Examination of the Hip Flashcards
What should be observed in standing (8 points)?
Posture of spine and LL
- spinal curves
- position of pelvis
- skin creases
- varus/valgus deformity
- foot posture
- soft tissues - quality and colour of skin, swelling, bruising, discolouration, scaring
- Ease of weight baring
- Signs of leg length discrepencies
What should be observed in movement?
Sit to stand - internal rotation or adduction of femur
Gait - stride length, stance time, WB ability
What should be observed in supine (5 points)?
Leg position from bottom and side of the plinth
- gene valgum/varus
- femoral or tibial position
- patella positioning
- muscle wasting
- position of heels
What movements should be assessed in hip aROM?
flex, abduct, adduct, MR, LR in supine
Ext in side ly
Why may aROM differ from pROM?
pain, muscle weakness
What adjacent joints COULD be tested in a hip exam?
Lx flexion, extension, lateral flexion
SIJ provocation tests
Knee - flex and ext
Why would testing the SIJ or Lx spine be appropriate?
Problem with the hip can cause secondary changes in Lx spine - lordosis
Why would testing the knee joint be appropriate?
FFD in the knee can cause altered gait and abnormally load the hip
Why would isometric testing be used?
To test muscles overlying areas of pain as the muscles could refer pain to the area
If there is too much pain, limiting ROM
How to document isometric testing?
Good contraction against firm resistance
Why is isotonic muscle testing used?
To differentiate between true muscle weakness and pain inhibited muscle contraction
What muscle groups should be tested?
Hip flexors, abductors, adductors, MR, LR and extension
How to measure isotonic strength?
Using MRC
What are the special tests for hip (7 points)?
- Leg length
- Thomas test
- Modified Thomas test
- FABER
- FADIR
- Trendelenburg
- Muscle length testing of hamstrings and quads
What is the appropriate AM used for the hip?
Longitudinal caudad of the hip
What are the specific palpation points?
- Joint line
- Greater trochanter
- Adductor Longus tendon
- Gluteus Medius tendon
- Ischial tuberosity
What additional tests can be used if indicated?
- Myotomes/Dermatomes/Reflexes
- Functional testing - sit to stand/stairs
What does tenderness of the greater trochanter indicate?
Gluteal tendinopathy
Why palpate the ischial tuberosity?
Hamstring strain
Why palpate the joint line?
Diffuse tenderness in inflammatory conditions (OA or RA)
Crepitus when passively rotating hip (OA)
Three reasons to complete longitudinal caudad of hip?
Assess for pain, resistance or spasm in the early middle or late range
Applies capsular stretch - improving flexion and abduction
Used in proprioception to reduce pain
What is the effect of a capsular stretch (grade 3-4 AM) on soft tissues?
Stretching the capsule into the plastic region - causes breaking of the individual collagen fibres and cross-links -leads to plastic deformation and an overall increase in length
What is the effect of grade 1-2 Acsessory Movements?
Reduces pain
Causes proprioceptive feedback via A-delta fibres
Synapse in the WDR of lamina 5 of dorsal horn - the same place as the C-fibres
Preferential transmission of the non-nociceptive pain signals
(Pain Gate Theory)
How to palpate adductor longus tendon?
Supine Ly
Resist slight hip flexion and adduction
Palpate medial border of femoral triangle
How to palpate gluteus medius?
Side ly
Resist hip flexion and medial rotation - palpate anterior fibres
Resist hip extension and lateral rotation - palpate posterior fibres
