10/14 - Hip Exam Considerations Flashcards
what is the significance of subjective history
may determine up to 90% of dx
what are 6 components of hisotry
subjective hx
MOI
chronicity
pain intensity
sport demands
activity status
what does pain w static positions indicate
intra-articular path
what paths may be associated w sitting buttock pain (4)
ischial bursitis
hamstring syndrome
gluteal bursitis
lumbar disk
what does pain w dynamic activity indicate
extra-articular / ms
what does pain w walking on level ground indicate
dysplasia
hip flexors
what does pain with walking up stairs indicate
inc demand on ABDs
what does pain with deep flexion indicate
possibly FAI
what does sharp pain indicate and what other sx are typically associated
labrum or articular loose bodies
- clicking, catching, locking
what does a C-sign indicate
intra-articular path
what does burning pain indicate
nerve entrapment
what nerves at the hip are at risk for being entrapped (6)
femoral
lateral femoral cutaneous
ilioinguinal
genitofemoral
obturator
sciatic
if in addition to burning pain, the patient is also experiencing paresthesias, numbness, weakness - what should be considered
lumbar involvement
what is one of the first things to consider when hearing of night pain
r/o systemic dz, tumor
what should be considered when getting imaging for a hip
high prevalence of (+) findings in asymptomatic people
- abnormalities seen might not even have anything to do w sx
since imaging shouldn’t be done in isolation, what other things should be considered (2)
sx
clinical signs
what sx are more likely to be coming from the hip than the spine
limp
groin pain
dec IR
how does labral path pain present
central groin and peritrochanteric
what does (-) groin pain r/o
labrum and FAI involvement
in a relaxed supine position, why would inc ER be seen
lax ant capsule
retroversion
in a relaxed supine position, why would dec ER be seen
ant capsule restriction
what primary motions will you see dec strength in if a patient has hip related pain
ADD
ABD
flex
ER
IR
conflicting evidence on ext
how does 90deg of hip flex vs <90deg bias hip flexors
90deg - biases psoas
<90 - biases many other flexors
what position should ADD be tested and why
neutral
- flex may be provocative
fulcrum test
tests for stress fracture (ie femoral neck)
- through recreating sx by loading or creating vibration moment
tension-sided vs compression-sided femoral neck stress fracture
tension sided
- sup lat neck
- high risk
compression sided
- inf med neck
- low risk
when will pts with a femoral neck stress fx have sx
in WB
- esp running or hopping
- when loading the joint
why are tension sided femoral neck stress fx problematic and who are they often seen in
often non union and develop into AVN
- see in younger, female, endurance athletes
where can lumbar spine sx refer to
hip and gluteal regions
what are ways to test for discogenic/radiculopathy (2)
repeated motion
SLR
how can you test for lumbar facet related pain
extension rotation test
what test is used to test for SIJ originated pain and how does this work
thigh thrust
- post force on femur into acetabulum shears the pelvis on the sacrum
what is a (+) FADDIR
sx of ant hip pain/discomfort reproduced
what is FADDIR testing for
intra-articular hip path
sensitivity and specificity of FADDIR
high sensitivity - if neg, confident that not
poor specificity - if pos, doesn’t tell us that it is intra articular hip path for sure
what is the most specific test for hip injuries
log roll
what is a log roll test doing
rotates fem head in relation to acetabulum without stressing surrounding structures
what is a (+) log roll
“click”
what is a consideration of the log roll test
not sensitive
how can sx be interpretted from a FABER test
post sx - SIJ
ant sx - acetabulum femur joint
stretch - ms length
what are the 4 defined clinical extra-articular entities for groin pain
ADD related
iliopsoas related
inguinal related
pubic related
what are 2 ways to test for ADD related groin pain
ADD tenderness w palpation
pain w resisted testing
what test do you use the traffic light approach for with ADD related groin pain
testing w pain if squeezing legs together
- red light >5/10 pain
- want pain <5
what are 3 ways to test for inguinal related groin pain
palpation - inguinal canal / lower ab pain
pain w resisted ab testing
pain w cough/sneeze
what is a way to test for pubic related hip pain
palpate - pain at pubic symphysis region
what can cause irritation at pubic symphysis manifesting in groin pain
rotation at one side of pelvis while other is stable
- shearing is created
what are 3 ways to test for iliopsoas related groin pain
palpate - iliopsoas tenderness
pain w resisted hip flex
pain w hip flex stretching
what are functional tasks impacted by hip-related pain
- dec squat depth
- impaired single-leg balance
- trendelenburg sign - hopping tasks
- conflicting evidence
what are dynamic assessments to assess someone with hip-related pain (3)
- timed lateral step-down
- star excursion balance test
- Y balance test
what does a normal timed lateral step down look like
stable pelvis with no trunk compensations
stable pace
what are compensations seen in a lateral step down (4)
trunk lean
trunk flexion
pelvic drop
knee valgus
what plays a large role in the compensations seen in lateral step down
influence of hip position
what dynamic assessment has components of FADDIR
timed lateral step down
what does the star excursion balance test test for
strength
flexibility
proprioception
what directions does the Y balance test assess in
anterior
posteromedial
posterolateral
what are ways to assess the Y balance test
both quantitatively (distance) and qualitatively (good form)
what outcome measures are utilized in young and middle aged adults w hip related pain
hip and groin outcome score (HAGOS)
international hip outcome tool (iHOT)
what context were the two patient reported outcome tools devleoped in
surgical context
tests w high sensitivity should be used early w hip pain to r/o what
fx
hip path
SIJ
