Hip Flashcards
Greater Trochanter Pain Syndrome tests
- Palpation
- 30 sec single leg stance ( Trendelenburg gait)
- External de-rotation test
- Hip lag sign
- FADDER / -(R)
- Ultrasound
Tests that assess the glutes
- External De-rotation test
- Hip lag
- FADDER/ - (R)
Tests that assess hamstrings
- 90-90 test
- Bent knee stretch test
- Puranen-Oreva
Typical presentation of GTPS
- Lateral Hip Pain
- Onset acute/ gradual
- Pain on activity
- Dull, achy, sharp or lancating pain
- Lying on affected side will increase pain
- Hip flexion-extension, internal-external rotation will increase pain
- Stiffness getting out of a chair, especially if hip flexion is >90°
Pathologies that affect the lateral hip
- GTPS
- Snapping Hip
- Greater trochanteric bursitis
- Gluteal muscle tear/or avulsion
- Iliac crest apophysis avulsion
- IT band syndrome
- FAI
Pathologies that affect the posterior hip
- Piriformis syndrome
- Ischio-femoral impingment
- SIJ dysfunction
- Lumbar radiculpathy
- Vascular claudication
- Ischial apophysis avulsion
- Hamstring muscle strain/avulsion
List signs/symptoms that are associated with hip OA?
- Over 45
- Morning Stiffness
- Anterior hip/ groin pain
- L3 dermatomal pain distribution
- ROMs discrepancies
- Pain over 3 months
3 findings associated with presence of Hip OA:
- Family History
- Personal history of Knee OA
- Pain climbing stairs/ walking down slopes
A positive HEER test
Anterior hip, apprehesion or reproduction of symptoms.
Which test is used as an indicative of anterior instability or anterior labral pathology?
HEER
Hyperextesion, external rotation
A positive Log roll indicates?
indicates instability, mainly anterior.
A log roll test is Ve+ when?
the affected leg externally rotates >45. and theres no mechanical endpoint
FABER test
Diagnose osteoarthritis clinically without investigations if a person:
- 45 or over
- has activity-related joint pain
- either no morning joint-related stiffness or morning stiffness that lasts no longer than 30 minutes.
Holistic/conservative approach to osteoarthritis assessment and management
- Access to appropriate information
- Activity and exercise
- Interventions to achieve weight loss if the person is overweight or obese
Differential diagnosis for anterior hip pathology
OA
FAI
Hip labral tear
Iliopsoas bursitis (snapping)
femoral stress fracture
Oesteonecrosis
meralgia paresthetica
athletic pubalgia
loose bodies/chondral lesions
legg-calve perthes disease
slipping captial femoral epiphysis
transiet synovitis
septic arthritis
Hip point
Apophysealavulsion injuries (ASIS;AIIS)
The trochanteric abductors consist of
GMed and GMin, and the ITB tensioners consist of the TFL, VL, and UGMax
**
Orthopaedic tests for hip OA
ROM
Scour test
Long axis distraction
Log Roll Test
Red flags to rule out for acute hip pain
Tumour, infection, septic arthritis, osteomyelitis, fracture, AVN
Red flags to rule out for chronic hip pain
Inguinal pathology
Adductor pathology
Pubalgia
Treatment for FAI
- Avoid aggravating activities
- Muscles’ rehabilitation
- NSAID
- Surgical intervention is often warranted
The acetabular labrum is supporting by which ligaments?
- Pubofemoral (inferiorly)
- Ischiofemoral (posteriorly)
- Iliofemoral (anteriorly)
The most common injury pattern for labral tears
Hip hyperextension with external rotation
Who are at grater risk of developing labral tears?
Athletes participating in sports involving repetitive end-range movements into hyperflexion, hyperextension, and abduction
Why is the labrum suspectable to degeneration?
poorly vascularised.
Pain in the lateral hip region is likely associated with
Trochanteric bursitis, OA, ITB or gluteal tendinopathy
Tests for Iliopsoas
- modifed thomas/thomas
- Active iliopsoas snapping test
Tests for TFL/ITB
Ober/modified ober
modified thomas
bicycle test
Tests for hamstrings
90-90 straight leg raising
bent knee stretch test (proximal hamstrings)
Purpose of orthopaedic tests for FAI
Decrease the distance between the femoral head and acetabulum to recreate symptoms
Differential diagnosis for FAI
OCD- osteochondral lesions
Labral tears
External vs Internal snapping hip
External: TFL/ITV rubs over the greater trochanter during flexion and extension.
Internal: Ilipsoas rubs over pectineal line
Tests for External snapping hip
Ober
Modifed ober
Modifed thomas test
Orthopaedic test for Hip OA, and purpose of test?
Long axis distraction
Remove pain by decreasing intra-articular pressure through the distraction.
S&S of a patient with OA
Morning stiffness
Associated groin pain
Progressive course
Hard to put on shoes/socks
Reduced ROM
Pain on IR/ER hip
The greater trochanter is an attachment site for
Glut med + min
TFL
What neurological condition would you need to consider if patient had numbness/tingling in the lateral upper thigh?
