Hip Assessment

Question 1

What are subjective special questions for the hip for history of present condition (HPC)?

Answer 1

• Traumatic Vs insidious onset
• Training load (any recent changes in training / activities or any high impact activities)
• Location of pain (groin, buttock, lateral hip or a combination)
• Other symptoms (eg limping, feeling unstable, clicking, clunking, catching associated with pain, neurological)

Question 2

What are subjective special questions for the hip for aggravating/easing factors & 24hr pattern?

Answer 2

• Early morning stiffness (esp in patient over 45)?
• How are symptoms after long periods of sitting, putting on socks, squatting or bending etc?
• Have they stopped sports activities due to pain?
• What are the aggravating activities - Deep flexion based or loaded rotation?

Question 3

What are some important past medical history questions to ask about the hip?

Answer 3

• Childhood diseases (e.g.: Perthes disease, SUFE, hip braces)
• Family history of Osteoarthritis
• Fracture
• History of cancer
• History of surgery

Question 4

The acronym SAM can be used to remember what specific red flags for the hip?

Answer 4

• Stress fractures – more common in young white females with BMI less than 19.
  (Present with acute onset ache in anterior aspect of thigh and unable to run. Should be wary of runners who have stopped running due to pain or have pain with weight bearing activities.)
• Avascular necrosis
  (Can be insidious or post NOF and if often initially missed on x-ray and needs an MRI for diagnosis. )
• Metastasis
  (Be cautious of any patient presenting with insidious onset hip pain and a history of cancer. May initially present with mechanical osteoarthritis type symptoms.)

Question 5

What are some functional tests for strength/stability of the hip?

Answer 5

• Single leg balance (Trendelenburg?)
• Squat (double/single leg)
• Bridge (double/single leg)
• Clam/hip abduction (single leg)
• Prone hip extension

Question 6

What are (2) examples of capacity tests used to assess the hip?

Answer 6

• Hamstring – SL bridge to failure – expect 25 reps in runners
• Abductors / gluteal – Side lying leg lift to failure (watch for compensation)

Question 7

How do you ‘resist’ muscles to assess strength of hip adduction muscles?

Answer 7

• Squeeze fist in between knees
• Pull/resist against one side

Question 8

When assessing muscle strength of hip adduction, what muscles are being assessed at 90 degrees of hip flexion?

Answer 8

Pectineus

Question 9

When assessing muscle strength of hip adduction, what muscles are being assessed at 0 or 45 degrees of hip flexion?

Answer 9

• Adductor magnus
• Adductor longus
• Gracilis

Question 10

What muscles must be known around the pelvic girdle & hip?

Answer 10

• Tensor Fascia Lata (TFL)
• Psoas Major
• Iliacus
• Iliotibial Band (ITB)
• Pectineus
• Adductor Magnus
• Adductor Longus
• Adductor Brevis
• Gracilis
• Sartorius
• Gluteus maximus
• Gluteus medius
• Gluteus minimus
• Piriformis
• Quadratus femoris
• Obturator internus
• Obturator externus
• Gemellus superior and inferior

Question 11

What are the bony landmarks of the hip?

Answer 11

• Greater Trochanter
• Anterior Superior Iliac Spine (ASIS)
• Pubic Tubercle
• Iliac Crest
• Posterior Superior Iliac Spine (PSIS)
• Ischial Tuberosity