hip

Question 1

hip ROM

Answer 1

Question 2

antalgic gait

Answer 2

patient spends less time on the painful limb so that stance phase is reduced when the painful side contacts the floor

Question 3

stiff leg gait

Answer 3

when hip flexion/extension is lost or markedly restricted, the patient will tend to circumduct and swing their leg

Question 4

short leg gait

Answer 4

when the patient is wait bearing on the shorter leg, he or she dips down

Question 5

trendelenberg gait

Answer 5

with each step the patient takes toward the affected limb they lurch toward the unaffected limb

Question 6

trendelenberg test

Answer 6

Question 7

possible causes of positive trendelenberg sign

Answer 7

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

Question 8

thomas test

Answer 8

• 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

Question 9

positive thomas test indicates

Answer 9

fixed flexion deformity

Question 10

FADDIR stands for

Answer 10

flexion/adduction/internal rotation

Question 11

how do you perform FADDIR

Answer 11

hip at 90° flexion, adduction and IR
positive response: anterior groin pain

Question 12

positive FADDIR my indicate

Answer 12

labral tear/pathology

Question 13

differential diagnosis for pain around the hip girdle outside the hip joint

Answer 13

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

Question 14

nerve root pain

Answer 14

Question 15

anterior hip pain

Answer 15

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

Question 16

lateral hip pain

Answer 16

greater trochanteric bursitis
gluteus medius tendinopathy/dysfunction
IT band syndrome
meralgia paresthetica

Question 17

posterior hip pain/buttock pain

Answer 17

referred from lumbar spine
piriformis syndrome
sacroiliac joint dysfunction
high hamstring strain or ischial tuberosity avulsion

Question 18

4 signs of OA on x-ray

Answer 18

1. loss of joint space
2. osteophyte formation
3. subchondral sclerosis
4. subchondral cysts

Question 19

non operative management of OA

Answer 19

rest, activity modifitcation, weight loss, walking aids
physiotherpy
analgescis

Question 20

locations of hip fracture

Answer 20

if the fracture is intracapsular the retinacular arteries may not be intact

Question 21

initial mnagement of broken hip

Answer 21

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

Question 22

how soon should a patient be operated on after theyve broken their hip

Answer 22

improved outcomes with surgery <24 hours

Question 23

gluteal tendinopathy

Answer 23

greater trochanteric bursitis
IT band syndrome

Question 24

clinical presentation of gluteal tendinopathy

Answer 24

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

Question 25

manegement of gluteal tendinopathy

Answer 25

hip abductor and flexor strenghtening
decreased peak hip adduction in running - increasing caddence
corticosteroid injction
surgical repair of torn gluteus medius and minimus

Question 26

look for hip examination

Answer 26

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

Question 27

feel for hip examintion

Answer 27

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

Question 28

move

Answer 28

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

Question 29

how do you peform FABER

Answer 29

• 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

Question 30

the FADDIR test is

Answer 30

flexion
adduction
internal rotation

production of pain indicates femuroacetabular impingement