Greater trochanter percussion pain

Introduction The trochanteric pain is a clinical manifestation of traumatic femoral head necrosis. Traumatic femoral head necrosis refers to femoral neck fracture, hip dislocation, and hip contusion caused by external impact. Trauma is the main cause of femoral head necrosis. Most of them are caused by trauma, and most of them are unilateral femoral hair disease, and it must be the side of the injured side. There are very few bilateral diseases, except bilateral infection may cause bilateral necrosis, which is different from Caused by other reasons.

Cause

(1) History of traumatic disease

1, femoral neck fracture: the most significant cause of traumatic femoral neck fracture. It is a relatively serious injury. After the injury, the number should go to the examination, take X-ray films, use traction, reduction, fixation and surgical treatment. Therefore, the medical history is clear, but it should also be questioned and recalled. The patient can even clarify the cause and location of the injury, the treatment process, etc. Therefore, the diagnostic reference value is exact.

2, hip dislocation: This is also a relatively large trauma, the patient will also remember clearly, whether it is the injury and treatment, can be described completely, with reference value.

3, other fractures: In addition to the above mentioned more trauma, there are some fractures. Such as intertrochanteric fractures, femoral head fractures, femoral head spondylolisthesis, simple acetabular fractures, etc., need further inquiry, it is best to produce original examination and diagnostic data, etc. This is not only the need for diagnosis, but also observation and summary of cases , the need for analytical research.

4, hip contusion: This is some minor trauma, need more detailed tips and inquiries. Because these injuries often do not attract the attention of the patient, the memory is not too deep and clear, so it is necessary to repeatedly ask questions before they can recall.

(2) The injured part

Most of them are caused by trauma, and most of them are unilateral femoral hair disease, and it must be the side of the injured side. There are very few bilateral diseases, except bilateral infection may cause bilateral necrosis, which is different from Caused by other reasons.

(3) Memories of treatment

Patients who have had a hip injury will be treated systematically. Such as whether or not traction, repeated reduction, surgery, etc. The treatment effect is good or bad, such as whether the reduction is satisfactory, whether there is no reduction, malunion, and the internal fixation is still in the body. All provide important materials for timely and correct diagnosis.

an examination

Related inspection

Bone and joint soft tissue CT examination bone imaging

(1) Clinical manifestations: more common in young adults, after the femoral neck fracture, hip pain occurred again 1.5 to 10 years. 85% of the time of pain occurred within 3 years after injury and 98% within 5 years. In some patients, persistent joint pain after femoral neck fracture lasts for half a year or even more than one year. In this case, the avascular necrosis of the femoral head should be highly alert. The pain is located in the thigh root and buttocks. Some patients have pain in the knee. The weight of the affected limb will aggravate the pain. Due to the joint braking after the femoral neck fracture, the range of motion of the hip joint is severely restricted, and the activity of the non-traumatic patient is significantly restricted. Much more.

(2) Signs: Patients with internal fixation can find surgical scars, soft tissue adhesions, atrophy, and stiffness. The quadriceps atrophy, tenderness in the groin area, pain in the greater trochanter, and positive heel pain in the heel. With the nonunion of the femoral neck fracture, the signs are more obvious, the hip joint activity is severely limited, the longer the history, the more obvious the activity limitation. The patient has a gait. The affected limb has long been afraid to bear weight. If the femoral head collapses severely, there may be a shortened deformity of the affected limb.

(3) Special examination: 'rhomas sign, 4 word test are positive, femoral head collapse is serious, AHis sign and single leg independent test (trendelenburg) sign positive. Ober's sign was positive with fascia lata or tendon contracture. The hip joint is severely collapsed or the subluxation is moved upwards (Nelaton line), and the squat line (Shoemaker line) intersects the midline under the umbilicus. Bryant, the bottom edge of the triangle is less than 5 cm, and the sink line is discontinuous.

(4) Auxiliary examination: The time of avascular necrosis of the femoral head was found on the X-ray film after the injury. It was 1.5 months as early as 17 months after the injury. There are three X-rays for early diagnosis of avascular necrosis of the femoral head. Indications: the appearance of nail marks, declining height of the femoral head and hardened transparent bands.

Differential diagnosis

Differential diagnosis of trochanteric pain:

1. Ankylosing spondylitis involving the hip joint: common in adolescent males, mostly bilateral ankle joint involvement, characterized by HLA-B27 positive, the femoral head remains round, but the joint space is narrowed, disappears or even merges, so no Difficult to identify. Long-term use of corticosteroids in some patients can be associated with femoral head necrosis, and the femoral head can collapse, but it is often not serious.

2, acetabular dysplasia secondary to osteoarthritis: CE angle is less than 30 degrees, Shenton's continuous interruption, femoral head incomplete, acetabular line in the upper part of the femoral head, joint space narrowed, disappeared, osteosclerosis, sac Changes, similar changes in the corresponding area of the acetabulum, and easy identification of femoral head necrosis.

3, synovitis: synovitis of various reasons. Including pigmented villonodular synovitis, non-specific synovitis, etc., on the X-ray can be seen on the acetabular and femoral head edge bone erosion, MRI shows extensive lesions with joint effusion, etc., should be identified.

4, rheumatoid arthritis: more common in women, the femoral head remains round, but the joint space is narrowed and disappeared. Common femoral head articular surface and acetabular erosion, identification is not difficult.

5, advanced osteoarthritis: when the joint space is slightly narrow, there may be confusion when subchondral cystic changes occur, but the CT manifestation is hardening and cystic change, MRI changes are mainly low signal, which can be identified .

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