Hip

Question 1

What is assessed within each of look, feel and move?

Answer 1

Skin
Soft tissue
Bone

Question 2

Where are scars found from hip arthroscopy?

Answer 2

Anterior, lateral and posterior port scars

Question 3

Where might the scar be from a hip replacement?

Answer 3

Posterior or lateral

Question 4

What nerve damage could cause wasting of gluteal muscle?

Answer 4

Superior gluteal nerve

Question 5

What might lumbar lordosis indicate?

Answer 5

Fixed flexion deformity of the hip commonly due to osteoarthritis

Question 6

How might Trendelenburg gait be described?

Answer 6

Waddling gait

Pt body sways side to side

Question 7

What is the cause of Trendelenburg gait?

Answer 7

Weakness of hip abductor muscles forcing patient to use trunk muscles to lift pelvis high enough to swing leg through

Question 8

How do you carry out Trendelenburg test?

Answer 8

Ask patient to lift each leg up, standing facing you with their palms on your palms

Question 9

What indicates a positive Trendelenburg test?

Answer 9

When pt tries to stand on affected leg, examiner feels push down on hand on contralateral side

Question 10

How do you initially assess leg length discrepancy?

Answer 10

Have the patient lie down with legs together in same extended position and ensure ASIS align

Question 11

How do you tell which bone causes the leg length discrepancy?

Answer 11

Flex both knees to 90
If femur on shorter side lies lower - shortening is below the knee
If tibia on shorter side les further back than the other leg - shortening is above the knee

Question 12

What causes apparent leg length discrepancy?

Answer 12

Joint deformity e.g. fixed flexion deformity

Question 13

How do you measure apparent leg length discrepancy?

Answer 13

Measure from xiphisternum to medial malleolus of each leg

Question 14

What makes up neurovascular assessment in hip examination?

Answer 14

Distal sensation
Peripheral pulses
Capillary refill

Question 15

What should be palpated in hip examination and why?

Answer 15

Feel the greater trochanter as tenderness may indicate greater trochanteric bursitis

Question 16

How is flexion and extension assessed?

Answer 16

Combined in modified Thomas’ test

Question 17

Outline modified Thomas’ test

Answer 17

Patient lies supine, examiner places one hand under lumbar spine and ask patient to actively bring up both knees to chest
Watch patients face and passively push each hip into further flexion
Patient holds one leg in flexion and extends the other - pressure under lumbar spine should be continuous

Question 18

What is normal hip flexion?

Answer 18

130°

Question 19

What may a reduction in lumbar spine pressure indicate?

Answer 19

Fixed flexion deformity - pt compensating by lifting pelvis in order to extend the leg

Question 20

What position is required to assess rotation?

Answer 20

Assessed at mid range - flex hip and knee to 90°

Question 21

How is internal and external rotation assessed?

Answer 21

With leg in mid range position, use tibia as a lever to move in direction of both internal (foot out to the side) and external rotation (foot across body)

Question 22

What is normal external rotation?

Answer 22

45°

Question 23

What is normal internal rotation?

Answer 23

45°

Question 24

How do you assess abduction?

Answer 24

Place arm across pelvis with fingertips on one ASIS and forearm across the other
Abduct and adduct each leg, note the angle at which you feel the pelvis move under your hand

Question 25

Normal abduction?

Answer 25

45°

Question 26

Normal adduction?

Answer 26

30°

Question 27

What may the FABER test show?

Answer 27

Hip pain or reduction in movement indicating intra-articular pathology e.g. OA
Sacroiliac pain suggesting sacroiliac joint dysfunction

Question 28

How is FABER test conducted?

Answer 28

Position leg: Flexion, ABduction, External Rotation

Place foot across contralateral knee, stabilise ASIS and push down gently on the knee

Question 29

What is the position for the FABIR test?

Answer 29

Flexion, ADuction, Internal Rotation

Question 30

What may the FABIR test show?

Answer 30

Anterolateral hip pain is a sensitive indicator of femoroacetabular impingement