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P- 2 - Ortho 2 > 4 - Hip (1) > Flashcards

4 - Hip (1) Flashcards

1
Q

What factors are going to largely drive your hip DDx?

A

Age and history

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2
Q

What is the deepens acetabulum?

A

Peripheral atachment (kinda like an additional labrum); assists in constraint of the femoral head at extremes of motion

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3
Q

Without the labrum, the femur would displace:

A

Laterally

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4
Q

The labrum limits:

A

Cartilage deformation through sealing mechanism

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5
Q

Intra-articular causes of hip pain?

A 
Labral tears
Loose bodies
Femeroacetabular impingement 
Capsular laxity
Ligamentum teres rupture
Chondral damage
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6
Q

Extra-articular causes of hip pain:

A 
Iliopsoas tendonitis 
Iliotibial band
Gluteus medius or minimus 
Greater trochanter bursitis
Stress fx (common in IET)
Adductor strain
Piriformis syndrome
Sacroiliac joint pathology
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7
Q

Trendelenburg gait suggests:

A

Abductor weakness

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8
Q

Antalgic gait suggests:

A

Traumatic injury, synovial inflammation

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9
Q

What is the normal hip internal rotation ROM:

A

20 to 35 degrees

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10
Q

What is the normal hip external rotation ROM:

A

30 to 45 degrees

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11
Q

What does the Straight Leg Raise Test evaluate for?

A

Lumbar pathology

Passive test

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12
Q

A leg length difference of more than ___cm is considered problematic

A

2

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13
Q

Normal hip flexion (degrees)?

A

120

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14
Q

Normal hip abduction (degrees):

A

30 to 45

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15
Q

Normal hip adduction (degrees):

A

20 to 30

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16
Q

The passive supine rotation test (Logroll) tests for:

A

Intra-articular hip pathology

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17
Q

The straight leg against resistance (Stinchfield) test evaluates for:

A

Psoas strength and intra articular pathology

Positive test is pain with resistance

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18
Q

What is FADDIR?

A

Flexion adduction internal rotation

Assesses for anterior labral tear, FAI Cam or Pincher, Chondral)

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19
Q

What is FABER?

A

Flexion abduction external rotation

Tests for Superior labral injury, FAI w/diff knee height, SI joint

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20
Q

What is the Ober test?

A

Passive Adduction Test

Evaluates for: tensor fascia lata, gluteus maximus and medius contractures, IT snapping, greater trochanter bursitis

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21
Q

Craig’s Test evaluates:

A

Femoral anteversion

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22
Q

Muscles that correspond to iliac crest:

A

Tensor fascia lata

Abdominal muscles

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23
Q

Muscles that correspond to ASIS:

A

Sartorius

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24
Q

Muscles that correspond to AIIS:

A

Rectus femoris

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25
Q

Muscles that correspond to the greater trochanter

A

Gluteus medius

Gluteus minimus

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26
Q

Muscles that correspond to lesser trochanter

A

Iliopsoas

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27
Q

Muscles that correspond to ischial tuberosity

A

Hamstring

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28
Q

Muscles that correspond to symphysis

A

Adductors

29
Q

Distance from pubic symphysis to tip of the coccyx should be:

A

1 to 3 cm

30
Q

If acetabular inclination is greater then 10 degrees:

A

These patients are subject to structural instability

31
Q

If acetabular inclination is less than 0 degree:

A

These patients are at risk for pincer type femoral acetabular impingement

32
Q

A lateral center-edge angle of less than 25 degrees indicates:

A

Inadequate coverage of the femoral head

33
Q

What is the Tonnis Grade?

A

Assesses severity of osteoarthritis of the hip

Grades 0 through 3 (3 is worst)

34
Q

In a cross table (lateral view), a ratio of less than 0.17 suggests:

A

A cam deformity

35
Q

Indications for hip MRI?

A

Occult femoral neck fx

Stress fx

Osteonecrosis of the femoral head

Labral tears

Persistent pain

Neoplasm (soft tissue or bone)

36
Q

What are the four appearances of the hip labrum on MRI?

A

Triangular
Round
Irregular
Absent

37
Q

What is the primary goal of the hip exam?

A

Distinguish between hip pathology and referred etiology

38
Q

What is the secondary goal of the hip exam?

