Hip Eval & Treat Flashcards
Hip Joint (OP/CP)
-synovial joint
-Designed for stability and less mobility
-Convex head of femur and concave acetabulum
-Femoral head faces Medially, anteriorly, superiorly
Resting Position: Flx 30, Abd 30, Slight ER
Closed Packed: Full ext, IR, ABD
Capsular Pattern: Flx, Abd, IR (sometimes IR first)
Hip Dysplasia
-undercoverage of femoral head by acetabulum
-instability
Femoro-Acetabular Impingement
-FAI
-excessive bony development or overcoverage by acetabulum
-too much contact
Acetabulum
-faces anteriorly, laterally, inferiorly
-concave
-2/5 ilium and ischium, 1/5 pubis
-labrum provides neg pressure and suction (fibrocartilage)
-Acetabular fossa: shock absorption and proprioception
Angle of Inclination
-frontal plane of femoral neck
Normal:
-Adults: 125-139
-Infants: 150
-Elderly: 120
Coxa Valga: >139, longer limb, neck straight
Coxa Vara: <125, shorter limb, neck bent
Angle of Torsion
-horizontal plane of femoral neck in relation to condyles
Normal:
-Adults: 10-15 Anterior
-Infants: 30
Excessive Anteversion: >15 deg
-toe in and IR of hip to compensate
Relative Restroversion: <10 deg of anteverison
-toe out and ER of hip to compensate
Absolute Reroversion: <0 deg
-toe out and ER
Joint Capsule
Anterior/Superior:
-thick and dense
-more disposed to shortening and becoming a restriction
Posterior/Inferior:
-thin and loose
-dislocation risk
Posterior Oblique System
-lats, contra glue max, L fascia
-helps with SLS
Anterior Oblique System
-EO/IO, contra hip add and abdominal fascia
-helps wih SLS
Lateral Muscle System
-Glute med/min and contra hip add
Pectineus action
- Adducts hip.
- Slightly flex hip.
- Internal rotation of hip.
Sartorius action
- Flex hip.
- Abduct hip.
- Externally rotate hip.
- Flex knee
- Internally rotate leg with flexed hip.
Gluteus maximus action
- Extend hip joint.
- ER of hip.
- Flex hip.
- AB hip (Sup fibers)
- ADD hip (Inf fibers)
Gluteus, medius action
- Abduct hip.
- Internally rotate hip.
- Support, contralateral leg
Gluteus, minimus action
- Abduct hip
- Internally rotate hip (ant fibers)
- ER hip (post fibers)
- Support, contralateral leg
commonly weak
Tensor fasciae latae action
- Internally rotate hip.
- Abduct hip.
- Flexes hip
- Support, contralateral leg
commonly short and stiff
Piriformis action
- Externally rotate, extended hip.
- Abduct hip while flexed.
- Stabilize hip.
- IR when >90 flexed
Adductor Longus Action
- Adducts hip
- Flexes Hip
most commonly strained
Adductor Brevis Action
- Adducts hip
- Flexes hip
Adductor Magnus Action
- Adducts hip
Adductor Part:
1. Flex hip (anterior)
Hamstring Part:
1. Extend hip (posterior)
Gracilis Action
- Adducts hip
- Flexes knee
- Internally rotate hip when flexed
Rectus Femoris Action
- Extend knee
- Stabilized Knee and hip
- Help iliopsoas flex hip
- APT
Semitendinosus Action
- Extend hip
- Flex knee
- Internal rotation when hip is flexed
- Extend trunk at hip when hip and knee are flexed
Semimembranosus Action
- Extend hip
- Flex knee
- Internal rotation when hip is flexed
- Extend trunk at hip when hip and knee are flexed
Biceps Femoris Action
- Flexes and ER knee
- External rotation of hip
- Extends hip
Iliopsoas major action
- Iliacus: Flex the hip (all the way to end range)
- Psoas: lumbar side bending, vertical stabilizer
- Externally rotate the hip.
- Flex the trunk toward the thigh
- Tilted pelvis anteriorly
- Stabilize the hip joint.
Iliopsoas Bursa
-largest and most constant bursa around hip
-near lesser trochanter
-cushions tension from anterior structures
Trochanteric Bursa
-greater troch and glue min
Ischiogluteal Bursa
-located btwn ischium and glute max
-on isch tub
Femoral Triangle
-VAN (m-l)
Superior Border: inguinal lig
Medial Border: adductor longus
Lateral Border: Sartorius
Neurology of Hip
-L1-L2 and L3
-supply joint capsule and joint
Flow of arterial supply
-Abdominal Aorta
-Common iliac
-External iliac———–Internal iliac (to PF)
-(@inguinal lig) Femoral A.–Deep Femoral (circumflex)
-(@hiatus) Popliteal A.
-(@soleal line) Pos. Tib A. —— Fibular A.
