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Hip Pathology
Dr. Brown's Lecture
60
Anatomy
Graduate
11/06/2010

Additional Anatomy Flashcards

 


 

Cards

Term

 

 

True or False

If the hip is injured, the lesion will usually be immediately perceptible during gait.

Definition

 

 

True

Term

 

 

What other areas need to be examine when the hip has been implicated?

Definition

 

Lumbar spine

SI joint

Knee

Term

 

 

Where does the hip refer pain to?

Definition

 

 

Lumbar Spine

SI joint

Knee

Ankle

Groin

Term

 

 

List 3 signs/symptoms of a femoral nerve injury

Definition

 

 

  1. Loss of sensation medial aspect of thigh and leg
  2. Loss of quadriceps deep tendon reflex
  3. Weakness of hip flexors and knee extensors

 

Term

 

Groin pain that increases during Valsalva that

is not relieved with rest is characteristic of

what nerve injury?

Definition

 

 

Obturator Nerve

Term

 

 

Injury to the obturator nerve will result

in weakness where?

Definition

 

 

ADductors

Knee flexion (gracilis)

ER (obturator externus)

Term

 

 

Rate of neural regeneration

Definition

 

~1" per month

Term

 

 

What gait may patients present with if obturator nerve is injured?

Definition

 

 

Waddle

(due to pain and weak adductors)

Term

 

 

Piriformis Syndrome

Definition

 

 

Entrapment of Sciatic Nerve by the Piriformis

Term

 

 

 

High Step Gait

Cause?

Definition

 

 

Possibly a result Sciatic nerve injury

 

(hamstrings and all muscles below will be affected)

Term

 

Patient Reports:

Burning pain in the sacral/gluteal region

Sensory alteration down the post. thigh and leg

 

Possible Cause?

Definition

 

 

Sciatic Nerve Injury

Term

 

 

Is Piriformis Syndrome more common in men or women?

Definition

 

 

Women

Term

 

 

Typical complaint with Piriformis Syndrome

Definition

 

 

Pain in the buttocks  and into the lateral calf and foot

Term

 

 

Treatment for Piriformis Syndrome

Definition

 

 

Gentle Stretches

Ice massage

Trigger Point Release

Neural tensioning addressed

Spray and stretch

Strain-counterstain

Term

 

 

Trochanteric Bursitis

 

 

Definition

 

  • Pt c/o deep aching pain in lateral hip, thigh, or groin
  • Pain usually made worse w/ stair climbing and sidelying on involved side
  • Palpation typically reproduces pain
  • Area usually warm to touch
Term

 

 

Typical gait with Trochanteric Bursitis

Definition

 

 

Shortened WB stage or an

ABducted leg to reduce pain

Term

 

Who is it common to see trochanteric bursitis in?

Definition

 

Runners who run on the same side of the road causing one leg to repetitively adduct

 

*overuse injury common in runners, bikers, and cross-country skiers

Term

 

 

Trochanteric Bursitis Treatment

Definition
  • Modalities: ultrasound/phonopheresis/ionto
  • ice
  • NSAIDS
  • ITB/TFL stretching
  • Biomechanical faults addressed
  • slow integration of PRE
Term

 

Snapping Hip Syndrome

External Snapping

Definition

 

  • Caused by tight ITB or Gluteus Max riding over greater trochanter
  • Snap or pop felt laterally
  • occurs during hip flex/ext and may be worse if trochanteric bursa is inflamed

 

Term

 

Snapping Hip Syndrome

Internal Snapping

 

Cause?

Definition

 

Iliopsoas tend snapping over ridge of lesser trochanter

OR

Iliofemoral ligament snapping over femoral head

OR

Stenosising tenosynovitis of iliopsoas insertion

Term

 

Snapping Hip Syndrome

Internal Snapping

 

When does snap/click occur?

Definition

 

 

when hip is extended from a flexed position, adducted and externally rotated

Term

 

 

Snapping Hip Syndrome

Intra-articular snapping

Definition

 

  • Caused by labral tear or loose body which may lead to degeneration
  • Worst with pivoting motions resulting in sharp groin/ant. thigh pain
  • passively, clicking may be felt when extended hip is adducted and externally rotated
Term

 

Snapping Hip Syndrome

 

Interventions/treatment during acute phase

Definition

 

 

Standard anti-inflammatory care

eliminate exacerbating activities

modalities may be used

Term

 

 

External Snapping Hip Treatment

Definition

Conservative Management

-Rest

-NSAIDS

-Static/dynamic functional assessment

treatment (ITB stretching)

 

*If conservative Tx fails, surgery may be appropritae

Term

 

Internal Snapping Hip Treatment

Definition

 

Conservative management

 

*If that doesn't work, surgery good option

Term

 

Intra-Articular Treatment

Definition

Somewhat controversial

 

-Conservative management including non-WB appears to completely resolve patients symptoms;

*NWB technique shows no signs of healing even though symptoms are relieved

 

-Arthroscopic debridement (good short-term outcomes)

Term

 

What is Femoraacetabular Impingement (FAI)?

Definition

Premature or improper collision of femoral head and acetabulum.

