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Hip
Orthopedics
| Question | Answer |
|---|---|
| Hip Exam: Hx | Trauma, OA, infection |
| Hip Exam: Inspection | Gait; Scars; Swelling |
| Hip Exam: Palpation | Iliopsoas bursa; Gr trochanter/ bursa; Ant iliac spine; Ischial tuberosity/ bursa |
| Hip Exam: ROM / Strength | Hip flex/ ext; Abd/ addn; Int / ext rotation; resisted ROM for strength |
| Gait Analysis: Width of the gait: | Normal =2-4 in heel to heel; Wide based gaits = instability |
| Gait Analysis: Ctr of gravity: | Normal gait oscillates no more than 2 in. vertically; pain & mx weakness => pt shifts COG over affected hip |
| Gait Analysis: Knee position: | S/B flexed in all phases of stance ex. heel strike; pt hikes up affected leg or swings it out & around to front |
| Gait Analysis: Pelvic shift: | pelvis & trunk shift laterally 1 in. to wt bearing side |
| Gait Analysis: Pelvic shift: in gluteus mx weakness: | lateral shift is accentuated to the side involved |
| Gait Analysis: Length of step: | Ave length is 15 in. With age/ fatigue/ pathology: step is shortened |
| Gait Analysis: Cadence: | Ave cadence is 90-120 steps/ min. With age/ fatigue/ pain: cadence is decreased to conserve energy |
| Gait Analysis: Pelvic rotation: | Normal during swing phase = 40 degrees in leg that is moving forward; if pain or stiffness in hip, pelvis will not rotate normally |
| Antalgic gait: | Limp from pain |
| Wide based gait = | Instability from cerebellar disease or peripheral neuropathy |
| Steppage gait = | Weak ankle dorsiflexors results in increase knee & hip flexion |
| Flat foot gait = | Gastrocnemius/ Soleus weakness (S1-S2 radiculopathy) |
| Back Knee gait = | Quadriceps weakness forces pt to push on thigh w/ hand to try to lock knee in stance phase |
| Trendelenberg (abduction lurch) gait = | Gluteus medius weakness (L5); pt lurches toward weak side to place COG over hip |
| Extensor lurch = | Gluteus max weakness (S1); pt thrusts thorax posteriorly to maintain hip extension |
| Foot Drop = | Weakness of tibialis anterior (L4) |
| Pelvic Films: Pelvic ring fx is commonly: | disrupted in 2 places |
| Pelvic Films: AP view: Inspect: | inner & outer main ring cortices; 2 small obturator rings; acetabulum for step off; SI joint spaces s/b equal; symph pubis should align, < 5mm joint space |
| Pelvic Films: CT if: | fx identified or suspected |
| High energy pelvis fx assoc with: | organ & vascular laceration |
| Hip Films: Order: | AP pelvis w/ both hip joints; Lateral of affected hip |
| Hip Films: Femoral Neck | Smooth cortex w/ no buckle, step or ridge; Normal trabecular pattern; No transverse sclerotic lines |
| Hip Films: Intertrochanteric Region | Cf to other hip; No lucency across the bone; No cortical defect |
| Hip fx: prevalence | 90% in > 65 y.o. pt |
| Hip fx: Sx: | Pain, shorter, rotated leg |
| Hip fx: Causes: | Falls, MVA |
| Hip fx: Risk factors: | Age, sex, nutrition, meds |
| Hip fx: Complications: | PE, pneumonia |
| Femoral neck fx & hip dislocations prone to: | AVN |
| Hip fx: Rx: | Screws, partial or total hip replacement |
| Hip fx: Prevention: | Calcium, activity, exercise, safety |
| Femoral Neck fx: Garden type I | Incomplete fx w/ valgus impaction; ORIF |
| Femoral Neck fx: Garden type II | Complete fx w/o displacement; ORIF |
| Femoral Neck fx: Garden type III | Complete fx / partial displacement; Prosthetic replacement |
| Femoral Neck fx: Garden type IV | Complete fx w/ total displacement; Prosthetic replacement |
| Femur fx: tx: Femoral neck | ORIF |
| Femur fx: tx: Intertrochanteric | ORIF |
| Femur fx: tx: Subtrochanteric | Open or closed reduction; Interlocking nail or screw |
| Femur fx: tx: Femoral shaft | Closed reduction & Nail |
| Femur fx: tx: Distal Femur | ORIF with plate & screws |
| Femoral Stress fx: prevalence | Thin, female endurance athletes (AAO) |
| Femoral Stress fx: Sx | Groin pain with running, progressing to ADL pain |
| Femoral Stress fx: PE: | Pain limits extremes of int. & ext. rotation |
