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Flashcards in Lower Extremity Disorders Deck (55)
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1

Which nerves create the sciatic nerve?

L4-S3

2

Which nerves create the femoral nerve?

L2-4

3

Which nerve create the lateral femoral cutaneous nerve?

L3-4

4

Blood Supply to the Hip

Circumflex
Profunda femoris
Posterior division of the obturator artery
Femoral head

5

Possible Reasons for AVN

Fracture
Dislocation
Slipped capital femoral epiphysis
Steroids
ETOH
Perthes
Coagulopathy
Sickle cell

6

Hip Imaging

X-rays: weight bearing if possible
Bone scan
CT
MRI
MRI arthrogram

7

Differential Diagnosis for Anterior Hip Pain

Osteoarthritis
Inflammatory arthritis
Muscle/tendon strain
Tendinitis
Femoral neck stress fracture
Obturator/ilioinguinal nerve entrapment
Osteitis pubis
Acetabular labral tear

8

Differential for Pre-Pubescent Individuals

Legg Calve Perthes disease
Slipped capital femoral epiphysis (SCFE)

9

Differential for Hip Pain of Adolescence

Avulsion fracture
Hip pointer
Contusion
Myositis ossificans
Femoral neck stress fracture

10

Differential of Hip Pain for Older Individuals

Femoracetabular impingement (FAI)
Osteoid osteoma
ITB syndrome
Trochanteric bursitis
Piriformis syndrome
Iliopsoas bursitis
Meralgia paresthetica
Osteoarthritis

11

Clinical Presentation of Iliopsoas Bursitis or Tendinosis

Pain & snapping in groin & anterior hip with hip flexion & crunches

12

Evaluation of Iliopsoas Bursitis or Tendinosis

H&P
X-ray
MRI
R/o other diseases

13

Treatment of Iliopsoas Bursitis or Tendinosis

Relative rest
Stretch
NSAIDs
PT
Injection, surgery??

14

Clinical Presentation of Acetabular Labrum Tear

Hip pain
Deep click
Catching sensation
Worse with deep flexion & raising from seated position
Decreased ROM

15

Evaluation of an Acetabular Labrum Tear

H&P
Pain with hip flexion, add, and axial load
X-rays
MRI arthrogram

16

Treatment for Acetabular Labrum Tear

PT to maximize ROM & strength
Corticosteroid injection?
Surgery?

17

Clinical Presentation of Trochanteric Bursitis

Lateral hip pain
Gradual onset
Can't lie on side

18

Evaluation of Trochanteric Bursitis

H&P
Tender to palpation over lateral thigh
Pain with Ober test
X-ray??

19

Treatment of Trochanteric Bursitis

Ice
NSAIDs briefly
PT: stretch IT band, strengthen hip muscles
Evaluate biomechanics
Corticosteroid injection

20

Clinical Presentation of Osteoarthritis of the Hip

Progressive hip & groin pain
Decreased ROM

21

Evaluation of Osteoarthritis of the Hip

H&P
Weight bearing x-rays

22

Treatment of Osteoarthritis of the Hip

PT
Tylenol > NSAIDs
US guided hip injection
Surgery

23

Clinical Presentation of Pubic Ramus Stress Fracture

Pain with jumping, running, stretching, & landing
Increased pain with activity

24

Evaluation of Pubic Ramus Stress Fracture

Point-tender superior pubic ramus
Non-tender adductors
Normal physical exam
X-ray
Bone scan
MRI

25

Treatment of Pubic Ramus Stress Fracture

Relative rest
Non-painful activity
Slowly increase
Address other fractures

26

Other Problems Associated with Stress Fractures Besides Overuse

Estrogen deficiency
Hormonal abnormalities
Nutritional deficiencies
Metabolic disorders

27

Presentation of a Stress Fracture

Gradual onset
Increased intensity/duration of activity
Change in footwear
Change in surface

28

Evaluation of Stress Fractures

H&P
X-rays
Bone scan
MRI

29

Key to Treatment of Stress Fractures

Pain free activity

30

Treatment of Inferior Hip, Pelvis, or Thigh Stress Fractures

Non-painful activity
Gradual return to activity