 

Causes decreased hip ROM and pain

Term

 

CAM FAI

Definition

 

 

result of excess bone that has formed around head and/or neck of femur

 

often occurs in pts with post-traumatic deformities, SCFE, coxa vara, and AVN

 

Males who are heavy day laborers

Term

 

 

Risk factors for FAI

Definition
  • Athletic activities, medical/family/social hx
  • Hx of trauma
  • Use of glucocorticoids
  • Previous surgery
Term

 

 

FAI treatment

Definition

 

Conservative

  • rest, activity modifications, NSAIDS
  • Mobilizations, strengthening and stretching
  • Gait mechanics, orthotics, improve core stability
  • Lifestyle modifications
  • Injection of anesthtetic
  • Surgery
Term

 

 

Structural Risk Factors for

Developing Labral Tears

Definition

 

 

Retroversion

FAI

Hip Dysplasia (leads to decreased joint SA)

Term

 

In US, most common location of labral tears

Definition

 

 

Anterior

 

*Ant. region undergoes higher forces than other areas

Term

 

PT for labral Repair

Definition

Month 1: tissue healing phase (RICE)

Month 2: early functional recovery (full AROM)

Month 3: late functional recovery (strength, balance)

Term

 

 

Clearest indication for hip arthroscopy

Definition

 

 

Loose Body

Term

 

Three phases of Hip Arthroscopic Rehab

Definition
  1. tissue healing, reduce inflammation, avoid muscle atrophy, PROM
  2. early strengthening and WB activities
  3. full strength, endruance, ROM
Term

 

 

Avascular Necrosis

Definition

 

Occurs when the blood flow to the femoral head is interrupted

 

the affected part of the bone begins to die

Term

 

Causes of AVN

Definition

Hip Fx, dislocation

diabetes

sickle cell disease

gout

prolonge/high doses of steroids

arthritis

Term

 

 

AVN Treatment

Definition

 

Rest and protected WB

Gentle exercise may help

Surgery (THA) is usually required

Term

 

 

Legg-Calve-Perthes

Definition

 

Self-limiting pediatric disorder

idiopathic

usually occurs in boys 4-10

insidious onset of limp with c/o of hip/knee pain

Term

 

Slipped Capital Femoral Epiphysis

(SCFE)

Definition

Adolescent hip disorder characterized by displacement of femoral head on neck

 

usually kids 11-13

pt often overweight

pt either late pre-puberty or early puberty

Term

 

SCFE

Direction of slippage?

Definition

 

Always posterior

Often medial

Term

 

Chronic SCFE

Definition

 

Occurs over several months

Term

 

Acute SCFE

Definition

 

Sudden femoral head displacement

Term

 

Chronic SCFE Presentation

Definition

 

Painful limp for several months

aching in thigh

change in hip ROM: loss of abd and IR

Term

 

Acute SCFE Presentation

Definition

 

Severe pain and limping

Guarded and restricted hip ROM

Often limited WB

Term

 

 

SCFE Treatment

Definition

 

Prompt surgical repair

Term

 

Predisposing factors for Hip DJD/OA

Definition

 

SCFE

Increased femoral anteversion

Leg length disparity

Long standing obesity

previous knee trauma/surgery

Rheumatoid Arthritis

Acetabular Dysplasia (shallow socket)

Term

 

 

Hip DJD/OA

Definition

 

Capsular tightness

 

*accelerates progression of dz through bringing joint continually close-packed position during normal functional activities like walking

Term

 

Hip DJD/OA

Management in Early Stages

Definition

Stretching: hip flexors, adductors, ITB, hamstrings, gastroc

Strengthening: closed chain, SLR all planes, walking, balance, aquatics

Determine underlying factors: obesity, leg length discrepancy, etc.

Term

 

Hemiarthroplasty

Definition

 

Replacement of only one side of a diarthrodial joint

 

often used for displaced fractures of femoral neck

Term

 

Total Hip Arthroplasty

Definition

 

replacement of acetabulum and femoral neck and head

Term

 

Common Indication for THA

Definition

Pain: with movement and at rest

functional limitations: capsular restriction/joint deformity cause decrease ROM

Loss of mobility: stiffness

Intra-articular disease: considered w/ above symptoms

Term

 

Contraindications for THA

Definition

 

Active infection

Inadequate bone stock

Youth

Obesity

High impact recreational activities

Arterial insufficiency

Neuromuscular disease

Mental Illness

Term

 

Benefits of Minimally Invasice

Surgical approach to THA

Definition

longer life of prosthesis

faster and less painful rehab

quicker return to work and daily activities

Reduced possibility of DVT or clots

Term

 

Anteriolateral THA outcomes

Definition

 

allows for more ROM post-surgery

lower dislocation rates

greater blood loss and longer operation time

increased likelihood of antalgic gait post-rehab

Term

 

 

Posteriolateral THA outcomes

Definition

 

Preserves glut. medius and minimus and vastus lateralis

Quicker normalization of gait

Higher dislocation rate post-surgery

Term

 

Types of Hip Fixations

Definition
Term

 

Posterior Lateral THA

Precautions

Definition
  • No combination of hip flex, IR, adduction
  • No hip flexion > 90 degrees
  • No hip IR
Term

 

Anterior Lateral THA Precautions

Definition
  • No hip ext beyond neutral
  • No bridging
  • No prone lying
  • No combined motions of ext and ER
Term

 

Minimally Invasive THA precautions

Definition
  • No combination of motions of flex, IR, and adduction
  • No hip flex > 90 degrees
  • No hip IR
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