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NMS3 Final


Classic presentation of a hip fracture? Elderly patient with hip pain who is unable to bear weight. Hx of fall onto hip.
Causes of hip fractures? Osteoporosis, Pagets, Endocrinopathies, multiple myeloma, renal osteodystrophy, trauma, benign/malignant tumors
How to you evaluate for a hip fracture? History, palpated, X-ray
What are the two types of hip fractures? Intracapsular and extracapsular.
Which type of hip fracture is twice as likely to develop complications? What are those complication? Intracapsular. Osteonecrosis, nonunion, thromboembolic disease, osteomyelitis.
How do you treat a hip fracture? Referral.
Classic presentation of a stress fracture of the hip? Young, active, pain that is insidious and worse with weight bearing, often anterior and deep.
What is the cause of a stress fracture of the hip? Repetitive stress
How do you evaluate a stress fracture of the hip? May have end-range restriction and pain with flex and internal rotation. Bone scan if suspect b/c Xrays are often inconclusive.
How do you manage a transverse stress fracture of the hip? It's potentially unstable, may lead to complications, referral for pin recommended.
How do you manage a compression stress fracture of the hip? These are usually stable, rest and elastic support for 2 weeks, then non-weight bearing exercses (bike/swim), approx 4-6 week healing time
What is the classic presentation for a congenital hip dislocation? Newborn that is diagnosed on physical exam, and child with non-painful limp and diminished active abduction.
What is the cause of a congenital hip dislocation? Acetabular deformities, Capsular tightness or looseness.
What is the evaluation of a congenital hip dislocation? Ortolani's click test (reduces), and Barlow's maneuver (dislocates).
How long can it take before you can see congenital hip dislocation on x-ray? 4-6 weeks
What are the findings on x-ray for congenital hip dislocation? Underdeveloped proximal femoral epiphysis, lateral displacement of femur, Increased inclination of acetabular roog.
How is congenital hip dislocation managed in infants up to 6 mo. old? Pavlik harness that holds hips in flexion and prevents adduction.
How is congenital hip dislocation managed in 6-15mo old children? 2-3 months in a spica cast.
How is congenital hip dislocation in toddlers and children who are not responding to close reduction? Open reduction is needed.
What is the classic presentation of a Posterior traumatic hip dislocation? 90% of all sports dislocations. Acute injury of force to a flexed and adducted hip. Post injury hip held in flex, add, internal rot. Severe pain. Posterior leg may have sciatic nerve damage.
What is the classic presentation of an anterior traumatic hip dislocation? Acute injury force to an extended externally rotated leg. after injury hip held in flex, abduction, internal rotation.
Whats an example of a posterior traumatic hip dislocation injury? Bottom of a pile.
What's an example of an anterior traumatic hip dislocation injury? Hit from behind while diving for the big catch.
How do you evaluate for a traumatic hip dislocation? History and observation are usually enough.
How do you manage for a traumatic hip dislocation? Refer. Relocation under anesthesia, rest, period of non-weightbearing, gradual return to weight bearing.
What is the classic presentation of slipped capital epiphysis? Most common hip condition in adolescents. overweight. minor traumatic history. knee pain only. chronic could be gradual hip pain and antalgia. Could also be acute.
What are causes of slipped capital epiphysis? 50% trauma, hormonal influences may play a role in obese or tall and fast growing adolescents.
How do you evaluate a slipped capital epiphysis? May not detect on physical exam. X-ray needed for definitive diagnosis. Bilateral view needed because 10-20% of cases are in opposite hip.
How do you manage a slipped capital epiphysis? Surgical pinning, adjusting is CONTRAINDICATED! prevent further slipping.
What is the classic presentation for Legg- Calve- Perthes Disease? Male 4:1, 80% b/t 4-9yo. mild hip pain and limp insidious onset. Bilateral 10% of the time. 17% with trauma. 15% knee pain only. Past history of trauma or metabolic disease.
What is the cause of Legg- Calve- Perthes Disease? undetermined disruption of vascular supply to femoral head. AVN, subcapital fractures, posterior hip dislocations, long-term steroid use, hyperlipidemia, alcoholism, pancreatitis, hemoglobinopathies.