-Ant. Tib A.
-Dorsalis Pedis
Lateral Femoral Circumflex A.
-comes from femoral
-anterior femoral neck and capsule
Medial Femoral Circumflex A.
-comes from femoral
-supplies posterior hip joint, synovium, and femoral head (lig teres)
Normal ROM Hip
Flx: 110-120
Ext: 10-15(20)
IR: 30-40
ER: 40-60
Abd: 30-50
Add: 25-30
Hip Flexion ROM
-120 (soft)
-supine, knee flexed
-stabilize pelvis
Stationary: lat midline Pelvis
Axis: greater trochanter
Movement: midline of femur to Lateral epicondyle
Hip Abduction and Adduction ROM
-45 ab, 30 add (firm)
-supine, knee extended
-stabilize pelvis
Stationary: Opposite ASIS
Axis: ASIS
Movement: Midline of femur
Hip Extension ROM
-10-15 (firm)
-prone, knee extended
-stabilize pelvis
Stationary: lat midline Pelvis
Axis: greater trochanter
Movement: midline of femur to Lateral epicondyle
Hip IR/ER ROM
-45 (firm)
-sitting or prone, knee flexed
-stabilize pelvis
Stationary: Perpendicular to ground or table
Axis: Patella
Movement: Midline of tibia
Arthrokinematics of Hip
Flexion: sup spin, post glide
Extension: inf spin, ant glide
Abd: inf glide, med glide
Add: sup glide, lat glide
IR: posterior glide
ER: anterior glide
Hip Pathologies by Age
Newborn: congenital dislocation
2-8yrs: Legg Perthes
Children: Hemophilia
10-14yrs: SCFE, osteochondritis dissecans
14-25yrs: stress fx, synovitis, FAI, trauma, bursitis
45-60yrs: OA, synovitis
Females 50+: glute med tear
65+: stress fx, OA, replacement surgery
Congenital Hip Dislocation
Age: birth
-Females>Males
Observation: short limb, hip flexed and abducted
-upward and lateral displacement
ROM: limited abd
Legg-Calve-Perthes
Age: 2-8yrs
-avascular necrosis
S/s: gradual onset, ache in hip
Observation: short limb, higher g troch, quad atrophy, adductor spasm
ROM: limited abd and ext
Intervention: ROM and positioning
Slipped Femoral Capital Epiphysis
Age: 10-17 yrs males, 8-15yrs female
-ice cream falling off cone
S/s: gradual onset, vague pain
Observation: short limb, usually obese, quad atrophy
ROM: limited IR, abd, flex
Gait: antalgic acutely, Trendelenburg chronically
Avascular Necrosis
Age: 30-50yrs
-sharp pain or intermittent with motion
ROM: decreased
Intervention: Protected WB
Degenerative Joint Disease
Age: >40yrs
S/s: insidious onset, pain with WB
Observation: often obese, joint crepitus, muscle atrophy
ROM: capsular pattern
Radiographic: increased bone density, bone spurs, degenerative cartilage
Interventions: manual, exercise
Altman’s Clinical Criteria (Hip)
-do you have hip OA?
- Hip pain
- IR <15deg
- Pain with IR
- Morning stiffness up to 60min
- Age >50yrs
Sutlive CPR
-what are the odds you have hip OA
3/5 present= 68%
4/5 present= 91%
- Self-reported squatting is aggravating
- SCOUR test w/ ADD causes groin or lat hip pain
- Active hip flx causes lat pain
- Active hip ext causes hip pain
- Passive hip IR less than or equal to 25deg
Hip OA Clinical Guidelines
- Asses for impairments in the mobility of hip
- Consider Age as Risk Factors
- Diagnosis and classification using CPR
- Differential Diagnosis
- Exam: Outcome Measures
- Exam: Activity and Participation Limitations
- Intervenions: Education
- Interventions: Functional, gait, balance
- Interventions: Manual Therapy
- Interventions: Flexibility, strength, endurance
Differential Diagnosis w/ Hip OA
-SCOUR/FABER/Fitzgerald’s/FADIR for labral tears
-SIJ provocation
-Femoral nerve stretch for radiculopathy
Hip Replacement Patient
Acute:
-prevent DVT
-precautions (posterior MC)
-home equipment
Outpatient:
-progressive strengthening
-mobilization (ext MC)
-Balance and gait
Muscle Strains
-rule out neural irritability
-hamstrings, rec fem, adductor long MC
Myositis Ossificans
-heterotopic ossification
-bone-like tissue in places it shouldn’t be
Osteitis Pubis/ Symphysiolysis
-inflammation of pubic tubercles
-during surgery or pregnancy
ITB Syndrome
-gradual onset; overuse
-Ober’s test
S/s:
-lat hip, thigh, knee pain
