applied anatomy exam 1-hip Flashcards
def osteokinematics
motions distal to the aspect that moves
3 types of arthrokinematics
roll: will continue unless stopped
glide: usually with a role
spin: rotates w/o the object moving across a distance
concave & convex rule with roll/glide
concave: same direction
convex: opposite direction
what are the 3 parts of contractile tissue in the body
muscle belly, tendon, tendoperiosteal junction
7 steps of orthopedic exam
observe, AROM, PROM, RROM, mobility test, palpation, special tests
P/R1
when patient feels resistance or pain
P/R2
when movement is stopped due to pain or resistance
examples of abnormal end feels
springy, empty, spongy
4 types of resisted testing that can be done
gross muscle testing, MMT, contractile unit testing, myotomal (nerve testing for 6 seconds and repeat)
what are the 4 options for CUT that a patient should be asked
strong/weak/painful/painless
if a patient has pain w/ CUT should the next step be to perform MMT
no b/c pain causes MMT to not be valid so don’t do them
what are the 4 parts of palpation
TART
texture, asymmetry, restriction, tender
def hyperalgesia
putting pressure on the patient creates a larger than expected amount of pain
if active movement is limited in the same direction or painful what could the cause of the problem be
inert, agonist contractile or antagonist contractile issue
if passive movement is limited in the same direction or painful what could the cause of the problem be
could be inert or antagonist contractile
what’s an example of gross muscle testing
see if patient can get out of a chair on their own- very generalized test with no real way to measure
what kind of testing should be done first in an exam
CUT b/c see if pain exists with movement before continuning
what finding of the CUT would indicate wanting to do MMT and/or myotomal nerve testing
weak and painless
how long should a CUT movement be held for
5-6 seconds at submax force
what is the main physiological purpose of CUT
isolate muscles and help indicate what part of the contractile tissue may be the problem
what is a break test
MMT w/ maximal force applied to see how strong the patient is
if the patient can’t do AROM against gravity, what do you do
place them in a gravity lessoned position and see if the score is a 2- or 2+
what may a 0/5 MMT indicate
complete tear or neurological problem since there is 0 movement happening
what 4 MMT should be done in seated position for gravity position
hip flexion, ER, IR, sartorius
what is the axis called for the transverse plane
longitudinal axis
what is the axis called around the frontal plane
anterior posterior axis
what axis does the sagittal plane move
medial lateral axis
open chain osteokinematics means
femur moves on the pelvis
closed chain osteokinematics means
pelvis moves on the femur
does open or closed packed allow for more movement
open packed
what hip positions are open packed
flexion, abduction, ER
what hip positions are closed packed
extension, aBduction, IR
open chain means what about concave and convex
convex ON concave & roll and glide in opposite directions
closed chain means what about concave and convex
concave ON convex & roll and glide in the same direction
sagittal plane flexion & extension
F: anterior roll, posterior glide
E: posterior roll, anterior glide
frontal plane abduction & adduction
AB: superior roll, inferior glide
AD: medial roll and lateral glide
transverse plane IR & ER
IR: anterior roll, posterior glide
ER: posterior roll, anterior glide
sensitivity vs specificity
rule OUT, rule IN
high sensitivity means
a positive test is likely a positive test, so it would have a score of like 0.8/1
high specificity means
3 intra-articular pathology special tests
scour, FADIR, FABER
2 other names for FABER test
patrick’s and figure 4
tests for muscle tightness
ely’s, thomas, modified thomas, ober, modified ober, piriformis, 90/90, SLR
femoral torsion test
craig’s
muscle function special tests
trendelenburg, step down
scour test position
supine, PT standing next to
scour test procedure
PT moves hip into end range of hip flexion, adds COMPRESSION and moves AD w/ IR, AB w/ ER to see if symptoms arise
if scour test the first time feels fine for the patient what can you do
do it again and add more pressure
+ scour test if
pain, popping, clicking, catching
FADIR test means
flexion, aD, IR
FADIR test set up
supine w/ PT behind
FADIR test procedure
PT brings leg to 90 deg hip/knee flexion, AD w/ IR, if no s/s then repeat and increase hip flexion degrees
+ FADIR test
stiff, increase symptoms, apprehension
FABER test means
flexion, AB, ER
FABER test set up
supine w/ PT standing over
FABER test procedure
position in figure 4, apply pressure at contralateral ASIS while pushing against figure 4 to see if s/s increase
+ FABER test symptoms in groin
iliopsoas or intraarticular pathology
+ FABER test symptoms in posterior hip
SIJ, ligamentum teres, posterior hip impingement
ely’s test set up
prone, PT standing beside
ely’s test perform
PT bring leg into flexion and see if ASIS rises, lumbar rotation, lumbar extension to compensate; if this happens before 90 deg flexion then it’s positive
+ ely’s test
rectus femoris tightness
modified thomas test set up
supine at end of table, PT beside
modified thomas test procedure
PT bring hips and knees into flexion while feeling spine flatten, patient hold extremities w/ hands, PT lowers limb slowly to see if thigh can rest flat on table
+ modified thomas test
TFL tight: leg moves aB
iliopsoas tight: can’t get hip extension neutral
rectus femoris tight: can’t flex 90 deg knee at rest
ober test set up
sidelying, PT behind
ober test procedure
flex knee to 90 deg, bring hip aB then slight EXTENSION to test TFL, lower leg down to table in horizontal plane
+ ober test
IT band or TFL tightness
fair test set up
sidelying, PT behind or in front
fair test procedure
PT flex hip to 60 deg and AD +IR
fair test +
increase sciatic or piriformis symptoms
90/90 test +
> 20 deg knee flexion at end range
SLR test +
patient unable to reach 70 deg hip flexion
craig’s test set up
prone, PT beside
craig’s test procedure
passively flex knee 90, ER/IR until greater trochanter is in lateral position, measure angle of tibial crest
eccentric step down test set up
stand on 8 inch step w/ hands on hips with stance leg, slowly lower non-weight-bearing leg to the floor and perform 3-5 reps while PT looks for compensation
eccentric step down test results
weak ER or unstable joint if arm aB, trunk flexes, hip aB, hip IR
2 MMT
100% of motion in gravity lessened
2+ MMT
partial ROM against gravity
2- MMT
partial motion in gravity lessened position
what is PROM looking for
relationship b/w pain and motion and end-feel and motion limited
what is AROM looking for
quality and quantity of movement
normal value for hip flexion
110-120 deg
what is the axis of the goniometer for hip flexion
greater trochanter of femur
normal value of hip extension
10-15 deg
hip abduction normal value
40 deg
what is the axis of the goniometer for abduction and adduction
ipsilateral ASIS
hip adduction normal value
20 deg from neutral
IR normal values
30-40 deg
normal end feel for IR/ER, AB/AD
firm
ER normal values
40-60 deg
uncompensated trendenelburg
contralteral hip drops during the motion
compensated trendenelburg test
contralateral hip moves upwards due to compensation of the QL
what does eccentric step down test primarily test for
ER
what does trendenlburg test primarily test for
AB
how to decide if a joint will likely roll or glide
can only roll when there is room for it to move across the joint, otherwise it will glide
congruency for open-packed position
the least stable position b/c ligaments are laxed
