Term
| What are the bones of the hip? |
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Definition
| innominate (ischium, illium, pubis), sacrum, coccyx |
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Term
| What are the joints of the hip? |
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Definition
| acetabularfemoral (hip), sacroiliac, pubis symphysis |
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Term
| When does acetabular fusion occur? |
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Definition
|
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Term
| What are the flexors of teh hip? |
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Definition
| iliopsoas, sartorius, rectus femoris |
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Term
| What are the adductors (medial) of the hip? |
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Definition
| gracilis, pectineus, adductor longus/brevis/magnus |
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Term
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Definition
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Term
| What extends the leg (posterios)? |
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Definition
| gluteus maximus, hamstrings |
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Term
| What is examined on the hip when the pt is in supine position? |
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Definition
| excessive le rotation, foreshortening |
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Term
| When performing a pe of the hip, what abnormality can be observed in the pt's stance? |
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Definition
| asis/dimples of venus level (also gluteus) |
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Term
| What are 5 bony prominences that can be palpated in the hip? |
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Definition
| iliac crest, asis, grtr troch, psis, ischial tuberosity |
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Term
| What soft tissue can be palpated in the hip? |
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Definition
| femoral a, troch bursa, inguinal ligament, lymph nodes, hernia, etc |
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Term
| What is the rom for flexion of the hip? |
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Definition
|
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Term
| What is the rom for extension of the hip? |
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Definition
|
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Term
| What is the rom for ABduction of the hip? |
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Definition
|
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Term
| What is the rom for ADduction of the hip? |
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Definition
|
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Term
| What is the rom for internal rotation of the hip? |
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Definition
|
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Term
| What are abnormalities you look for w/ variances in leg length? |
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Definition
| true v. apparent. tibial v. femoral (galeazzi sign) |
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Term
| If you break one bone in a ringed structure, for what else should you look? |
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Definition
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Term
| What are 3 neurological tests involving the hip? |
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Definition
| mm strength, sensation, dtr |
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Term
| At what spinal level do the top of the iliac crests intersect? |
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Definition
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Term
| What are 2 major nn of the hip? |
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Definition
| sciatic, obdturator n (pain in medial side of thigh toward knee, some pts w/hip pain can present w/no hip pain, just knee pain from obturator n) |
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Term
| Pt presents w/pain on medial part of knee. What outside the knee should you check? |
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Definition
| (pain in medial side of thigh toward knee, some pts w/hip pain can present w/no hip pain, just knee pain from obturator n) |
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Term
| What are the 3 major bursae in the hip? |
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Definition
| ischial, iliopsoas, greater trochanter |
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Term
| What is an antalgic gait? |
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Definition
| pt won't put weight on one leg b/c of pain- causes limp |
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Term
| What is the trendelenberg sign? |
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Definition
| stand on one leg, (testing gluteus medius on side you're standing on), hip falls on opposite side of weakness |
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Term
| Which level of the spine intersects the psis, midpoint of the si jt? |
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Definition
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Term
| Where are the sciatic n/piriformis located? |
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Definition
| half-way b/t ischial tub adn grtr troch |
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Term
| Most cases of ankylosing spondylitis involve which jt? |
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Definition
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Term
| Does ankylosing spondylitis occur more in males or females? What gene is involved? |
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Definition
| m>f; hla-b27 (caucasians) |
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Term
| What hip problem can occur w/pain in multiparous women? |
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Definition
| ostelitis condensans Ilii |
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Term
| To where can lumbar spine pathology radiate? |
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Definition
|
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Term
| When is a hip problem not diagnosed via exclusion? |
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Definition
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Term
| What are 3 goals of conservative tx of hip problems? |
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Definition
| relieve pain, maintain function, prevent deformity |
