Y2S2B2 Cs- Hip

Front 1

Inspection

Back 1

STS
Erythemia
Eccymosis
leg length discrepancy q

Front 2

palpation

Back 2

• Greater trochanter
• Pubic symphysis
• Sciatic notch
• Lumbar spine
• Femoral artery
• Inguinal ligament

Front 3

what do you want to do when you are testing ROM?

Back 3

Compare AROM/ PROM

Front 4

Muscle Strength
grade 5

Back 4

Complete ROM against gravity with full resistance

Front 5

Muscle Strength
grade 3

Back 5

complete ROM against gravity

Front 6

Muscle Strength grade 2

Back 6

complete ROM with gravity eliminated

Front 7

Muscle Strength grade 1

Back 7

evidence of slight contractility, no joint motion

Front 8

Muscle strength grade 0

Back 8

No evidence of contractility

Front 9

Hip and tingling on calf what dermatome

Back 9

L5

Front 10

Trendelenberg

Back 10

dont have good adductor strength

Front 11

Leg length discrepancy
- True

Back 11

measure bony point to point- ASIS to medial malleolus

Front 12

Leg length discrepancy
- Apparent

Back 12

umbilicus to medial mallelus

Front 13

Thomas Test

Back 13

for hip flexion contracture- should have arch to back but when flex hip and back should flatten out, if you lay one leg down, other should follow (otherwise test is positive)

Front 14

Ober's Test

Back 14

Tight IT band- knee should be able to go down and touch bed, if not IT band is tight

Front 15

L4 - Motor, Sensory and reflex

Back 15

motor- tibialis anterior
reflex- patellar tendon
sensory- Medial side of the foot

Front 16

L5 - Motor, Sensory, reflex

Back 16

Motor- Extensor Digitorum Longus
Reflex- none
Sensory - on top of the foot

Front 17

S1 - Motor, Senosory, Reflex

Back 17

Motor - Peroneus Longus
Reflex- Achilles tenson
Sensory - lateral side of the foot

Front 18

Ortolani test

Back 18

(O is out)
push hips out, put palm on knees and fingers on greater trochanter, abduct and lift up and feel ball slip into socket is positive

Front 19

Barlow test

Back 19

(B is back)
in but subluxatable, adduct and push backwards and if feel going back its positive

Front 20

Developmental Dysplasia of the Hip (DDH) Risk Factors

Back 20

females, 85% breech, family history, first born
--Increased incidence with first born with Oligohydramniosis

Front 21

DDH results of
- Ortolani Test
- Barlow Test
- Galeazzi Test

Back 21

-Ortolani test: elevation and abduction of femur hip (dislocated)

-Barlow test: adduction and depression of femur dislocates hip

-Galeazzi test: knee on affected side is lower

- Accentuation of skin folds of affected side

Front 22

+ Ortolani what do you do?

Back 22

get them to peds ortho ASAP (femur is out)

Front 23

after how many + Barlows do you send the kid to a peds ortho?

Back 23

2

Front 24

Septic Hip vs Transient Synovitis
- need 3 out of the 4 to be septic

Back 24

-WBC >12,000 cells/ml
-ESR >40
-Inability to bear weight (key feature)
-Fever >101.5 F

Front 25

Osteomyelitis

Back 25

-More common in children (bc growth plates aren’t closed)

-Rich metaphyseal blood supply

-Most common organism- Staph aureus except neonates- B step

-History of trauma common

-Seeding bony metaphysis, small arterioles

-IV antibiotics 4-6 weeks

-Aspiration 50% positive cultures

Front 26

Transient Synovitis

Back 26

-Most common cause of painful hips in childhood
-Diagnosis of exclusion
-Viral infection, allergic reaction, trauma
-Voluntary limitation of motion/muscle spasm
-ESR < 20
-R/O septic hip with aspiration

Front 27

Osteonecrosis of proximal femoral epiphysis

Back 27

Legg-Calve-Perthes

Front 28

Legg-Calve-Perthes most commonly seen in

Back 28

boys 4-8
- + family history
- low birth weight

Front 29

Legg-Calve-Perthes
- SX

Back 29

knee pain
effusion
limp
decrease ROM, especially abduction, internal rotation

Front 30

Legg-Calve-Perthes
- Prognosis

Back 30

depends on bone age
> 6 years with collapse poor prognosis

Front 31

Slipped Capital Femoral Epiphysis (SCFE)

Back 31

- weakness of perichondral ring

-Slippage through hypertrophic zone of growth plate

-Neck displaces anterior/externally rotates (lose internal rotation)

Front 32

SCFE most common in

Back 32

-Most common in African Americans, obese, adolescent boys (10-16) with positive family history
-High incidence with hypothyroidism

Front 33

SCFE physical exams shows

Back 33

external rotation with flexion of the hip

(Lose internal rotation, when bend knee up while laying down- it will externally rotate and abduct)

Front 34

Subcapital Femoral Neck Fracture

Back 34

-Poor blood supply
-Common in elderly
-Osteoporotic bone
-Technology for “early mobilization”
(- Breaks in neck region- all vessels are severed and only have obturator artery to supply head- not enough to allow for healing/repair)

Front 35

Degenerative Adult hip in what diseases

Back 35

- Osteoarthritis
- Osteonecrosis (AVN)
- RA
- Other arthridities
- Hip Replacement

Front 36

Inflammatory Adult hip

Back 36

- Trochanteric bursitis
- NSAIDs
- Cortisone shots
- More common in women

Front 37

Referred Pain

Back 37

- Knee
- Back (SI joint, sciatic notch)
- Hernia (inguinal, femoral)
- Pelvic (ovarian)