| Femoral Stress fx: Dx: | Xray may be negative; Bone scan pos in 2-8 days |
| Femoral Stress fx: most common area = | Femoral neck |
| Femoral Stress fx: Rx: All displaced fx: | ORIF |
| Femoral Stress fx: Rx: Non displaced medial fx: | NWBA 6-8 weeks |
| Femoral Stress fx: Rx: All lateral fx: | ORIF |
| Hip Dislocation: prevalence | 90% are posterior |
| Hip Dislocation: PE: | hip flexed, adducted & internally rotated |
| Hip Dislocation: Dx/ tx: | Xray, pain relief, reduction; Poss N/V entrapment |
| Hip Dislocation: Allis Maneuver | Anesthesia; Assistant stabilizes pelvis w/ pressure on iliac sp; Gently flex hip to 90; apply progressive traction to extremity; apply adduction/ internal rotation |
| Hip Osteoarthritis: Sx | Achy pain over hip & ant groin; Loss of ROM |
| Hip Osteoarthritis: Xray | Decreased Joint space; Sclerosis; Osteophytes |
| Hip Osteoarthritis: RX | NSAIDs; Intraarticular injection; Hip replacement |
| Pelvic Apophyses = | Separation or widening of apophysis |
| Avulsion fx of Hip: ASIS: MOI | knee flexed & hip hyper-extended |
| Avulsion fx of Hip: ASIS: locus = | origin of Sartorius |
| Avulsion fx of Hip: ASIS: PE: | Pain over ASIS & with resisted hip flexion |
| Avulsion fx of Hip: ASIS: Dx: | Xray may reveal avulsion fx |
| Avulsion fx of Hip: ASIS: Rx: | RICE, progressive wt bearing, splint with knee flexed, ORIF for displaced fx |
| Avulsion fx of Hip: Ischial Tuberosity: locus = | Origin of hamstring |
| Avulsion fx of Hip: Ischial Tuberosity: MOI: | Vigorous hip flexion/ knee extension |
| Avulsion fx of Hip: Ischial Tuberosity: Sx: | Pain in buttock |
| Avulsion fx of Hip: Ischial Tuberosity: PE: | TTP at ischial tuberosity |
| Avulsion fx of Hip: Ischial Tuberosity: Rx: | RICE, progressive wt bearing, ORIF for displace fx |
| Groin Pull: MOI | Forced abduction during fall or collision |
| Groin Pull: Sx | Pain at origin of adductors |
| Groin Pull: PE: | Increased pain on resisted adduction |
| Groin Pull: DDx: | Hernia, torsion |
| Groin Pull: Rx: | Rest, ice, meds, stretching & strengthening |
| Hip Pointer injury: MOI | Direct blow to iliac crest |
| Hip Pointer injury: PE: | Swelling, tenderness, ecchymosis at iliac crest |
| Hip Pointer injury: Dx | Xray to R/O fx |
| Hip Pointer injury: Rx: | Ice, compression, pain meds; Progressive stretching |
| Legg-Calve-Perthes Dz: MOI | Avascular necrosis of the femoral head |
| Legg-Calve-Perthes Dz: prevalence | Child 2-11 y.o. |
| Legg-Calve-Perthes Dz: PE: | Loss of int / ext rotation |
| Legg-Calve-Perthes Dz: Xray = | Mottled femoral head |
| Legg-Calve-Perthes Dz: Rx: | Containment of femoral head with bracing / casting |
| Legg-Calve-Perthes Dz: Outcome: | self limiting, revascularization occurs in some |
| Slipped Capital Femoral Epiphysis: prevalence | Obese, pre-pubescent boys > girls; 40% are bilateral; most are idiopathic |
| Slipped Capital Femoral Epiphysis: Sx | Limp & hip, thigh, or knee pain; loss of IR, flexion, & abduction |
| Slipped Capital Femoral Epiphysis: Rx: | surgical fixation & non wt bearing |
| Snapping Hip Syndrome: MOI | 1: ITB snaps over Gr trochanter; 2: Iliopsoas tendon snaps over ASIS |
| Snapping Hip Syndrome: Sx: | Hip pain worse with activity; Snapping with hip flexion |
| Snapping Hip Syndrome: PE: | Pain with resisted hip flexion; Pain lateral with ITB, anterior with ASIS |
| Snapping Hip Syndrome: Rx: | Ice, meds, activity modification, S&S, injection |
| Trochanteric Bursitis: Sx | Pain over Gr trochanter when moving hip into full flexion; Extreme point tenderness; Pain at night lying on affected side |
| Trochanteric Bursitis: PE: | Moving hip from extension to flexion reproduces pain; poss crepitus over trochanter; TTP over affected greater trochanter |
| Trochanteric Bursitis: Rx: | Hip stretches, meds, injection |
| Transient Hip Synovitis: Sx | Benign, non traumatic, self limiting hip pain; lasts 3-7 days |
| Transient Hip Synovitis: must R/O: | septic hip; Legg-Calve-Perthes |
