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PCM Exam 1 > Hip complaint > Flashcards

Hip complaint Flashcards

1
Q

What is an early symptom of a hip disease? What motion does this action require?

A

Difficulty putting on shoes, which requires external rotation of the hip, which is the first motion that is lost with a hip difficulty.

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2
Q

What is the order of motion movements that are lost with a hip disease?

A
  1. External rotation of the hip
  2. AB/ADduction of the hip
  3. hip flexion
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3
Q

What are the most common conditions that affect the hip?

A

Trochanteric and gluteus medius bursitits, osteoarthritis, and fractures of the femur

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4
Q

Describe neuralgia paresthtetica

A

characterized by a localized area of pain that is not influenced by direct pressure, hip movement, or lower back movement

DUE TO LATERAL FEMORAL CUTANEOUS NERVE ENTRAPMENT

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5
Q

What does anterior hip pain that is not aggravated by direct pressure or repetitive flexion suggest?

A

Presence of an inguinal hernia, lower abdominal pathology, or pain that is from a higher lumbar spinal roots

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6
Q

What is the classic pattern of trochanteric bursitis?

A

Lateral hip pain that is aggravated by direct pressure

cannot sleep on the affected side

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7
Q

What does posterior hip pain (glut pain) suggest?

A

SI joint disease
Lumbar radiculopathy
herpes zoster

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8
Q

What are the different variables that can cause anterior thigh pain?

A

Primary disease of the hip joint, lesions of the upper femur, stress fractures, radiculopathy

unless the pain can be reproduced with movements of the hip, require radiographic testing

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9
Q

Describe the three ways in which you would be able to evaluate the patients ambulation

A
  1. Evaluate the patients gait
  2. Tolerance of squatting
  3. See how they are able to move in the examination room
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10
Q

What is a Trendelenberg gait?

A

The patient shifts the torso over the affected hip and reduced the load on the hip

Basically they are moving the affected hip inward so that there is less weight being put on the joint with every step

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11
Q

What is an antalgic gait?

A

The patient spends a shorter amount of time weight bearing on the affected side because of pain

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12
Q

How do you determine a short leg limp?

A

If the patients head and shoulders move up and down as they walk; up with the long leg and down the short leg

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13
Q

How do you inspect for pelvic obliquity?

A

The patient is asked to stand and you place your hands on the top of the iliac crests to see if it is equal

If it is not, then there is a leg length discrepancy, pelvic fracture, scoliosis, unilateral paraspinal muscle spasm

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14
Q

What does the Patrick (fabere test) test?

A

Tests the hip and the sacroiliac joint

Flexes, Abducts, Externally rotates, and extends the affected legs that the ankle is on the opposite knee and the affected leg is lowered towards the table

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15
Q

What does a positive result of the Patrick test indicate? Differentiate between a positive and a negative test

A

A positive test is when the affected leg (the one that is in the figure 4) stays above the opposite leg and is not able to lower fully to the table

A negative test is when the affected leg is able to stay parallel with the affected leg

A positive test could be indicative of hip disease, iliopsoas spasm, or SI disease

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16
Q

Describe how to examine for trochanteric bursitis

A

Hip must be flexed to 90 degrees (patient seated)
Apply pressure over the area where the trochanteric bursa should be, especially in obese patients

tenderness is typically due to bursitis in most cases but can also be caused by an occult fracture, stress fracture, or metastasis

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17
Q

For a patient that has neuralgia parestetica, where would you expect them to have sensory deficits

A

anterolateral thigh secondary to entrapment of the lateral cutaneous femoral nerve

CAN be classified by loss of sensation (hypesthesia) or heightened sensation (dysesthesia)

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18
Q

Describe the straight leg raise including the causes of pain at different levels

  1. 30-70 degrees of hip flexion
  2. less than 30 degrees of hip flexion
  3. greater than 70 degrees of hip flexion
A
  1. lumbar disc herniation at the L4-S1
  2. Spondylolithesis, gluteal abscess, disc protrusion of extrusion, tumor
  3. tightness of muscles or SI joint pathology
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19
Q

Which muscle is involved in hip flexion and what is it innervated by?

