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28 Cards in this Set
- Front
- Back
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small artery in ligamentum teres...
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-if u disrupt this can get avascular necrosis
-branch of the obturator |
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most common hip disorders
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1. osteoarthritis
2. rheumatoid arthritis 3. avascular necrosis 4. bursitis 5. sports related injuries |
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with hip complaints must always consider
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LOWER BACK
nt pain? sickle cell --> avascular necrosis |
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Obers test
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-lie on side with affected thigh up
-abduct the hip as much as possible, flex knee to 90deg and extend the hip -release thigh -if hip remains in abduction, this represents a shortening of the iliotibial band |
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trandelenburg test
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Stand on 1 leg for about 10 seconds
Positive Test if pelvis on unsupported side falls lower than supported side Indicates weakness in the Gluteus Medius muscle |
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true leg length
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-measure from ASIS to medial malleolus
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apparent leg length
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-Measured from the umbilicus to medial malleolus. Signifies a functional discrepancy
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antalgic gait
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-Reduced time on affected limb secondary to pain
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short leg gait
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-Patient appears to bob up and down as they cycle from long to short leg
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OSTEOARTHRITIS
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-most common form of hip arthritis!!!!
-wearing away of the cartilage and exposure of bone ->50 yo -risk factors: obesity, genetics, trauma, infx -sx: pain that worsens with activity, nt pain, stiffness, limited ROM |
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avascular necrosis
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-caused by temporary or permanent disruption of bl supply to femoral head
-causes: 1. trauma 2. alcohol abuse 3. steroids 4. sickle cell anemia -Sx: pain that usually begins mild and progresses to severe; pain at nt and with any kind of activity -50% develop AVN, will have it bilat |
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avascular necrosis dx and tx
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-Dx: xrays, MRI!
-Tx: core decompression, fibular vascularized bone graft, THA |
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Rheumatoid arthritis
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-chronic inflamm AI disorder that attacks the joints
-pain usually improve with use of the affected joint -pain worse in AM! |
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Bursitis
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-hip bursa sits over the greater trochanter and can become irritated or inflammed
-sx: pain over the greater troch, worse at nt when lying on affected side, pain may inc with stairs, squatting, and prolonged walking -Tx: activity mod, NSAIDs, steroids, bursectomy |
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Labral tears
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-ant hip pain
-worse with activity, inc with extension -clicking -Dx: palpable click on thomas test, MRI athrogram -Tx: conservative, hip arthroscopy |
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hip infx
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-usually presents in children, but can be seen at any age
-risk factors: 1. IVDU !!!!! 2. THA 3. DM 4. Skin infxs -joint is swollen, red, warm -inability to bear wt -all movements are painful -fever and chills |
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hip infx dx and tx
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-Dx: CBS, ESR, CRP, MRI, hip aspiration
-Tx: abx, I&D |
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Ankylosing spondylitis
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-genetic?
-presents in spine and first in the SI joint -1/4 ppl have sx outside spine -if sx present <16, hips are more likely to be involved -1/6 ppl with sx involving the hip will need THA -bamboo spine |
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Acetabular fx
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-most fxs assoc with high E trauma such as MVC or high vel falls
-most pts with have other injuries -Conservative Treatment consist of bedrest for 5-8 weeks with or without traction -Surgical Indications are loss of joint congruency, or joint symmetry |
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Femoral neck fx
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-usually occurs in elderly with minor trauma
-fx in young healthy require a lot of force -Mortality rate is between 20%-35% within 1 year in patients over 70 |
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femoral fx classification
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1. femoral neck: b/w femoral head and Greater troch; High incidence of damaging blood supply and causing AVN
2. intertrochanteric: most common, b/t lesser and greater troch; good prognosis 3. subtrochanteric: Involves femoral shaft below lesser trochanter |
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femoral fx classic pt
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-leg is shortened and externally rotated!!!
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hip dislocations
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-most common cause is direct trauma esp MVCs and falls
-a violent force is usually needed to dislocated the adult hip, where a child may sustain a dislocation with relatively minor trauma |
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post dislocation
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-most common
-usually caused by major force to flexed hip and knee -affected side is shortened and int rotated!!!!! -dx usually made on xray -tx: closed reduction with sedation -Complications include sciatic nerve injury, vascular injury, AVN, and post traumatic arthritis |
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ant dislocation
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-10% of dislocations
-caused by forced abduction that levers the hip anteriorly out of acetabulum -less cmmonly cause by direct blow to post hip -leg is externally rotated, abducted and extended -closed reduction with sedation |
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Hip arthroscopy
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-Majority of patients are younger and active, with a h/o hip pain not relieved by conservative measures
-can be diagnostic and therapeutic uses: synovectomy, loose body removal, labral tears, I&D of spetic joints -NOT indicated in the tx of progressive hip OA |
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complications of hip arthroscopy
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Chondral Injury
Pudendal and Sciatic Nerve injury with aggressive traction Injury to the lateral femoral cutaneous nerve from portal placeement Pressure ulcer to foot or perineum with excessive or prolonged traction Infection and PE are rare |
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total hip arthroplasty surgical considerations
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-for pain only!!!
1. pts age 2. activity level 3. wt 4. degree of pain and disability 5. non response to conservative tx |