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Term
| How do you ms true deviations from nml leg length? |
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Definition
| ms from marks on bo sides (ie, asis and medial malleolus in bo legs). |
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Term
| Are hip injections easy/difficult? |
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Definition
|
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Term
| What is the galeazzi sign? |
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Definition
| ms femur differences versus tibial differences by having them sit w/legs bent at 90degrees to see if knee is higher or leg more protruded |
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Term
| What is the faber/patrick's test? |
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Definition
|
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Term
| What is saddle anesthesia? |
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Definition
| any type of anesthesia in places where you'd be sitting on a saddle |
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Term
| What is loss of articular cartilage leading to pain and loss of motion? |
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Definition
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Term
| Inflammation such as ra, sle, or psoriatic arthritis, can lead to what hip abnormality? |
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Definition
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Term
| The following secondary problems can lead to what problem with the hip? |
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Definition
| post-traumatic, avn, crystaline disease, infectious |
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Term
| How frequently do the sacrum and ilium move? Why is this? |
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Definition
| very rarely moves. large, practically immobile jt. irregular bone surfaces, ligamentous support |
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Term
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Definition
| sacroilitis and destruction on x-ray |
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Term
| Pt has anterior groin pain w/activity, radiating up to knee w/progressive limp, stiffness w/inactivity, and progressive loss of adls (shoe-tying, sitting, getting in and out of car) |
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Definition
|
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Term
|
Definition
| bamboo spine- ankylosing spondylitis |
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Term
| Pseudomonas from IVDA can cause what? |
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Definition
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Term
| On PE you find loss of rot and abdx of hip, difficulty w/slr, and flexion contracture |
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Definition
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Term
| How might you tx si jt problems? |
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Definition
| conservative tx prevails: nsaids, heat, rest, massage (injections difficult) |
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Term
| You see the following on xray: jt space narrowing (superolateral initially), osteophyte formation, sclerosis, and subchondral cysts. |
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Definition
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Term
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Definition
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Term
| What is one of teh few common medical emergencies w/hip problems? |
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Definition
| infections- can degenerate cartilage w/in 48 hrs |
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Term
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Definition
| deep in groin. if pt points to lateral part of hip, they're lying to you. |
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Term
| what are conservative tx options for djd of hip? |
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Definition
| T/NSAIDS. modified activity, weight loss, glucosamine, viscosupplementation, cane, pt (NWB) |
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Term
| What are sx tx options of djd of hip? |
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Definition
| osteotomy, arthrodesis, tha |
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Term
| what is pt's 2nd most satisfying surgery? |
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Definition
| total hip replacement. #1 cateract surgery |
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Term
| What are the 4 things you see typically w/ x-rays of djd of hip? |
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Definition
| jt space narrowing, osteophyte formation, sclerosis, subchondral cysts |
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Term
| Where does initial jt space narrowing of hip occur? |
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Definition
|
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Term
| What protective purpose does the pelvis serve? |
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Definition
| protective ring for bladder, urethra, rectum, and female reproductive organs |
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Term
| Every time you take a step, how much weight goes through each jt of your leg? what about running? |
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Definition
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Term
| What type of impact are necessary to cause fx? |
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Definition
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Term
| How effective is glucosamine in mild/moderate vs. severe hip arthritis? |
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Definition
| not any better for mild/moderate arthritis vs. placebo?. helpful statistically for severe. |
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Term
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Definition
| viscosupplementation from chicken/rooster comb, injected into jt space. not great clinically- used for grade 1/2 arthritis. not as helpful for extreme cases. you can have an immune rxn to it (10% have rxn after 2nd injection) |
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Term
| What is it called when you cut out a wedge of bone from the femur so that you have good cartilage left? |
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Definition
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|
Term
| What is it called when you fuse the hip jt w/screws? |
