Hip Exam Flashcards
Query #1
Is pain really coming from hip joint, or just a hip-related structure?
What simple test isolates pain from hip joint remarkably well?
Passive hip internal rotation
What may cause painful internal hip rotation in a child age 0-3?
Septic Hip
Hip Dysplasia
Hip Fracture
What may cause painful internal hip rotation in a child age 4-10?
Toxic Synovitis
Legg-Calve-Perthes Disease
Juvenile Rheumatoid Arthritis
What may cause painful internal hip rotation in a teenager age 11-16?
Slipped Capital Femoral Epiphysis (SCFE)
Avascular Necrosis
GC Arthritis (aka Gonococcal or septic arthritis)
What may cause painful internal hip rotation in an adult age 17-39?
Femoral Neck Stress Fracture
What may cause painful internal hip rotation in an adult age 40-80+?
Osteoarthritis of Hip
What may cause painful internal hip rotation in an adult age 60-80+?
Hip Fracture
Query #2
Is the pain coming from the trochanteric bursa region?
Where is the trochanteric bursa located?
Over the greater trochanter of the hip
What is the cause of trochanter pain for most patients?
A degenerative process of the gluteal tendons that insert on the trochanter (before it was thought pain was from inflammatory bursitis)
Which region is the source for most lateral hip pain?
Trochanter bursa – it usually responds well to stretching, strengthening, and other simple therapy techniques
How do you determine if your patient has trochanteric pain?
Simply press on the trochanteric bursa (COMPARE injured and uninjured sides)
Query #3
Long muscles play Double Jeopardy – if pain isn’t from hip itself or trochanteric pain, it could be an injury to a muscle-tendon unit around the hip
Which muscles are more likely to be injured?
Long muscles that span 2 joints more likely to be injured than short muscles that span 1.
Ex. So if pt pulls quad, it is more likely the rectus femoris is hurt than a vastus muscle
What hip muscles are considered “double jeopardy” muscles?
Rectus femoris
Sartorius
Iliotibial band (tensor fascia latae)
Hamstrings
How double jeopardy muscle injuries occur in children vs adults?
Children – injuries occur as avulsions; the muscles pull off little pieces of bone from their origin/insertion points
Adults – injuries happen at the myotendinous junction, which is usually w/in a few cm off from the origin/insertion of the muscle belly
What is the site of origin and insertion of the sartorius?
Origin – Anterior Superior Iliac Spine (ASIS)
Insertion – Pes Anserine
What is the site of origin and insertion of the rectus femoris?
Origin – Anterior Inferior Iliac Spine (AIIS)
Insertion – Tibial tuberosity (via patella)
What is the site of origin and insertion of the Biceps femoris (long head)?
Origin – Ischial Tuberosity (short head is NOT double jeopardy)
Insertion – fibular head
What is the site of origin and insertion of the Semimembranosus?
Origin – Ischial Tuberosity
Insertion – Medial Tibial Condyle
What is the site of origin and insertion of the (Ilio) Psoas?
Origin – Thoraco-lumbar vertebrae
Insertion – Lesser tuberosity of femur
What to look for on inspection?
Gait – normal, limping (antalgic), shuffling, or won’t walk
Swelling of soft tissue
Ecchymosis (brusising)
Muscular Atrophy
What to palpate w/ pt supine?
ASIS – bony bump – for the sartorius origin
AIIS – absence of bony bump – for the rectus femoris origin
Pubic ramus/symphysis
What to palpate w/ pt lateral?
Greater trochanter
IT Band
What to palpate w/ pt prone?
Sacroiliac (SI) Joint Ischial tuberosity (Origin of Biceps femoris long head, semimembranosus, and semitendonosus) Piriformis muscle
What is the site of origin and insertion of the Semitendinosus?
Origin – Ischial Tuberosity
Insertion – Pes Anserine
What ROM to test w/ pt supine?
Flexion (both w/ knee bent and w/ knee extended)
Internal (log roll or FADIR) and External Rotation
Abduction and Adduction
What ROM to test w/ pt prone?
Extension
What special tests to perform?
FABER (Flexion, ABduction, and External Rotation)
FADIR (Flexion, ADduction, and Internal Rotation)
What denotes a positive FABER test?
Pain in the hip joint or SI joint – suggest dysfunction in the painful joint
What denotes a positive FADIR test?
Pain indicates probable pathology in the hip joint proper
Where to stabilize in FABER test?
Stabilize pelvis w/ hand on contralateral anterior superior iliac spine (ASIS), press down on thigh of affected side
What is another test done for inspection from the video?
Trendelenburg Test – pt. stands on one foot
Positive test if pelvis sags and pt leans toward bent knee
Reverse Positive test if lean more towards straight leg they are standing on, causing the opposite hip to raise in the air
Which way do you rotate foot for external rotation?
Rotate foot inwards (backwards of what you might think)