How do you evaluate for Legg- Calve- Perthes Disease? X-ray for definitive diagnosis. Limited hip abduction and internal rotation secondary to spasm, Trendelenburg positive, Atrophy and leg length inequality over time.
How does Legg- Calve- Perthes Disease look on an X-ray? Small radio-opaque femoral nucleus, crescent sign, fragmentation, re-ossification with remodeling, deformity of femoral head.
How do you manage Legg- Calve- Perthes Disease in children <4 with <1/2 femoral head involvement? Generally agreed require no treatment. Medical consultation.
How do you manage Legg- Calve- Perthes Disease in children 4-5 with good motion (abduction >30 degrees)? may not require surgery. Medical consultation.
How long does Legg- Calve- Perthes Disease usually take to heal? 18 months.
What is the classic presentation of Trochanteris Bursitis? well-localized lateralized hip pain with minor limp, 40-60 yo, radiation pain occassionally to low back, lateral thigh and knee. Often unable to sleep on involved side.
What are the 3 bursae of the hip. 2 major, 1 minor? Major: sub-gluteus medius, Sub-glut maximus. Minor: gluteus minimus.
What are causes of trochanteric bursitis? any condition leading to altered hip mechanics. Degree of discomfort proportional to activity.
How do you evaluate for trochanteric bursitis? Tenderness and sometimes swelling over greater trochanter. Palpation may cause "jump sign". Pain may increase with hip motion which may include patrick's and/or Ober's test.
How do you manage trochanteric bursitis? correct bio-mechanics and adjust. Decrease inflammation with (ice, electric stim, stop irritating factors). Stretch of hip abductors, Be careful with side posture positioning.
What is the classic presentation for Iliopectineal and Iliopsoas Bursitis? sever, acute anterior hip pain with antalgic gait. Radiating pain down anterior leg. Hip flexion and external rotation may relieve pain.
What is the cause of Iliopectineal and Iliopsoas Bursitis? hip flexor tightness, repetitive activity.
How do you evaluate for Iliopectineal and Iliopsoas Bursitis? Deep anterior tenderness 1-2 cm below middle 1/3 of inguinal ligament. Located by pt supine, hip flexed to 90 and palpate over lesser trochanter. Resisted hip flexion (iliopsoas testing) will be painful.
How to you manage Iliopectineal and Iliopsoas Bursitis? Rest and stretch hip flexors, myofacial release of iliopsoas..gently!
Classic presentation of Ischial bursitis (bleacher butt)? patient presents after sitting for long periods on hard surfaces. Or from excessive hamstring contraction. May have referral down posterior leg similar to sciatic.
Cause of Ischial bursitis (bleacher butt)? Direct blow to bursa (acute/chronic) or prolonged irritation. Chronic hamstring strains and occassionally prolonged standing.
How do you evaluate for Ischial bursitis (bleacher butt)? Patient will lean toward affect side with accompany shortened stride length. Toe standing will be painful. Tenderness over ischial tuberosity. SLR or patricks will reproduce their pain.
How do you manage Ischial bursitis (bleacher butt)? padding/pillow to sit to relieve pressure on area. Avoid activity.
What are the classic presentations for Snapping hip syndrome? Hip snapping often without pain. location is a good indicator of structural cause. If traumatic consider acetabular labrum tear.
What are the causes of Snapping hip syndrome? Tendons that snap over bony prominences or bursae. Rarely due to loose body in joint-would also have mechanical restricted movement.
How do you evaluate for Snapping hip syndrome (lateral hip)? Occurring on hip flexion with adduction. Most often iliotibial band snapping at greater trochanter.
How do you evaluate for Snapping hip syndrome (anterior hip)? With active extension of flexed, abducted and externally rotated hip. Iliopsoas tendon or iliofemoral ligament over anterior joint capsule.
How do you evaluate for snapping hip syndrome (posterior hip)? In the gluteal region. Biceps femoris tendon over ischial tuberosity.
