Hip Assessment Flashcards
Special Questions
Clicking, clunking, and giving way.
Observations
General:
Erythema (Redness)
Haematoma (Bruising)
Oedema (Excessive build-up of fluid, normally feet/ankles)
Excessive hair growth
Oozing/weeping
Effusion (Swelling)
Bony Deformities
Atrophy/Hypertrophy
Observe posture in different positions, assess for any deformity/mal-alignment, leg length discrepancy, lower limb rotation. Observe from different angles.
Gait - trendelenburg, antalgic
AROM/PROM
Hip: flexion 0-120°, extension 5-20°, abduction 0-40°, adduction 0-25°, internal rotation at 90° flexion 0-45°, external rotation at 90° flexion 0-45°, internal rotation in extension 0-35°, external rotation in extension 0-45°
Active - muscle control, pain
Passive - resistance and pain
Close Packed Position: extension and medial rotation
Capsular Pattern: Flexion, abduction and medial rotation (order may vary), extension is slightly limited
Muscle tests
Power:
- Gd I – V
- Through Range
Length:
- Resistance
- End Feel
Control:
- Jerky
- Smooth
Special Tests
- Ober’s Sign
Tests: tensor fascia lata and iliotibial band contractures
Positive sign: upper leg remains abducted and does not lower to plinth
Procedure: in side lying with hip and knee of lower leg flexed. Stabilise pelvis. Passively abduct and extend upper leg with knee extended or flexed to 90°, then allow it to drop towards the plinth
- Thomas Test
Tests: hip flexion contracture
Positive sign: opposite leg lifts off plinth
Procedure: patient supine. Patient hugs other knee to chest
- Trendelenberg’s Sign
Tests: stability of the hip, strength of hip abductors
Positive sign: pelvis on opposite side drops
Procedure: patient stands on one leg
- Quadrant test
Functional tests
Gait, squats, steps/stairs, hopping, running, jumping, single leg stand/squat
Palpation
Palpate temperature, muscle tone, tissue mobility, and bony alignment.
Soft Tissue:
- Tenderness
- Scar Tissue
- Sensitivity
- Thickened
Bone/Joint:
- Joint Line Tenderness
- # ’s?
Differential Diagnosis of Anterior Hip Pain
OA:
- Constant, deep, aching pain and stiffness; pain with weight-bearing or prolonged standing
- Older than 50 years, pain with activity that is relieved with rest
- Decreased ROM in capsular patter; Internal rotation < 15 degrees, flexion < 115 degrees
- Extremes of hip motion often cause pain
Femoral neck fracture/stress fracture:
- Deep, referred anterior hip/groin pain; pain with weight bearing
- Females (especially with female athlete triad/REDS), endurance athletes, low aerobic fitness, steroid use, smokers
- H/O repetitive weight-bearing exercise
- Painful ROM, pain on palpation of greater trochanter
- Pain may be present with extremes of motion, active straight leg raise, the log roll test, or hopping
Femoroacetabular impingement:
- Deep, referred pain; pain with standing after prolonged sitting
- Young and physically active
- Insidious onset of pain that is worse with sitting, rising from a seat, getting in or out of a car, or leaning forward
- Pain is located primarily in the groin with occasional radiation to the lateral hip and anterior thigh
- FADIR and FABER tests are sensitive
Hip labral tear:
- Dull or sharp, referred groin pain; pain with weight bearing
- One-half of patients with a labral tear have pain that radiates to the lateral hip, anterior thigh, and buttock
- Mechanical symptoms, such as catching or painful clicking; history of hip dislocation
- Usually has an insidious onset, but occasionally begins acutely after a traumatic event
- Trendelenburg or antalgic gait, loss of internal rotation, positive FADIR and FABER tests
Iliopsoas bursitis (internal snapping hip):
- Deep, referred anterior hip pain; intermittent catching, snapping, or popping
- Ballet dancers, runners
