Hip Exam and Eval Flashcards
The big 4
Observation, gait, ROM, palpation
Large percentage of hip complaints stem from
lumbar spine/pelvis
Hx should include
Mechanism, severity, onset, area, type of pain, 24 hour pain, weightbearing, agg and rel positions, numbness/tingling, hx of low back problems, diagnositc imaging, surgery, changes in ADL, red flag questions
Purpose of history
Develops a diff dx
Gives us red flags or specific concerns
Assists with determining if pt fits into scope of PT
Determine pt goals
Diff Dx - SI or lumbar spine
Previous hx of back pain
Diff Dx - Mm strain
Onset of symptoms, area of pain
Diff Dx - Mm tear
onset of symptoms, area of pain
Diff Dx - Tendonitis
Onset of symptoms, area of pain
Diff Dx - Avulsion
Onset of symptoms, area of pain
Diff Dx - Bursitis
Ilipsoas, Iliopectineal, ischial tubercle, greater troch, area of pain and onset
Diff Dx - DJD
Onset, x-ray, age, groin pain, radiating to knee, morning stiffness, OA in other joints, pain with prolonged ambulation
Diff Dx - Stress fracture
onset, xrays, rule out other pathology, osteoporotic, athlete
Diff Dx - synovitis
onset, intensity of pain
Diff Dx - Labral Tear
Athlete, trauma, clicking
Diff Dx - avascular necrosis
previous trauma, congenital hip dislocation, Legg Calve perthes, slipped capital femoral, steroid use, deep aching throb in hip
Diff Dx - Pubic symphysis dysfunction
Previous history of back pain, trauma
Diff Dx - Lower abdominal strain
area of pain
Dff Dx - Entrapment of nerves
femoral, obturator, iliohypogastric, numbness/weakness in leg
Diff Dx - Leg Calve Perthes
Age, positioning of limb
Diff Dx - Slipped capital femoral epiphysis
Age, leg position
Diff Dx Osteoid osteoma
Onset of sx, night sweats, loss of weight, rule out musculoskeletal/neuro path
Diff Dx Meralgia paresthetica
Abnormal sensation in testing lateral femoral cutaneous
Diff Dx Inguinal/femoral hernia
onset of sx, bulging at site
Diff Dx - Muscle calcification
previous muscle contusion
Diff Dx - tumor
night sweats, rule out musculoskeletal/neuro
Diff Dx - inflammatory synovitis
history of it, systemic issues versus single joint
Diff Dx - subluxation
trauma
Diff Dx - Dislocation
Trauma
Diff Dx - Infection
fever, acute pain
Diff Dx - Inflamed lymph nodes
palpation will reveal, need to rule out musculo/neuro
Diff Dx - Referred visceral pain
Rule out musculo/neuro
Diff Dx - thrombosis of femoral artery, great saphenous vein, gluteal arteries
pulses, are of pain
Diff Dx - bladder infection
fever, pain with urination
Diff Dx - congenital hip dislocation
age
Diff Dx - septic arthritis
Fever, history of infection
Lumbar scan
Observation/palpation
Gait
AROM and overpressure
If needed - PA spring, neural, dermatomes, myotomes, reflexes
Lumbar scarn observation/palpation
Lumbar spine and hip
Anteversion or Retroversion
Knee and foot position
LE sx can radiate up to hip and vica versa
Lumbar Scan - Gait
observe lumbar spine and LE
Determin pain level with WB
ROM with gait
Trendelenburg or any other muscle weakness
Lumbar Scan - Neuro
Slump, SLR, derm, myo, reflexes
How to clear joint below
Knee
AROM and overpressure
Hip tests and measures
Observation Gait AROM and overpressure Palpation Muscle contraction Joint mob Flexibility Special tests Functional tests Outcome measures
Observation - Posture
Anteversion/Retroversion
Coxa vara/valga
Leg length differences
If patient has lordotic posture…
weak RA, tight iliopsoas
If patient has sway back
weak iliopsoas, tight ES, tight hams, weak glut max
If patient has asymmetrical iliac crests
tight hip abductors, tight quadratus lumborum
Balance/Gait - One leg stand
Trendelenburg
Balance
PF strength
Balance/Gait - Gait
Affect of posture on gait