How do you manage Snapping hip syndrome? Usually its benign and positional dependent. Strengthing involved muscle. Stabilization. If strengthing muscle doesnt help then try stretching.
What is the classic presentation of Transient Synovitis? Child <10 complains of acute or gradual onset of inguinal pain with difficult bearing weight. Often the hip is held in external rotation, adbuction, and flexion. Trauma is uncommon. Often a prior viral infection.
What are the causes of Transient Synovitis? Often unknown. may be an idication of rheumatoid disease or ensuing Legg-Calve- Perthes disease.
How do you evaluate for Transient Synovitis? Decreased internal rotation. general, nonspecific tenderness/pain. Bone scan can be diagnostic but low specificity. Ultrasound may determine fluid in joint. Primary ddx is septic hip, so aspiration may be needed.
How do you manage Transient Synovitis? Resolution over several weeks with non-weight bearing period followed by crutch use over several weeks.
What is the classic presentation for Adductor Strain (Groin pull)? Usually an athele involved in kicking, sprinting or jumping. Sudden incapacitating pulling sensation in the groin.
What are the causes of Adductor Strain (Groin pull)? Sudden contraction of the adductors from a stretch position of hips abduction or flexion. Most common is adductor magnus.
How do you evaluate for Adductor Strain (Groin pull)? Tenderness in adductor muscle group or at pubic attachment. resisted adduction is painful.
How do you manage a Adductor Strain (Groin pull)? Elastic figure of 8 strapping with hip in slide extention, internal rotation which helps adductor in normal walking for a week or so. Gentle stretching with slow return to activity.
What is the classic presentation for Hamstring Strain? Athlete or weekend warrior. Sudden pull or pop in posterior thigh after forceful knee extension.
What are the causes of Hamstring Strain? Over contraction of hamstrings when in a position of stretch. Avulsion of ischial apophysis possible in adults.
How is a Hamstring Strain evaluated? Palpatory tenderness in the distal muscle belly associated with pain upon resisted knee flexion. Degree of injury related to pain level, pull ruptures are extremely painful.
How is a Hamstring Strain managed? Rest, ice, crutches for several days. Gentle stretching when tolerable. Long-term goal of restrengthening when 75% of normal ROM returns. Focus on prevention with stretching pre/post events and balance strength with quads.
How long does it take to return to normal activity with a Hamstring Strain? 1st degree- within a couple weeks. 2nd degree- 4-6 weeks. full ruptures- 3-4 months.
What is the classic presentation of a quadriceps sprain? Sudden pulling pain in anterior thigh after attempt to sprint, missing a kick, sudden stop.
What are causes of a quadriceps sprain? Sudden contraction of quads. Could be predisposed due to tight quads, lack of stretching, muscular imbalance with quads of opposite leg, short leg.
How is a quadriceps sprain evaluated? Pain upon active knee extension. With moderate-severe damage= inability to isometriclly contract quads with knee extended. Possible rupture= palpable defect or muscle mass with resisted knee extension.
How is a quadriceps sprain managed? Ice, neoprene or elastic support wrap. Crutches for a length of time-depends on extent of injury. Stretching as soon as tolerable. Surgery for complete rupture.
What is the classic presentation for meralgia paresthetica? numbness or tingling in the lateral thigh. No pain or loss of function
What are the causes of meralgia paresthetica? compression of lateral femoral cutaneous nerve at or slightly below the inguinal ligament due to prolonged sitting. Overweight and carries objects in front pockets. Fluid retention due to diabetes or preg.
How is meralgia paresthetica evaluated? If mechanical/non diabetic: Increased symptoms with pressure over superficial nerve (1 inch below ASIS). Increased ssx with passive hip extension or forced hip flexion producing traction and compression. Hyperesthesia of anteriolateral thigh.
How is meralgia paresthetica managed? Removed cause of compression. Avoid sitting longs times. lose weight. Keep objects out of pockets. modify clothing. Check for diabetes.
What is a hip pointer? Results from a contusion to the iliac cress or from a separation of the muscle fibers from the iliac crest.
Created by: 774708205
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