- Snap with FABER to extension, adduction, and internal rotation; reproduction of snapping and/or pain with extension of hip from flexed position
Legg-Calvé-Perthes disease:
- Deep, referred pain; pain with weight bearing
- 2 to 12 years of age, male predominance
- Antalgic gait, limited ROM or stiffness
Slipped capital femoral epiphysis:
- Deep, referred pain; pain with weight bearing
- 11 to 14 years of age, overweight (80th to 100th percentile)
- Antalgic gait with foot externally rotated on occasion, positive log roll and straight leg raise against resistance tests, pain with hip internal rotation relieved with external rotation
Differential diagnosis of Lateral Hip pain
External snapping hip*:
- Pain with direct pressure, radiation down lateral thigh, snapping or popping
- All age groups, audible snap with ambulation
- Positive Ober test, snap with Ober test, pain over greater trochanter
Greater trochanteric bursitis*:
- Pain with direct pressure, radiation down lateral thigh
- Runners, middle-aged women
- Pain over greater trochanter
Greater trochanteric pain syndrome:
- Pain with direct pressure, radiation down lateral thigh
- Mild morning stiffness and may be unable to sleep on the affected side
- Associated with knee osteoarthritis, increased body mass index, low back pain; female predominance
- Proximal iliotibial band tenderness, Trendelenburg gait is sensitive and specific
- * - Conditions associated with greater trochanteric pain syndrome.
Gluteal muscle tear or avulsion*:
- Pain with direct pressure, radiation down lateral thigh and buttock
- Middle-aged women
- Weak hip abduction, pain with resisted external rotation, Trendelenburg gait is sensitive and specific
Iliac crest apophysis avulsion:
- Tenderness to direct palpation
- History of direct trauma, skeletal immaturity (younger than 25 years)
- Iliac crest tenderness and/or ecchymosis
Differential diagnosis of Posterior Hip pain
Hamstring muscle strain or avulsion:
- Buttock pain, pain with direct pressure
- Eccentric muscle contraction while hip flexed and leg extendedSkeletal immaturity, eccentric muscle contraction (cutting, kicking, jumping)
- Ischial tuberosity tenderness, ecchymosis, weakness to leg flexion, palpable gap in hamstring
Piriformis syndrome:
- Buttock pain that is aggravated by sitting or walking, with or without ipsilateral radiation down the posterior thigh from sciatic nerve compression
- History of direct trauma to buttock or pain with sitting, weakness and numbness are rare compared with lumbar radicular symptoms
- Positive log roll test, tenderness over the sciatic notch
Sacroiliac joint dysfunction:
- Pain radiates to lumbar back, buttock, and groin
- Female predominance, common in pregnancy, history of minor trauma
- FABER test elicits posterior pain localized to the sacroiliac joint, sacroiliac joint line tenderness
Presence of a limp, groin pain, and limited internal rotation of the hip is more predictive of hip disorders than disorders originating from the low back
Neurological testing
- Dermatomes (see picture)
-
Myotomes (look for weakness not pain)
- L2: Hip flexion (iliopsoas); femoral nerve
- L3: Knee extension (quadriceps); femoral nerve
- L4: Dorsiflexion (tibialis anterior); deep peroneal nerve
- L5: Great toe extension (FHL); deep peroneal nerve
- S1: Eversion (peronei; superficial peroneal nerve), contract buttock, knee flexion (hamstrings; sciatic nerve)
- S2: Knee flexion, toe standing (gastroc, soleus); tibial nerve
-
Reflexes
- Patella tendon jerk
- Achille’s tendon jerk
- Babinski reflex - UMNL
-
Clonus (UMNL?)
- Quick passive ankle DF
- Hoffman’s sign (UMNL?)
-
SLR
- Sciatic nerve and branches
- SID - sural nerve, INV + DF
- PIP - peroneal nerve, INV + PF
- TED - tibial nerve, EV + DF
-
PKB
- Femoral nerve
-
Slump
- Sciatic nerve and above