Hip Exam

Question 1

Query #1

Answer 1

Is pain really coming from hip joint, or just a hip-related structure?

Question 2

What simple test isolates pain from hip joint remarkably well?

Answer 2

Passive hip internal rotation

Question 3

What may cause painful internal hip rotation in a child age 0-3?

Answer 3

Septic Hip
Hip Dysplasia
Hip Fracture

Question 4

What may cause painful internal hip rotation in a child age 4-10?

Answer 4

Toxic Synovitis
Legg-Calve-Perthes Disease
Juvenile Rheumatoid Arthritis

Question 5

What may cause painful internal hip rotation in a teenager age 11-16?

Answer 5

Slipped Capital Femoral Epiphysis (SCFE)
Avascular Necrosis
GC Arthritis (aka Gonococcal or septic arthritis)

Question 6

What may cause painful internal hip rotation in an adult age 17-39?

Answer 6

Femoral Neck Stress Fracture

Question 7

What may cause painful internal hip rotation in an adult age 40-80+?

Answer 7

Osteoarthritis of Hip

Question 8

What may cause painful internal hip rotation in an adult age 60-80+?

Answer 8

Hip Fracture

Question 9

Query #2

Answer 9

Is the pain coming from the trochanteric bursa region?

Question 10

Where is the trochanteric bursa located?

Answer 10

Over the greater trochanter of the hip

Question 11

What is the cause of trochanter pain for most patients?

Answer 11

A degenerative process of the gluteal tendons that insert on the trochanter (before it was thought pain was from inflammatory bursitis)

Question 12

Which region is the source for most lateral hip pain?

Answer 12

Trochanter bursa – it usually responds well to stretching, strengthening, and other simple therapy techniques

Question 13

How do you determine if your patient has trochanteric pain?

Answer 13

Simply press on the trochanteric bursa (COMPARE injured and uninjured sides)

Question 14

Query #3

Answer 14

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

Question 15

Which muscles are more likely to be injured?

Answer 15

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

Question 16

What hip muscles are considered “double jeopardy” muscles?

Answer 16

Rectus femoris
Sartorius
Iliotibial band (tensor fascia latae)
Hamstrings

Question 17

How double jeopardy muscle injuries occur in children vs adults?

Answer 17

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

Question 18

What is the site of origin and insertion of the sartorius?

Answer 18

Origin – Anterior Superior Iliac Spine (ASIS)

Insertion – Pes Anserine

Question 19

What is the site of origin and insertion of the rectus femoris?

Answer 19

Origin – Anterior Inferior Iliac Spine (AIIS)

Insertion – Tibial tuberosity (via patella)

Question 20

What is the site of origin and insertion of the Biceps femoris (long head)?

Answer 20

Origin – Ischial Tuberosity (short head is NOT double jeopardy)

Insertion – fibular head

Question 21

What is the site of origin and insertion of the Semimembranosus?

Answer 21

Origin – Ischial Tuberosity

Insertion – Medial Tibial Condyle

Question 22

What is the site of origin and insertion of the (Ilio) Psoas?

Answer 22

Origin – Thoraco-lumbar vertebrae

Insertion – Lesser tuberosity of femur

Question 23

What to look for on inspection?

Answer 23

Gait – normal, limping (antalgic), shuffling, or won’t walk
Swelling of soft tissue
Ecchymosis (brusising)
Muscular Atrophy

Question 24

What to palpate w/ pt supine?

Answer 24

ASIS – bony bump – for the sartorius origin
AIIS – absence of bony bump – for the rectus femoris origin
Pubic ramus/symphysis

Question 25

What to palpate w/ pt lateral?

Answer 25

Greater trochanter

IT Band

Question 26

What to palpate w/ pt prone?

Answer 26

Sacroiliac (SI) Joint
Ischial tuberosity (Origin of Biceps femoris long head, semimembranosus, and semitendonosus)
Piriformis muscle

Question 27

What is the site of origin and insertion of the Semitendinosus?

Answer 27

Origin – Ischial Tuberosity

Insertion – Pes Anserine

Question 28

What ROM to test w/ pt supine?

Answer 28

Flexion (both w/ knee bent and w/ knee extended)
Internal (log roll or FADIR) and External Rotation
Abduction and Adduction

Question 29

What ROM to test w/ pt prone?

Answer 29

Extension

Question 30

What special tests to perform?

Answer 30

FABER (Flexion, ABduction, and External Rotation)

FADIR (Flexion, ADduction, and Internal Rotation)

Question 31

What denotes a positive FABER test?

Answer 31

Pain in the hip joint or SI joint – suggest dysfunction in the painful joint

Question 32

What denotes a positive FADIR test?

Answer 32

Pain indicates probable pathology in the hip joint proper

Question 33

Where to stabilize in FABER test?

Answer 33

Stabilize pelvis w/ hand on contralateral anterior superior iliac spine (ASIS), press down on thigh of affected side

Question 34

What is another test done for inspection from the video?

Answer 34

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

Question 35

Which way do you rotate foot for external rotation?

Answer 35

Rotate foot inwards (backwards of what you might think)