hip

Usually febrile

Pseudoparalysis due to intense pain

17
Q

Septic dx and tx

A

Aspiration

Emergent, ABs, and drainage if Hip/knee/shoulder

18
Q

Osteomyelitis

A

Acute or chronic

Hematogenous typically…could be extnsion or direct inoculation

S. aurues most coommon but can differ

19
Q

Osteo in children vs. adults

A

Moe acute hema, better prognosis because of blood supply, easier to tx

In adults, more likely to be chronic, can involve foreign bodies, more difficult to tx

20
Q

Greater torchanter bursitis

A

Separates gluteus maximus from the laterla side of greater trochanter

Irritation of burse produces lateral hip pain

Point tender over greater trochanter

21
Q

Hx, exam, tests, and managmenet of greater trochanter bursitis

A

Hip pain with exercise or direct pressure

Tender over greater torchanter or ilioopsoas tendon

NSAIDs, PT, intra-articular GCs

22
Q

Meralgia paresthetica

Hx, exam, tests, management

A

Lateral femoral cutaneous nerve entrapment

Localized area of pain…nerve pain

Not affect by movmeent or pressure

None

Education, avoid tight garments, weight loss

23
Q

Hip OA

Hx, exam, tests, managmenet

A

Age over 40, stiffness, radiate to groin

Pain with hip rotation or FABER test…limited ROM later

Radiography

PT, analgesics, surgical replacement

24
Q

Osteonecrosis causes

A

Femoral neck fracture or dislocation

GCs, alcohol, idiopathic, sickle cell

25
Q

Osteonecrosis hx, exam, tests, mangement

A

Anterior groion pain with joint use that can lead to thigh or buttock pain

Freuqnet pain on walking and at rest

Often steroid hx

Pain with ROM

Radiography

Preserve the joint…non-op, preserving procedures, joint replacement

26
Q

Femoral neck fractures

A

Elderly

Falls and osteoporosis

Complications - immobility and avascular necoriss and nonunion

Also increase risk of DVT or PE

Surgical repair needed and manage comorbidities

27
Q

SI joint dysfunction

Hx, exam, tests, managment

A

Pain radiates…more in females and common in pregnancy

FABERE test eleicits posterior pain localized to SI joint…SI joint tenderness

Radiography, possibly none, narrowing and slcerotic changes

Determine cause, TNF alpha inhibitors, analgesics, PT, joint infections

28
Q

Lumbar spinal stenosis hx, exam, tests, managmenet

A

Lateral and posteriro hip pain radiating down lower leg or going…wors with standing and better with leaning forward

Usually normal exam…could have abnormal reflexes

Narrowing of intraspinal canal…see on MRI or CT

NSAIDs, PT, steroid injections, srugery