Hip assessment

Question 1

What are the clinical features of osteoarthritis in the hip?

history

Answer 1

Hx;

• 50+yrs; pain in buttock/groin spreading to anterior thigh;
• Increasing pain on bending, crossing legs, dressing, walking; eventually night pain

Question 2

What are the clinical features of osteoarthritis in the hip? (exam)

Answer 2

Exam;

• Capsular pattern –> Gross limitation of flexion, medial rotation and abduction; little limitation of lateral rotation
• Weak abductors/extensors
• +ve Trendelenburg’s sign

Question 3

What should you observe when call the patient in from the waiting room?

Answer 3

1) rising from chair
2) initial gait
3) listen for gait
4) Sitting down
5) Undressing
6) Crossing legs
7) Stairs

Question 4

What should be observed during standing observation from behind?

Answer 4

• Spinal alignment
• Iliac crest/PSIS levels
• Gluteal bulk/creases
• Knee creases

Question 5

What should be observed during standing observation from the side?

Answer 5

• Pelvic tilt
• Knee hyper ext
• Gluteal bulk.
• Flexion ‘deformity’ of hip and/or knee

Question 6

What should be observed during standing observation from in-front?

Answer 6

• Iliac crest/ASIS levels
• Quad bulk
• Femur/tibia alignment (valgus/varus)
• Foot posture

Question 7

What should be observed in supine?

Answer 7

• Resting position of hip/lower limb (flexion, rotation etc.)
• Leg length

Question 8

What should be considered during palpation?

Answer 8

• Lumps/bumps

- Trochanteric bursae

Question 9

What quick tests could be used to clear other joints aside from the hip?

Answer 9

• FABER (sacroiliac)
• SLR (neural)
• Flexion/extension of the knee with gentle over-pressure (passive)

Question 10

Which active movements should be performed?

Answer 10

• Flexion
• Medial/internal rot. (straight leg)
• Lateral/ext. rot. (straight leg)

Question 11

Which passive movements should be performed?

Answer 11

• flexion
• Medial/lateral rotation in 90deg hip flexion
• FADIR/FABER
• Abduction/adduction

Question 12

Which resisted movements should be performed and which muscles are being tested?

Answer 12

• straight leg, hip flexion (Psoas major, iliopsoas, rectus femoris/quads)
• 90deg hip flexion (Iliopsoas)
• Adduction (Adductors, gracilis)
• internal rotation
• external rotation.