Balance
Pain with gait
AROM
Flexion Extension Abduction Adduction IR ER
Hip Flexion -
Sitting or supine (Usually supine)
Hip Extension -
Supine - doesnt asses extensors unless PT adds resistance
Prone - only tests a limited range
Sidelying - resistance can be applied to imitate gravity, pelvis has to be stabilized
Hip Abduction
Supne
Hip Adduction
Supine
Hip IR
Supine - hip 90 degrees
Hip ER
Supine, hip 90 degrees
Hip OA cluster
Hip IR less than 15
Hip flexion less than or equal to 115
Age greater than 50
Hip OA cluster 2
Hip IR greater than or equal to 15
Pain with hip IR
Morning stiffness of hip for up to 60 min
Age greater than 50
End Feels for hip in normal
should all be tissue resistance (springy/muscular)
Muscle testing
Myotomal testing
GMT
MMT
Resisted contraction of muscle
GMT
helps you determine general strength
MMT
for specific muscles that are weak
Resisted Contraction
used to determine if greater muscle contraction will cause pain
Isolates to a muscle or tendon problem
Resisting muscle in lengthened position is a good way used for subtle lesions that midrange contraction may not pick up
Strong and painless Resisted COntraction
Normal or very isolated minor pathology
Strong and painful Resisted contraction
Minor/moderate pathology of mm, tendon, bursa
Weak and painful resisted contraction
more acute or major pathology of mm, tendon, fracure
Weak and painless resisted contraction
serious pathology, nervous system, tumor
Joint mobility assessment
Resting (open packed) position
Close packed position
Capsular pattern
Resting (open packed) position
Flexed 30 degrees, abd 30 deg, slight lateral rotation
Close packed position
max ext, medial rotation and abduction
Capsular pattern
medial rotation, flexion, abduction = extension
in treatment when contractile tissues are lengthened…
follow with lengthening non contractile tissue and vice versa
Joint Mobility Assessment
Lateral distraction
Longitudinal Distraction
Anterior Posterior
Posterior Anterior
Flexibility
Thomas Modified Thomas Elys Ober Modified Ober Hamstring Piriformis
Below 60 degrees of hip flexion, piriformis is
an external rotator
Above 60 degrees of hip flexion, piriformis is
a medial rotator and horizontal abductor
Special Tests
Scour
FABERE
Scour test
nonspecific for medial - anterior lesions and when done in abduction for posterior-lateral lesions
FABERE test
non specific for screening hip pathology if pain is in hip
Labral Tests
Internal rotation, compression = high Sn, poor Sp
MRA is best
Craigs Test
Used to assess anteversion/retroversion
Determine the point where GT is most lateral
Leg Length Test
x ray is gold standard
Activity limitations and participation restrictions
One leg balance Sit to stand Single leg squat Step ups Step downs Isolated sport activity 6 min walk test TUG
Outcome Measures - Lower Extremity Functional Scale
Intended for clients with musculoskeltal condition of LE
Low score = 0, high = 80
Discriminating btw acute and chronic, surgery/ no surgery and clients recieving or not recieving home care
For individual patient to evaluate true change with LE functional scale../
minimally important differece = 9 points
Outcome Measures - Patient Specific Functional Scale
Clients identify up to 5 activities with which they have difficulty
Clients rate 0-10 of current level of difficulty
Minimally detectable change for Patient specific functional scale
2.5 points
WOMAC - outcome measures
3 scales, pain stiffness and physical function
Mainly for OA
Harris Hip Score - outcome measures
Used by physicians for total hip replacement
Surgery deemed successful if score inc 20 points plus radiology looks stable
Final Eval
Tx dx Prognosis Goals Plan Intervention
