Hip/thigh Surgery I

Front 1

a. What is the immediate treatment for a muscle strain?

Back 1

i. RICE

Front 2

b. When do ROM exercise start in a muscle strain? What should you follow up with?

Back 2

i. After pain subsides
ii. Strengthening program

Front 3

c. When should a patient with a strained muscle return to full activities?

Back 3

i. When pain-free
ii. Full ROM
iii. Full muscle strength

Front 4

d. What is the goal of a muscle strain rehab?

Back 4

i. Prevention with proper warm-up
ii. Stretching
iii. Strengthening programs

Front 5

a. What limits displacement in apophyseal avulsion injuries?

Back 5

i. Periosteum

Front 6

b. When is surgery indicated for an apophyseal avulsion injury?

Back 6

i. >1 cm ischial avulsion OR
ii. 1-2 cm lesser trochanter avulsion
iii. Surgery is rarely indicated

Front 7

a. What is a hip pointer?

Back 7

i. Tenderness and ecchymosis w/ possible muscle spasm due to direct blow to iliac crest

Front 8

b. How do you tx a hip pointer?

Back 8

i. Protected weight bearing
ii. Stretching/strengthening
iii. Pad modification
iv. Possible injection for early return

Front 9

a. What causes a proximal thigh contusion? Where is it most common?

Back 9

i. Muscle compressed between external force and underlying bone
ii. Anterior thigh

Front 10

b. What is the tx goal of a proximal thigh contusion?

Back 10

i. Prevent loss of motion and myositis ossificans

Front 11

c. How do you tx a proximal thigh contusion?

Back 11

i. RICE in flexion
ii. Limited weight bearing until pain free ROM
iii. Stretching and strengthening
iv. Return when full ROM and strength recuperated

Front 12

a. What is myositis ossificans?

Back 12

i. Deep contusion misread by body
ii. Heals as fracture

Front 13

b. What is the usual presentation of myositis ossificans?

Back 13

i. Usually asymptomatic

Front 14

c. What is the tx for myositis ossificans?

Back 14

i. Excision after bone matures (6-12 mos.)
ii. Bone scan may help assess maturity

Front 15

a. In what direction does a hip usually dislocate?

Back 15

i. Posterior

Front 16

b. How will a patient present with a dislocated hip?

Back 16

i. Leg flexed
ii. Internally rotated
iii. Adducted

Front 17

c. What is the tx for a hip dislocation?

Back 17

i. Immediate reduction
ii. Careful neurovascular evaluation
iii. Post reduction CT and MRI

Front 18

d. When should a hip dislocation be examined for AVN?

Back 18

i. 3 months post-reduction

Front 19

e. What type of rehab is indicated for a hip dislocation?

Back 19

i. Crutches and partial weight bearing for 6 weeks
ii. Follow up with strengthening

Front 20

f. What are some complications of hip dislocation?

Back 20

i. AVN
ii. Neurovascular injury
iii. Post-traumatic arthritis
iv. Femoral head/acetabulum fractures

Front 21

g. When should you check for a fracture in a hip dislocation?

Back 21

i. Before reduction
ii. Use X-ray

Front 22

a. How will patients present with a labral tear?

Back 22

i. Groin pain
ii. Audible click
iii. Decreased ROM
iv. May not recall trauma/twisting injury

Front 23

a. What type of imaging may be helpful in labral tears?

Back 23

i. MRI arthrogram

Front 24

c. What is the tx for a labral tear?

Back 24

i. Partial weight bearing
ii. PT
iii. Surgery if necessary

Front 25

a. How do stress fractures present in high endurance female athletes?

Back 25

i. Eating disorders
ii. Irregular menses
iii. Stress fractures

Front 26

b. What should you keep in mind when a pt. presents with a non-obvious stress fracture?

Back 26

i. CONSTANT VIGILANCE

Front 27

c. What are the complications of stress fractures?

Back 27

i. Displacement
ii. AVN

Front 28

d. How will a patient with a hip stress fracture present?

Back 28

i. Groin pain with axial loading on heel strike
ii. Single leg hop

Front 29

a. What imaging is most effective to dx a stress fracture?

Back 29

i. MRI
ii. Bone scan secondary

Front 30

f. What are the classifications of stress fractures?

Back 30

i. Tension
ii. Compression

Front 31

g. How should you tx a compression stress fracture?

Back 31

i. Stable within 6 weeks of tx with rest
ii. No return to running until pain free
iii. No response=surgery

Front 32

h. What are the characteristics of a tension stress fracture? When is surgery indicated?

Back 32

i. Less stable, tend to displace
ii. Sx indicated to prevent displacement and osteonecrosis

Front 33

a. What causes osteitis pubis?

Back 33

i. Repetitive stresses at insertion of adductors and rectus abdominis

Front 34

b. How do osteitis pubis patients present?

Back 34

i. Pain in pubic region
ii. May radiate around hip
iii. Exacerbated with kicking, jumping, and running

Front 35

c. What may an x-ray show in osteitis pubis? What about a bone scan?

Back 35

i. Sclerosis or resorption
ii. Bone scan=hot area at pubis

Front 36

d. How do you tx osteitis pubis?

Back 36

i. NSAIDs
ii. Rest, stretching
iii. Passive ROM
iv. Steroid injection

Front 37

a. What is external snapping hip syndrome?

Back 37

i. Iliotibial band is extremely tight
ii. Physical exam will yield an audible “clicking’

Front 38

b. In what populations is external snapping hip syndrome most common?

Back 38

i. Runners on banked surfaces
ii. Women-- wider hips

Front 39

c. What is the Ober test?

Back 39

i. Abduct and extend leg
ii. If IT band is too tight, leg remains abducted and extended

Front 40

d. How do you tx external snapping hip syndrome?

Back 40

i. NSAIDs
ii. IT band stretching
iii. Steroid injection for bursitis
iv. Surgery if unresponsive

Front 41

e. What does internal snapping hip syndrome involve?

Back 41

i. Iliopsoas tendon

Front 42

f. Where does the snapping occur in internal snapping hip syndrome?

Back 42

i. Iliopsoas tendon snapping over femoral head or pelvic brim

Front 43

g. What condition is associated with internal snapping hip syndrome?

Back 43

i. Iliopsoas bursitis

Front 44

h. How do you tx internal snapping hip syndrome?

Back 44

i. NSAIDs
ii. Activity modification
iii. Iliopsoas stretching
iv. Tendon lengthening