Hip Assessment Flashcards by Mia Hebert

Sacrum is always opposite to

L/S

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Normal position of pelvis and L/S

Anterior tilt
slight extension

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Hip pain is most common in the population

over 60 years

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Why is it challenging to give a differential diagnosis

can be pelvis, SIJ, L/S, referred pain

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most common hip conditions in young and middle aged active adults

Femoral acetabular impingement
Acetabular dysplasia
hip instability
labral/chondral or ligamentous teres tears

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what is an overlooked cause of hip pain

myofascial pain

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most common hip pathology

musculotendinous groin and hamstring injuries

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extra articular hip pathologies(4)

snapping hip
muscle injuries
stress fractures
ITB restriction

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Snapping hip

external: IT over greater trochanter
Internal: Iliopsoas over pelvic rim
Intra-articular: symptoms of other pathologies

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Intra articular hip injuries

Femoral acetabular impingement
Acetabular labral tear
chondral injuries
Synovitis

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Intra articular patho radiate where

anterior and medial hip due to structures being innervated by femoral and obturator nerve

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Posterior hip pain

under recognized manifestation of fermoroacetabular joint disease

referral to L/S and SIJ

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Lateral hip pain

tendinosis of glute medius and minimus, thickening of IT band, trochanteric bursitis

Labral tear may refer laterally

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Anterior hip pain

C-sign anterior medial thigh
OA primary consideration with older individual
labral tears
FAI, iliopsoas impingement, internal snapping hip, stress fx

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limited ROM with OA

All but more hip flexion and internal rot.

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Physical examination to diagnosis

30%

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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)

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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

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alarming symptoms

fever
malaise
night sweats
weight loss
history of drug abuse
past or present cancer
being immunocompromised

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lumbar pathology pain regions

Back
Buttock
hip
thigh
leg
foot

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SIJ pathology pain regions

Buttock
Thigh
Groin
Back
Knee

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Hip pathology pain regions

Groin
Buttock
Thigh
Knee

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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

1. limited active hip flexion with lateral pain 2. active hip extension causes pain 3. limited passive hip medial rotation 4. squatting limited and painful 5. 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