| Transient Hip Synovitis: Etiology | Inflam immune response to URI; inc synovial fluid in hip joint causing pain |
| Transient Hip Synovitis: PE: | Painful ROM; Joint held in flex, abd & ext rotation |
| Transient Hip Synovitis: Xray: | Capsular swelling |
| Transient Hip Synovitis: Lab: | WBC & ESR normal; Joint fluid aspiration is normal |
| Meralgia Paresthetica = | Lateral femoral cutaneous n. entrapment; Exits pelvis near ASIS |
| Meralgia Paresthetica: Sx: | Pain & burning over lateral thigh |
| Meralgia Paresthetica: Etiology: | Obesity, tight clothing, repetitive trauma/ activity |
| Meralgia Paresthetica: Rx: | Correct offending source; pain relief; chronic pain may need injection or surgical release |
| DDH = | developmental dysplasia of the hip |
| Hip Pain: Other Causes | DDH (Peds); Tumor; Osteosarcoma; Ewing; Metastatic dz; Multi myeloma |
| Positive Faber test suggests: | hip disease, iliopsoas spasm, or sacroiliac disease |
| Hip pain exam: | inspect, gait, palpate, Faber, SLR, pulses |
| Hip dx tests: | wt bearing xray; bone scan if suspect fx/necrosis; MRI TOC for fx not seen in xray, and necrosis/ infxn/tumor; u/s for kids effusion |
| osteonecrosis | Groin pain (less often thigh / buttock pain) = femoral head dz. Wt-bearing & pain w/motion, possibly rest/night pain; RF: steroids; dx: MRI sens > xray/scan |
| severe anterolateral hip tenderness, severe pain w/wt bearing, intolerance to passive hip rotation; xray normal (dx w/MRI) = | occult hip fx (nondisplaced fx of femoral neck) |
| Hip pain DDx | hip dysplasia; nerve entrapment; ankyl spondylosis; RA; lumbar disk pathology |
| Idiopathic AVN of femoral head; painless limp | L-C-P dz (3-12 yo, M>F); tx abduction bracing |
| High energy pelvis fx is often associated with: | organ & vascular laceration |
| Hip fx: prevalence | 90% in > 65 y.o. pt |
| Hip fx: Sx: | Pain, shorter, rotated leg |
| Hip fx: Complications: | PE, pneumonia; Femoral neck fx & hip dislocations prone to AVN |
| Femoral Stress fx: prevalence | Thin, female endurance athletes (AAO) |
| Femoral Stress fx: Sx | Groin pain with running, progressing to ADL pain |
| Femoral Stress fx: Dx: | Xray may be negative; Bone scan pos in 2-8 days |
| Femoral Stress fx: most common area = | Femoral neck |
| Femoral Stress fx: Rx: All displaced fx: | ORIF |
| Femoral Stress fx: Rx: Non displaced medial fx: | NWBA 6-8 weeks |
| Femoral Stress fx: Rx: All lateral fx: | ORIF |
| Hip Dislocation: prevalence | 90% are posterior |
| Hip Dislocation: PE: | hip flexed, adducted & internally rotated |
| Hip Dislocation: Allis Maneuver | Anesthesia; Assistant stabilizes pelvis w/ pressure on iliac sp; Gently flex hip to 90; apply progressive traction to extremity; apply adduction/ internal rotation |
| Hip Osteoarthritis: RX | NSAIDs; Intraarticular injection; Hip replacement |
| Avulsion fx of Hip: Ischial Tuberosity: MOI: | Vigorous hip flexion/ knee extension |
| Hip Pointer injury: MOI | Direct blow to iliac crest |
| Legg-Calve-Perthes Dz: Sx | Insidious groin/ thigh pain; Limp; Loss of int / ext rotation |
| Snapping Hip Syndrome: MOI | 1: ITB snaps over Gr trochanter; 2: Iliopsoas tendon snaps over ASIS |
| Snapping Hip Syndrome: PE: | Pain with resisted hip flexion; Pain lateral with ITB, anterior with ASIS |
| Trochanteric Bursitis: Sx | Pain over Gr trochanter when moving hip into full flexion; Extreme point tenderness; Pain at night lying on affected side; poss crepitus over trochanter |
| Trochanteric Bursitis: Rx: | Hip stretches, meds, injection |
| Meralgia Paresthetica = | Lateral femoral cutaneous n. entrapment; Exits pelvis near ASIS |
| Meralgia Paresthetica: Sx: | Pain & burning over lateral thigh |
| DDH = | developmental dysplasia of the hip |
| Hip Pain: Other Causes | DDH (Peds); Tumor; Osteosarcoma; Ewing; Metastatic dz; Multi myeloma |
| Displacement of proximal femoral epiphysis due to disruption of growth plate = | SCFE |
Created by:
Abarnard
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