hip Flashcards
hip ROM
antalgic gait
patient spends less time on the painful limb so that stance phase is reduced when the painful side contacts the floor
stiff leg gait
when hip flexion/extension is lost or markedly restricted, the patient will tend to circumduct and swing their leg
short leg gait
when the patient is wait bearing on the shorter leg, he or she dips down
trendelenberg gait
with each step the patient takes toward the affected limb they lurch toward the unaffected limb
trendelenberg test
possible causes of positive trendelenberg sign
motor: abductor muscle weakness, superior gluteal nerve palsy
lever arm: shortening of femoral neck, abductor tendon rupture
fulcrum: pain arising from intrarticular pathology, dislocation or subluxation of the hip
thomas test
- Place one hand under the lumber spine (to identify lumbar lordosis) and patient brings up both knees to chest
- Test passive flexion of the hip by passively pushing the knees further toward the chest
- Patient holds affected hip and the other leg is extended
- If the other leg can flatten, the hip is extending
- The patient now holds unaffected knee and abnormal leg is extended
- If the other leg can’t flatten and the pressure on the examiners hand lessens, there is a fixed flexion deformity of the hip
o The patient is compensating by lifting the pelvis in order to extend the leg
positive thomas test indicates
fixed flexion deformity
FADDIR stands for
flexion/adduction/internal rotation
how do you perform FADDIR
hip at 90° flexion, adduction and IR
positive response: anterior groin pain
positive FADDIR my indicate
labral tear/pathology
differential diagnosis for pain around the hip girdle outside the hip joint
trochanteric bursitis
gluteus medius tendinitis
stress fracture
osteitis pubis
iliopsoas tendinitis or bursitis
iliopsoas abscess
adductor longus strain or tendinitis
referred pain from spine
metastatic disease
outside MSK system: inguinal herni, inguinl lymphadenopathy, GI, genitourinary, gynaecological
nerve root pain
anterior hip pain
OA,
inflammatory arthritis
fracture
tumour
avascular necrosis of the femoral head
acetabular labral tear
articular cartilage injuries
ligamentum teres injuries
extra articular: hip flexor strain, iliopsoas bursitis, snapping hip syndromes, avulsions
lateral hip pain
greater trochanteric bursitis
gluteus medius tendinopathy/dysfunction
IT band syndrome
meralgia paresthetica
posterior hip pain/buttock pain
referred from lumbar spine
piriformis syndrome
sacroiliac joint dysfunction
high hamstring strain or ischial tuberosity avulsion
4 signs of OA on x-ray
- loss of joint space
- osteophyte formation
- subchondral sclerosis
- subchondral cysts
non operative management of OA
rest, activity modifitcation, weight loss, walking aids
physiotherpy
analgescis
locations of hip fracture
if the fracture is intracapsular the retinacular arteries may not be intact
initial mnagement of broken hip
nerve block pain releief to avoid adverse effects of strong pain killers in elderly population
rehydrtion
DVT prophylxis
skin protection to void pressure sores
medical stabilisation
how soon should a patient be operated on after theyve broken their hip
improved outcomes with surgery <24 hours
gluteal tendinopathy
greater trochanteric bursitis
IT band syndrome
clinical presentation of gluteal tendinopathy
lateral hip pain of gradual onset
often associated with changes in work load or physical activity, particularly runnning
paain may progress to night pain
single leg tasks are particulalry painful
stiffness with extending hip when getting out of chair
manegement of gluteal tendinopathy
hip abductor and flexor strenghtening
decreased peak hip adduction in running - increasing caddence
corticosteroid injction
surgical repair of torn gluteus medius and minimus
look for hip examination
skin: scars, erythema
soft tissue: gluteal muscle wasting
bone: alignment, fixed flexion deformity
Gait assessment
trendelenberg test
leg length discrepency
- measure from the ASIS to the medial maleolus
- bend both knees up to a right angle to determine where the shortening is from
feel for hip examintion
neurovascular examination: peripheral pulses, sensation, capillary refill time
skin: sensation, capillary refill time
soft tissue: peripheral pulses
bone: feel over greater trochanter on the elateral side of the hip, tenderness indicates greater trochanteric bursitis
move
thomas test: to test hip extension and identify fixed flexion deformity
rotation of the hip: internal and ecternal normal is 45 degrees, reduced internal rotation is an early sign of osteorthritis
test abduction and adduction: normal abduction is 45, adduction is 30
how do you peform FABER
- Flexion, abduction and external rotation
- Push down on the knee with the foot resting above the contralateral knee
- The production of hip pain and restriction of movement indicates intraarticular pathology eg. Osteoarthritis
- Sacroiliac pain suggests sacroiliac joint dysfunction
the FADDIR test is
flexion
adduction
internal rotation
production of pain indicates femuroacetabular impingement