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Definition
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Term
| When could non-high energy impacts cause hip fx? |
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Definition
|
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Term
| What is often caused by hip fx? |
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Definition
| injury to other structures (ie bone/viscera) |
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Term
| What are 2 classifications of hip fx? |
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Definition
| stable (intact ring and not wb surface) or unstable (broken in 2 places) |
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Term
| What should you always suspect w/high velocity trauma such as mva, falls? |
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Definition
|
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Term
| What could occur w/access to retroperitoneal space w/pelvis fx? |
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Definition
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Term
| What should you consider prior to tx person w/injury to urethra/bladder? |
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Definition
| consider urethrogram or cystogram prior to foley |
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Term
| What is death of segment of bone d/t insufficient blood supply? |
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Definition
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Term
| What are 4 other names for avascular necrosis? |
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Definition
| osteonecrosis, aseptic necrosis, ischemic necrosis, legg-calve-perthes (kids) |
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Term
| How common is avascular necrosis? |
|
Definition
| common (up to 10% jt replacements) |
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Term
| What are 5 causes of avascular necrosis? |
|
Definition
| trauma (fx, dislocation), chronic etoh or steroids, embolism, atmospheric pressure, idiopathic [Bone TIME- the Bends, Trauma, Idiopathic, Meds, Embolism] |
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|
Term
| What will osteoarthritis of hand predict? or bmi>32? |
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Definition
|
|
Term
| What is graham's definition of a fx? |
|
Definition
| soft tissue injury in which bone is broken |
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|
Term
| Regarding avascular necrosis, what leads to osteopenia? |
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Definition
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|
Term
| Regarding avascular necrosis, what causes fragmentation? |
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Definition
|
|
Term
| How can fat or sickle cell cause avascular necrosis? |
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Definition
|
|
Term
| If you can't find cause of avascular necrosis, what is the risk? |
|
Definition
| 50% chance of developing it on contralateral side |
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|
Term
| What are the properties of bone that is progressively substituted bone in avascular necrosis? |
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Definition
|
|
Term
| What does death of all cellular elements in hip cause? what is retained? |
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Definition
| avascular necrosis. retained architecture |
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|
Term
| What age group tends to have avn? |
|
Definition
| younger population (20-40yo) |
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|
Term
| What imaging method for avn can produce an eariler dx? |
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Definition
|
|
Term
| What is the next step if x-ray is negative for avn? |
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Definition
|
|
Term
| what has a better negative predictive value for avn? how specific is this? |
|
Definition
| bone scan. very nonspecific |
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|
Term
| What are 2 things pts ingest that could cuase avn? |
|
Definition
| steroid use (thereapeutic or recreastional) or true etoh- use |
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|
Term
| Are fx or falls commonly seen w/avn? |
|
Definition
| 39-47? have hx of fx or fall |
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Term
| What is the best vie for x-ray for avn? What should you look for on x-ray? how is it used timewise for avn? |
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Definition
| often nml early on. lateral best view. look for loss of contour. can track progression |
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Term
| What is teh goal of avn management? |
|
Definition
|
|
Term
| What are s/e of corticosteroid hip injections? |
|
Definition
| lose fat in area, lose skin color in that area? |
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|
Term
| How must pts change activities w/avn? |
|
Definition
| stop offending activities, nwb until resolved, fosamax. |
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|
Term
| What imaging modality should be used to evaluate response of therapy w/avn? |
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Definition
|
|
Term
| What are 4 options for surgical intervention of avn? |
|
Definition
| core decompression (reduce pressure), free fibular graft, osteotomy, arthroplasty |
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Term
| What are types of arthroplasty w/avn? How effective is this? |
|
Definition
| hemi vs. total. high failure rate |
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|
Term
| What are tx options for bursitis? |
|
Definition
| rice and nsaids. pt for u/s, stretching. injection if accessible) |
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Term
| What imaging modalities are used for bursitis? |
|
Definition
| x-ray to r/o other pathology. mri rarely |
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|
Term
| Is hip bursitis usally widespread or localized? |
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Definition
| localized, occasional radiation. localized ttp |
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|
Term
| What are common sources of bursitis? |
|
Definition
| irritation (esp w/altered gait eg injury, sx, etc) or hardware |
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|
Term
| Where does weaver's bottom occur? |
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Definition
|
|
Term
| What are 3 common friction reducers w/bursitis? |
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Definition
| trochanteric, iliopsoas, ischial (weaver's bottom) |
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