Hip Assessment Flashcards
Sacrum is always opposite to
L/S
Normal position of pelvis and L/S
Anterior tilt
slight extension
Hip pain is most common in the population
over 60 years
Why is it challenging to give a differential diagnosis
can be pelvis, SIJ, L/S, referred pain
most common hip conditions in young and middle aged active adults
Femoral acetabular impingement
Acetabular dysplasia
hip instability
labral/chondral or ligamentous teres tears
what is an overlooked cause of hip pain
myofascial pain
most common hip pathology
musculotendinous groin and hamstring injuries
extra articular hip pathologies(4)
snapping hip
muscle injuries
stress fractures
ITB restriction
Snapping hip
external: IT over greater trochanter
Internal: Iliopsoas over pelvic rim
Intra-articular: symptoms of other pathologies
Intra articular hip injuries
Femoral acetabular impingement
Acetabular labral tear
chondral injuries
Synovitis
Intra articular patho radiate where
anterior and medial hip due to structures being innervated by femoral and obturator nerve
Posterior hip pain
under recognized manifestation of fermoroacetabular joint disease
referral to L/S and SIJ
Lateral hip pain
tendinosis of glute medius and minimus, thickening of IT band, trochanteric bursitis
Labral tear may refer laterally
Anterior hip pain
C-sign anterior medial thigh
OA primary consideration with older individual
labral tears
FAI, iliopsoas impingement, internal snapping hip, stress fx
limited ROM with OA
All but more hip flexion and internal rot.
Physical examination to diagnosis
30%
Pediatric patients condition and age
Legg-Calves-Perthes disease (3-11)
Slipped femoral epiphysis (12-15)
Labral tear (adolescents-adults)
OA and osteoporotic fx (older adults)
When and why should a patient be screened for infections and cancer
hip close to reproductive system and GI tract
in cases of systemic symptoms
alarming symptoms
fever
malaise
night sweats
weight loss
history of drug abuse
past or present cancer
being immunocompromised
lumbar pathology pain regions
Back
Buttock
hip
thigh
leg
foot
SIJ pathology pain regions
Buttock
Thigh
Groin
Back
Knee
Hip pathology pain regions
Groin
Buttock
Thigh
Knee
Active trigger point
constantly sending pain signal to referred area
latent trigger point
pushing on it creates pain
common trigger points
refers to posterolateral and anterolateral hip
refers to the anteromedial and thigh
Osteoarthritis
older individuals
limited motion
gradual onset
constant, deep, aching,and stiffness
worse with prolonged standing and weight bearing
decrease ROM, extreme ROM cause pain
FAI
young and physically active
insidious onset
worse with sitting, rising from seat
location in groin primarily
Hip labral tear
dull sharp groin pain
may radiate to lateral hip, anterior thigh and butt
insidious but could be traumatic
catching painful click
Iliopsoas bursitis
anterior hip pain when extending from a flexed position
intermittent catching snapping popping
Stress fx
trauma or repetitive WB
worse with activity
pain in extreme ROM, SLR, log roll test or hopping
piriformis syndrome and ischiofemoral impingement
pain in butt
worse with sitting and walking
ipsilateral radiation down post. thigh
increased with ER of hip
greater trochanteric pain syndrome
atraumatic
IT band thickening, bursitis, tears of tendinopathies of glute muscles
morning stiffness
unable to sleep on affected side
Lumbar spine pathology
low back pain
neurological deficits
pain with prolonged sitting or standing
pain with sneezing
releived with rest
SIJ pathology
precise SIJ pain
no neurological deficit
pain with transitional movements
pregnancy related s/s
movement alleviates
Hip joint pathology
groin or thigh pain
no neurological deficits
increased pain with loading or night pain
hip stiffness or catching
Piriformis neutral
external rotation and abduction
Piriformis in hip flexion past 60 degrees
internal rotation and abduction
clinical prediction rule for OA
- limited active hip flexion with lateral pain
- active hip extension causes pain
- limited passive hip medial rotation
- squatting limited and painful
- scour test with adduction causes lateral hip or groin pain
4 must be positive
Flex test
mod thom
ober’s
ely’s
hip provocation test(6)
FABER
FADDIR
scour
stinchfield maneuver
internal rotation over pressure
log roll test
what can a negative FADDIR do
rule out presence of hip related pain
posterior pain with FABER
SIJ may be responsible
Scour- greatest strain on labrum in what ROM
flex and add
Stinchfield test
resisted hip flexion
helps distinguish intra and extra articular hip patho
active 1st and resisted after
not great test
log roll test
stresses intra articular tissue
passive
looks at hip mobility
what tests are good to rule out intra articular hip pathology(3)
FABER
hip scour
Stinchfield
combination of 3
what test is good to rule in intra articular hip pathology
thomas test
4 tests for gluteal tendinopathies
trendelenburg
RROM ABD
RROM IR
hip external de-rotation test
leg length discrepancies associated with
compensatory gait abnormalities and may lead to degenerative arthritis in LE and L/S
anteversion and retroversion
angle made by femoral neck and femoral condylles
normal angle
8-15
anteversion increases risk of
dislocation
retroversion increases
stability
what test measures angle of anteversion
craigs
