Hip and SI Joint Assessment Flashcards
What are the most common isometric tests for hip assessment?
- Abduction (can be a glute medius test)
- Flexion
If people have hip pain where will they usually point?
If it is an anterior capsule problem (90% of the time it is) they will point to their groin. Posterior capsule they will point to glute area.
What things are you looking for with history for hip pathology?
- Insidious (more likely) vs traumatic
- Where is the pain?
- Ask about snapping (internal vs external)
When thinking about snapping of muscles in the hip joint what are we referring to? External vs Internal
External snapping: Iliopsoas may snap over trochanter or head of femur. Rectus femorus crosses over and may snap as well. These will create superficial clicking that does not hurt too much.
Internal snapping: be more suspicious of labral issues. Deep and painful. People have to grab onto something as they feel their hip is going to give out. A lot of people have labral pathology that is not too much of a problem.
What are we observing when it comes to hip pathologies?
Posture
- pelvis
- lumbar
- knees
- ankles
Stance - Foot position (rotation of the hips or tibia?)
- Weight bearing ability
Q angle
Leg length discrepancy
When we are looking at posture what are we looking for?
Pelvis - anteriorly or posteriorly rotated, upslips and downslips
Lumbar - check if they are standing in hyperlordosis are hip flexors torquing on back? Or maybe lordosis decreased, posteriorly rotated, with hamstrings really tight?
Knee angle, are they valgus (knees coming in) or varus (knees going out). Or one more than the other.
Foot rotation: often see interiorly rotated hip, valgus knee and pronated foot. If foot is pronated, is it because of internal rotation at tibia, does it stop at knee? Or does it go all the way to the hip?
What are we looking at when it comes to weight bearing?
With hip issues people will often stand off to one side and not want to bear weight on that side (will eventually cause Trendellenburg gait)
What is the Q angle? What does it mean for hip problems?
Q angle: Angle between patella and ASIS. If there is no angle: the patella will sit straight underneath ASIS (uncommon). Women often have a wider Q angle, usually have wider hips, innominate more outflared. More Q angle means more pressure at hip joint. Usually you will have larger glutes if you have wider hips. But if you get a weak glute med on top of a wider Q angle that will start to cause pain.
If you get a springy end feel for hip flexion what could this mean? What about a bony block?
Springy: could be a torn labrum
Bony block: thinking more OA
What is the most important sinew channel for the hip?
Stomach sinew
What are some special tests for intra-articular hip pathology? (Tests for femoroacetabular impingment or labral tears)
- Hip Quadrants
- Hip Scour
- FABER (Figure four position with gentle pressure)
- FADDIR
- Impingement Provocation Test (Patient supine and leg and hip off edge of plinth, hip into hyperextension, abduction and external rotation HABER)
Which of the tests for intraarticular hip pathology will also pick up SI joint pathology?
FABER
Impingement Provocation test
Which of the tests for intrarticular hip pathology test the posterior-inferior labrum?
Impingement Provocation Test (HABER)
What type of hip impingement problems will catch during internal rotation and adduction?
- Labral tears
- Osteoarthrits
- Cam and Pincer Lesions
Which tests will pick up anterior capsule problems?
Any of the intrarticular pathology tests performed with the patient supine such as:
- Quadrants
- Hip scour
- FABER
- FADDIR
What is a test for generalized capsular laxity?
Log roll test
Can also help pick up hip anterior impingement pathology.
What are 4 test for muscular imbalance of the hip? What does each of them test?
- Thomas Test (ITB, hip flexors, quads)
- 90/90 test (hamstring tightness)
- Noble’s Compression Test (ITB tightness, snapping)
- Trendelenburg’s sign (Glute med weakness of stance leg if other hip sags)
Describe the Thomas test
- Patient sits at edge of plinth, lies back and pulls both knees in.
- Asymptomatic leg held to chest and other leg lowered into extension of hip and knee relaxed
- Patient can be asked to pull pelvis into greater posterior rotation.
- Can use a goniometer to measure extension angle of hip and or knee
Hip flexor tightness: The leg should be in line with the plinth. If it goes up at an angle you might be looking at hip flexor tightness.
Quad tightness: Knee should be relaxed and dangling about 90 degrees. If it is sticking out into gerater extension there maybe quad tightness.
Glute or deep lateral rotator tightness: leg is externally rotated
IT band problems: leg is going out to the side
What are the clinical prediction rules for hip osteoarthritis?
- Self report of squatting as an aggravating factor
- Active hip flexion causing lateral pain
- Passive internal rotation less than or equal to 25 degrees
- Active hip extension causing pain
- Positive scour or FABER test.
What should one ask in terms of history for SI joint pathology?
a. MOI: Insidious or Traumatic
Really insidious one is during pregnancy as the hormone relaxin can cause shifting and problems.
b. Where is the pain?
Fortin’s finger test: they point asymmetrically to an SI joint.
SI joint problems you will usually see pain above the knee. Does not completely exclude the disc but less likely. Pain all the way down the foot, this is NOT your SI joint.
SI joint problems can often involve the anterior hip. Anterior hip pain may radiate down the back of leg or laterally and occasionally into the calf. More often than not it still stays above the knee.
c. What movements aggravate it?
What do we want to observe during an SI joint assessment?
a) Posture: especially pelvis and lumbar
b) Pelvic alignment:
- Look at position of ASIS to PSIS
- Anterior innominate rotation - ASIS will be lower than PSIS
- Posterior innominate rotation - ASIS will be higher than PSIS
- Look at relative position of sacrum to innominate
- Look for inflare/outflare
- Look for upslip/downslip
c) Check for leg length discrepancy
* Is it structural or functional?
Which is more common, an upslip or a downslip?
Upslips are more common. Could result from a fall onto the butt.
Downslips are very rare, would result from a very forceful pull on leg.
What are the special tests for SI joint assessment?
- Fortin’s Test
- Straight Leg Raise
- Active Straight Leg Raise
- Laslett’s Cluster
How is the straight leg raise performed? What other condition is this test used for?
- Pateint lies supine
- Examiner passively lifts leg maintaining knee extension and neutral ankle.
- Raise to point of symptoms
- Will usually see low back pain at 60/70 degrees if it is an SI joint problem
This test was also included in the tests for lumbar radiculopath or herniated nucleus pulposis. Nadine says it is more indicative of SI joint than disc problems