-snapping IT band over greater troch
Tx:
-activity modification
-stretching
-footwear
Trochanteric Bursitis
-pain over greater troch w/ resisted abd
Meralgia Paresthesia
-brittany spears
-gradual onset, obese, pregnancy
S/s:
-pain and paresthesia of ant lat thigh
-lateral femoral cutaneous
Gluteus Med Tendinopathy/Tear
-post menopausal, >50yrs
-Aggravating factors: stair climbing and sleeping on side
-muscle wasting
Diffx:
-troch bursitis
-hip OA
Testing Cluster:
-FABER
-external de-rotation tests
-palpation
-SLS
Femoroacetabular Impingement
-FAI
Cam Impingement:
-related to femoral head and neck morphology
-early contact
-damages labrum
Pincer Impingement:
-acetabular abnormalities
Pain locaions:
-Anterior-medial: flx/IR positioning
-Posterior: flx/abd/ER positioning
(ischtub pain)
Femoral Neck Fracture
-not on Xray
-unable to passively rotate hip
Hip Subjective Hx
-H/o LBP
-Hip problems as a child
-Clicking/popping/catching (w/ or w/o pain)
-OA
-Surgical Hx
Examination Order of Hip
- Hx
- Observation
- Gait/Squat/SLS
- Scan/Not
- Hip ROM > Back ROM > Knee ROM
- MMT
- Flexibility
- Joint Play
- Palpation
- Special Tests
Hip Joint (OP/CP)
-synovial joint
-Designed for stability and less mobility
-Convex head of femur and concave acetabulum
-Femoral head faces Medially, anteriorly, superiorly
Resting Position: Flx 30, Abd 30, Slight ER
Closed Packed: Full ext, IR, ABD
Capsular Pattern: Flx, Abd, IR (sometimes IR first)
Normal ROM Hip
Flx: 110-120
Ext: 10-15(20)
IR: 30-40
ER: 40-60
Abd: 30-50
Add: 25-30
Arthrokinematics of Hip
Flexion: sup spin, post glide
Extension: inf spin, ant glide
Abd: inf glide, med glide
Add: sup glide, lat glide
IR: posterior glide
ER: anterior glide
Legg-Calve-Perthes
Age: 2-8yrs
-avascular necrosis
S/s: gradual onset, ache in hip
Observation: short limb, higher g troch, quad atrophy, adductor spasm
ROM: limited abd and ext
Intervention: ROM and positioning
Slipped Femoral Capital Epiphysis
Age: 10-17 yrs males, 8-15yrs female
-ice cream falling off cone
S/s: gradual onset, vague pain
Observation: short limb, usually obese, quad atrophy
ROM: limited IR, abd, flex
Gait: antalgic acutely, Trendelenburg chronically
Altman’s Clinical Criteria (Hip)
-do you have hip OA?
- Hip pain
- IR <15deg
- Pain with IR
- Morning stiffness up to 60min
- Age >50yrs
Sutlive CPR
-what are the odds you have hip OA
3/5 present= 68%
4/5 present= 91%
- Self-reported squatting is aggravating
- SCOUR test w/ ADD causes groin or lat hip pain
- Active hip flx causes lat pain
- Active hip ext causes hip pain
- Passive hip IR less than or equal to 25deg
Osteitis Pubis/ Symphysiolysis
-inflammation of pubic tubercles
-during surgery or pregnancy
ITB Syndrome
-gradual onset; overuse
-Ober’s test
S/s:
-lat hip, thigh, knee pain
-snapping IT band over greater troch
Tx:
-activity modification
-stretching
-footwear
Trochanteric Bursitis
-pain over greater troch w/ resisted abd
Meralgia Paresthesia
-brittany spears
-gradual onset, obese, pregnancy
S/s:
-pain and paresthesia of ant lat thigh
-lateral femoral cutaneous
Gluteus Med Tendinopathy/Tear
-post menopausal, >50yrs
-Aggravating factors: stair climbing and sleeping on side
-muscle wasting
Diffx:
-troch bursitis
-hip OA
Testing Cluster:
-FABER
-external de-rotation tests
-palpation
-SLS
Femoroacetabular Impingement
-FAI
Cam Impingement:
-related to femoral head and neck morphology
-early contact
-damages labrum
Pincer Impingement:
-acetabular abnormalities
Pain locaions:
-Anterior-medial: flx/IR positioning
-Posterior: flx/abd/ER positioning
(ischtub pain)
Femoral Neck Fracture
-not on Xray
-unable to passively rotate hip
Subjective Hx
-H/o LBP
-Hip problems as a child
-Clicking/popping/catching (w/ or w/o pain)
-OA
-Surgical Hx
Examination Order of Hip
- Hx
- Observation
- Gait/Squat/SLS
- Scan/Not
- Hip ROM > Back ROM > Knee ROM
- MMT
- Flexibility
- Joint Play
- Palpation
- Special Tests
