Hip Flashcards
What is assessed within each of look, feel and move?
Skin
Soft tissue
Bone
Where are scars found from hip arthroscopy?
Anterior, lateral and posterior port scars
Where might the scar be from a hip replacement?
Posterior or lateral
What nerve damage could cause wasting of gluteal muscle?
Superior gluteal nerve
What might lumbar lordosis indicate?
Fixed flexion deformity of the hip commonly due to osteoarthritis
How might Trendelenburg gait be described?
Waddling gait
Pt body sways side to side
What is the cause of Trendelenburg gait?
Weakness of hip abductor muscles forcing patient to use trunk muscles to lift pelvis high enough to swing leg through
How do you carry out Trendelenburg test?
Ask patient to lift each leg up, standing facing you with their palms on your palms
What indicates a positive Trendelenburg test?
When pt tries to stand on affected leg, examiner feels push down on hand on contralateral side
How do you initially assess leg length discrepancy?
Have the patient lie down with legs together in same extended position and ensure ASIS align
How do you tell which bone causes the leg length discrepancy?
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
What causes apparent leg length discrepancy?
Joint deformity e.g. fixed flexion deformity
How do you measure apparent leg length discrepancy?
Measure from xiphisternum to medial malleolus of each leg
What makes up neurovascular assessment in hip examination?
Distal sensation
Peripheral pulses
Capillary refill
What should be palpated in hip examination and why?
Feel the greater trochanter as tenderness may indicate greater trochanteric bursitis
How is flexion and extension assessed?
Combined in modified Thomas’ test
Outline modified Thomas’ test
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
What is normal hip flexion?
130°
What may a reduction in lumbar spine pressure indicate?
Fixed flexion deformity - pt compensating by lifting pelvis in order to extend the leg
What position is required to assess rotation?
Assessed at mid range - flex hip and knee to 90°
How is internal and external rotation assessed?
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)
What is normal external rotation?
45°
What is normal internal rotation?
45°
How do you assess abduction?
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
Normal abduction?
45°
Normal adduction?
30°
What may the FABER test show?
Hip pain or reduction in movement indicating intra-articular pathology e.g. OA
Sacroiliac pain suggesting sacroiliac joint dysfunction
How is FABER test conducted?
Position leg: Flexion, ABduction, External Rotation
Place foot across contralateral knee, stabilise ASIS and push down gently on the knee
What is the position for the FABIR test?
Flexion, ADuction, Internal Rotation
What may the FABIR test show?
Anterolateral hip pain is a sensitive indicator of femoroacetabular impingement