A

Iliopsoas muscle

Femoral nerve (L2-L4) 
Ventral rami of lumbars (L1-L2)
20
Q

Which muscle is involved in hip extension and what is it innervated by?

A

Gluteus maximus muscle

Inferior Gluteal nerve (L5, S1, S2)

21
Q

Which muscle is involved in hip abduction and what is it innervated by?

A

Gluteus medius and minimus muscle

Superior Gluteal nerve (L5, S1)

22
Q

Which muscle is involved in hip adduction and what is it innervated by?

A

Adductor longus muscle

Obturator nerve (L2-L4)

23
Q

What are the 4 compartments of the hip?

A

Central, Peripheral, Lateral, Anterior

24
Q

What is in the central compartment of the hip?

A

Labrum
Ligamentum Teres
Articular Surfaces

25
Q

What is in the peripheral compartment of the hip?

A

Femoral neck

Synovial lining

26
Q

What is in the lateral compartment of the hip?

A 
Gluteus medius 
Gluteus minimus 
Piriformis 
IT band 
Trochanteric bursae
27
Q

What is in the anterior compartment of the hip?

A

Iliopsoas insertion

Iliopsoas bursae

28
Q

What is the ROM of hip flexion?

Knee straight and knee bent?

A

Knee straight: 90 degrees

Knee bent: 120-135 degrees

29
Q

What is the ROM of hip extension?

A

15-30 degrees

30
Q

What is the ROM of hip abduction?

A

45-50 degrees

31
Q

What is the ROM of hip adduction?

A

20-30 degrees

32
Q

What is the ROM of hip internal rotation?

A

30-40 degrees

33
Q

What is the ROM of hip external rotation?

A

40-60 degrees

34
Q

Describe the labral loading test

A

Flex the patients knee and hip to 90 degrees and load the femur with a downwards pressure

35
Q

What does a positive labral loading test insinuate?

A

Labral or cartilaginous pathology

36
Q

Describe the labral distraction test

A

disrate the patients femur away;

Flex the patients knee and hip to 90 degrees and apply traction to the joint

37
Q

What does a positive labral distraction test insinuate?

A

Labral or cartilaginous pathology

38
Q

Describe the scour test?

A

Flex the patients knee and hip and take the leg in the symbol of the omega sign

If there is pain with these movements, then the test is positive

39
Q

What does a positive scour test indicate?

A

A labral or articular cartilage pathology

40
Q

Describe the first portion of the Patrick test

A
  1. Apprehension

Patients hip is flexed, abducted, and externally rotated. An external rotation force is applied at the posterior knee

41
Q

Describe the jump sign test

A

Patient is seated and pressure is applied to the greater trochanter

a positive test is if the patient “jumps” with pain

42
Q

Describe the second part of the Patrick’s test

A

Physician has the patients hip flexed, abducted, and externally rotated

The physician braces down on the ASIS and the patient externally rotates/abducts against the resistance

43
Q

What does a positive Patricks 2/3 test indicate?

A

Gluteus medius pathology

44
Q

What does a patricks 3/3 test indicate?

A

Iliopsoas insufficiency or pathology

45
Q

What is the part 3/3 of the Patricks test?

A

Patients hip is flex, abducted, and externally rotated (in the figure 4 formation) and the physician braces the ASIS And the patient internally rotates against resistance

46
Q

What are the three parts of the patricks test?

A
  1. Apprehension
  2. Patient externally rotates with resistance
  3. Patient internally rotates with resistance
47
Q

Describe the Thomas test

A

Patient is supine. Have them grab their knees and roll up into a ball and then lower one of their legs to the table. If the leg does not hit the table, there there is an issue with the flexibility of the hip flexors

A positive test is the leg NOT hitting the table when let down

PCM Exam 1 (10 decks)

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