Neuralgia parasitica - Lateral femoral cutaneous nerve
What muscles/tendon involvement for GTPS
Hip abductor tendons
Glut medius/minimus and TFL inflam bursae.
What orthopaedic tests could you use for GTPS?
- Hip lag sign:
- FADDER
- FADDER-(R): Adds resistence to hip internal rotation.
- Resisted hip abduction test
Hip Lag sign
Bring patients leg into 10 extension, abduction 20, and full hip internal rotation, while knee remains 45 flexed. The patient is asked to hold. for at least 10 seconds.
Ve+ if they cannot maintain, if foot drops more than 10cm (glutes) or internal rotation is not maintained.
What is the FADDER/-(R) and what does it do?
FADDER
90 flexion, ADduction and External Rotation to end range. Positions the ITB over the greater trochanter and positions the Gmed/Min tendons under tension with the ITB fascia against the greater trochanter.
(R) adds resistance to hip internal rotation
Ve+ if recreates patients pain
Patient presentation for GTPS?
Pain on activity
Pain side lying disrupting sleep
Tender palpation of greater trochanter
Pain on SLS test 30 seconds
Gold standard for radiological assesment of GTPS
Good history taking
MOI and physical examination.
and then if needed, MRI
Lumbar spine referred
LBP
Radiation to lateral hip
Reduced ROM
Tender palapation
Straight leg raise Ve+
Hamstring strain and high HS tendinopathy
bent-knee stretch test
modifed bent knee stretch
Taking off shoe
All Hip OA tests
- ROM
- Scour test
- Long axis distraction
- Log roll test
OA of the HIP - Cluster Test
4 of 5 findings for diagnosis of OA hip:
- Lateral pain with active hip flexion
- Pain with active hip extension
- Passive internal rotation ≤ 25°
- (Self-reported or functional AROM*): squatting aggravates symptoms
- Scour test with adduction causes lateral hip or groin pai
All Femoro-acetabular impingement (FAI) tests
- FADDIR
- FABER
- Log roll
All Acetabular Labral Tears tests
- Faber test
- Scour test
- THIRD test
- Resisted SLR Test
- Impingement test (FADDIR)
- Log roll test
- Fitzgerald Test
- Long-axis distraction
- General ligament laxity
- Hip ROM
Best tests for Intra-articular lesions
- FABER
- Scour
- THIRD
- Resisted straight leg raise
Best tests for extra-articular lesion
- FADDIR
- Fitzgerald
When the history, signs/symptoms are consistent with a labral tear pathology, potential impingement, capsular laxity, and articular cartilage degeneration should be considered, and the following tests should be performed:
- Hip ROM
- General ligament laxity (Beighton’s scale (joint laxity))
- Impingement test (FADDIR)
- Fitzgerald test
- Log roll test
- Long-axis femoral distraction
All Hip instability tests
- Posterior apprehension test
- Hyperextension-external rotation test
- Log roll/dial test
- FABER Patrick
- Abduction hyperextension external rotation test
- Prone external rotation/instability test
All Snapping hip syndrome tests
- 90 - 90 Straight Leg Raising
- Bent-Knee Stretch Test
- Thomas/Modified Thomas
- Fair Test (piriformis)
- Ober/Modified (proximal Hamstrings)
- Active Iliopsoas Snapping
- Bicycle
- 30sec leg stance
Internal ITB snapping tests
Thomas + Modified Thomas
Stinchfield (resisted SLR)
Active iliopsoas test
External ITB snapping tests
All Gluteal Tendinopathy tests
- FABER
- 30s Leg Stance
- Resisted External De-Rotation
- Ober/Modified Ober
- Hip Lag Sign
- FADDER-R
- Resisted hip abduction
All greater trochanteric pain syndrome tests
- Pain on palpation
- FABER
- 30s Single-leg stance
- R-external de-rotation
- Ober
- Modified Ober
- Resisted hip abduction
- Hip Lag sign 9. FADDER-R
All Meralgia Paresthetica tests
- Pelvic compression test (45 secs hold)
- Neurodynamic testing (femoral N)
- Tinel sign
All Special provocative tests (proximal tendinopathy) tests
- The Puranen-Orava*
- The bent-knee stretch
- The modified bent-knee stretch
- Taking off the shoe
With hip disorders, because dynamic hip stabilizers may be overcompensating, what tests can help determine the presence of an internal or external snapping hip?
- Thomas Test
- Ober test
Considering the deep anatomical location of the hip joint, the pain presentation should be distinguished from referred pain.
- Lower back,
- Sacroiliac joint or
- Gastrointestinal,
- Genitourinary systems
For hip OA, Anterior hip pain differential diagnosis
- FAI
- Hernia
Lateral hip pain differential diagnosis
- Trochanteric bursitis
- ITB tendinitis
- Gluteal tendinopathy
Posterior Hip pain differential diagnosis
- SIJ