A

To distinguish between intra and extra articular pathology

39
Q

What direction is MC for hip dislocations?

A

Posterior

40
Q

What injuries are commonly associated with hip dislocations?

A

Head
Intra-abdominal
Chest

41
Q

How does an anterior hip dislocation appear?

A

Leg is flexed, abducted, and externally rotated

42
Q

How does the posterior hip dislocation appear?

A

Leg flexed, adducted, and internally rotated (and often shortened)

43
Q

What must be assessed with hip dislocations?

A

Function of sciatic and femoral nerves

44
Q

What type of nerve palsies are common to hip dislocations?

A

Sciatic nerve palsies

45
Q

With hip dislocations, associated fractures of the _____ are common

A

Acetabulum

46
Q

A delay in reduction of a dislocated hip can lead to:

A

Osteonecrosis

47
Q

Why is ongoing evaluation so important for the hip dislocation patient even years after reduction?

A

Osteonecrosis may not become apparent until several years later

48
Q

Postraumatic arthritis is the result of:

A

Severe impact of the cartilaginous surfaces

Chronic pain can occur

49
Q

Head of the femur is supplied by: (blood)

A

A branch of the obturator artery

50
Q

The neck, greater trochanter, and proximal shaft of the femur are supplied by: (blood)

A

Lateral and medial femoral circumflex arteries

51
Q

Risk factors or osteonecrosis of the femoral head

A

Long-term corticosteroid use

Alcoholism

Sickle cell anemia

Trauma

RA or SLE

52
Q

Osteonecrosis patient presentation:

A

Indolent onset of dull ache or throbbing pain in the groin, lateral hip, or buttock

Decreased ROM

Possibly antalgic gait

53
Q

If you suspect osteonecrosis, order:

A

MRI

54
Q

He said he won’t test us on this, but just in case, what does the Ficat Classification refer to?

A

Grading system for osteonecrosis of the hip

Grades 0-IV

55
Q

If atraumatic osteonecrosis of the hip is discovered, it’s probably a good idea to:

A

Get an MRI of the contralateral hip (80% bilateral involvement)

56
Q

Tx for osteonecrosis of the head of the hip?

A

Drill a hole in the femoral head - may stimulate revascularization

57
Q

If osteonecrosis of the hip is Grade III-IV, tx is:

A

THA (total hip arthroplasty)

Trailer hitch

58
Q

Describe transient osteoporosis:

A

Uncommon idiopathic condition

Middle-aged men
Third trimester pregnancy

Spontaneous resolution 6-12 mos

59
Q

Transient osteoporosis imaging?

A

Plain films show diffuse osteoporosis of the femoral head and neck

MRI shows bone marrow edema
T1 - decreased signal intensity
T2 - increased signal intensity

60
Q

What is Meralgia Paresthetica?

A

Compression injury or entrapment of the lateral femoral cutaneous nerve within the soft tissue tunnel as it exits the pelvis just medial to the ASIS

61
Q

Meralgia paresthetica presentation:

A

Pain burning, hypoesthesia over the lateral thigh

No motor dysfunction as these are sensory nerves that are affected

62
Q

How is the pain of meralgia paresthetica sometimes described?

A

Electric jab each time the hip extends

63
Q

Tx for meralgia paresthetica

A

Lose weight

Remove source of compression (i.e. tight waistband) (see above)

Gabapentin can be useful

64
Q

What is trochanteric bursitis?

A

Inflammation and hypertrophy of the greater trochanteric bursa

Pain over the greater trochanteric bursa, worse with rising from a seated or recumbent position

Unable to lie on affected side

65
Q

Trochanteric bursitis - increased pain with: (PE)

A

Hip adduction or abduction

Passive internal rotation

Resisted hip abduction test also causes pain

66
Q

Tx for trochanteric bursitis:

A

NSAIDs
Activity mod
Iliotibial band stretching
Use of cane (short term)

Steroid injection can be helpful to relieve symptoms

Surgery rare

67
Q

If you see lesser trochanter avulsion fracture, think:

A

Metastatic dz

68
Q

Ive just written a song about tortillas

A

Really its more of a rap…

P- 2 - Ortho 2 (5 decks)

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