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Advanced Orthopedics > Hip Exam and Interventions > Flashcards

Hip Exam and Interventions Flashcards

1
Q

What are the 3 classifications for hip

A
  • Arthritis (OA)
  • Non-arthritis
  • Regional movement differentiation
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2
Q

Remote/medical referral hip diagnoses

A
  • Femoral head & neck fractures
  • Avascular necrosis femoral head & neck
  • Colon cancer
  • Inguinal hernia
  • Visceral referral
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3
Q

Most likely diagnoses for the hip

A
  • Labral tear
  • Femoral acetabular impingement (FAI)
  • Glute med tendinopathy
  • Greater trochanter bursitis
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4
Q

Anterior hip pain possibilities

A
  • Referred: intra-abdominal or intra-pelvic
  • Extra-articular: flexor tendon
  • Intra-articular: FAI, labral tear, femoral neck stress Fx, AVN, OA, hip Fx
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5
Q

Posterior hip pain possibilities

A
  • Intra-abdominal
  • Intra-pelvic
  • Deep gluteal syndrome
  • Ischiofemoral impingement
  • Lumbar spine or muscle
  • SIJ pain
  • Proximal hamstring tendinopathy/tear
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6
Q

Later hip pain possibilities

A
  • Greater trochanteric pain syndrrome
  • Bursitis
  • Glute med tendinopathy
  • IT band: external snapping
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7
Q

AVN illness script

A
  • Trauma: dislocation, femoral head Fx, Cancer
  • Non-traumatic: ETOH (alcohol), steroid abuse, obesity, smoking
  • Gait abnormalities with loading
  • ROM limitations
  • Testing: any WB, possibly with hip compression (Scour)
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8
Q

Femoral neck stress Fx illness script

A
  • Females more affected than males
  • Athletes or those with poor nutrition & lifestyle activities
  • Gait: loading more than AVN
  • May not have ROM limitations but point tenderness to palpation
  • Testing: Fulcrum, Hop, Full extension
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9
Q

Outcome measures for hip pathology

A
  • Harris Hip Score: Pain, Gait, ADLs, Sport sub scales, ROM
  • WOMAC (Western Ontario & McMaster Universities Arthritis Index): more OA specific, physical function, pain, stiffness; higher scores indicate worse Sx
  • International hip outcome tool (i-HOT): for younger active populations, uses VAS, appropriate for activity level ≥4 on modified Tegnar Activity Scale
  • Patient Specific Functional Scale
  • FABQ
  • LEFS
  • Ostwestry
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10
Q

Differentiation sequence before testing the hip

A
  • After SERIOUS pathology clear AND after clear for femoral Fx/stress Fx
  • Rule out lumbar spine: repeated motions & neurodynamicis (SLR/Slump)
  • Rule out pelvic girdle pain: Thigh thrust
  • Finally the HIP TESTS
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11
Q

Differential diagnosis of the hip

A
  • Lumbosacral spine pathology
  • Nerve entrapment (lateral femoral cutaneous, obturator)
  • Hip osteoarthrosis
  • Iliopsoas tendinitis/bursitis
  • Adductor strain
  • Obturator internus strain
  • Inguinal hernia
  • Athletic pubalgia (sports hernia)
  • Osteonecrosis of femoral head
  • Stress fracture (proximal femur or pelvic)
  • Avulsion injury (sartorius or rectus femoris tendon)
  • Myositis ossificans
  • Heterotopic ossification of hip joint
  • Neoplasm (benign or malignant)
  • Legg-Calvé-Perthes disease
  • Slipped capital femoral epiphysis
  • Osteomyelitis
  • Psoas abscess
  • Septic arthritis
  • Rheumatoid arthritis
  • Prostatitis
  • Metabolic bone disease
  • Urogenital disorders
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12
Q

Occurs age 30-50 from extra loading or Non-Trauma like ETOH (alcohol) or steroids (illness script)

A
  • AVN (Avascular Necrosis)
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13
Q

Occurs in Pre-Teen and Teenagers especially those with obesity (illness script)

A
  • Slipped capital femoral epiphysis
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14
Q

Skinny Jeans, Tool Belt or a Gun Belt (illness script)

A
  • Peripheral nerve entrapments (Lateral cutaneous nerve); Meralgia Peresthetica AKA Skinny Jeans Syndrome
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15
Q

Occurs in childhood age 4-10 usually male (illness script)

A
  • Legg-Calve-Perthes disease
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16
Q

Occurs during childbirth – noted shortly after (child not the mom) (illness script)

A
  • Congenital Hip Dislocation
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17
Q

Slide 29

A
18
Q

What does glute minimus referral pattern mimic

A
  • Mimics Sciatica
  • Trigger points can also cause paresthesia
19
Q

What does TFL mimic

A
  • Mimics hip joint pain AKA “psuedotrrochanteric bursitis”
  • Pain worse with movement
20
Q

What are the 4 ways the sciatic nerve can exit the pelvis (in order of most common to least common)

A
  • All fibers pass anterior to piriformis b/w the muscle & the rim of the greater sciatic foramen (usual route)
  • Peroneal portion passes through piriformis muscle & the tibial portion travels anterior to muscle
  • Peroneal portion loops above & then posterior to muscle & the tibial portion passes anterior to it; both portions lie b/w the muscle and the upper for lower rim of the greater sciatic foramen
  • Undivided sciatic nerve penetrates the piriformis muscle
21
Q

Trigger points in what muscle is the most common cause of groin pain

A
  • Adductor longus
22
Q

Adductor Magnus trigger points can be a source of what problems

A
  • Pelvic pain syndromes
  • Menstrual problems
  • Painful intercourse
  • Stress incontinence or anal/genital/perineal pain
23
Q

How are pectinous trigger points described as

A
  • A deep seated aching pain in the groin immediately distal to the inguinal ligament
24
Q

How are gracilis trigger points described as

A
  • A local, hot, stinging, superficial pain that travels along the medial aspect of the thigh
25
Q

How are semitendiosus, semimembranosus, & biceps femurs trigger points described as

A
  • Sx described as buttock, thigh, knee pain, & sciatica
  • SemiT and SemiM trigger points have more proximal referral pain
  • Biceps femoris trigger points have more knee pain
26
Q

Intra-articular tests for hip

A
  • FABER
  • Grind/Scour
  • Resisted SLR
  • McCarthy sign
27
Q

Impingement tests for hip

A
  • FADIR
  • Anterior & posterior labral
28
Q

Laxity tests for hip

A
  • Log roll
  • Dial
  • Long axis distraction
29
Q

Pediatrics tests for hip

A
  • Ortolani & Barlow
30
Q

General hip tests

A
  • Thomas test
  • Trendelenburg
  • Step-down test
  • Craig test
  • Ober test
31
Q

What is the open and closed packed position of the hip

A
  • Open: 30º flexion, ABD, & slight ER
  • Closed: Max extension, IR, & ABD
32
Q

Normal ROM of the hip

A
  • Flexion: 120º
  • Extension: 20º
  • ABD: 40º
  • ADD: 20º
  • IR/ER: 45º
33
Q

What do the hip ligaments limit

A
  • Iliofemoral Lig (Y-Lig of Bigelow): Anterior Superior; Limits ER & ADD
  • Pubofemoral Lig: Anterior Inferior; Limits ABD
  • Ischiofemoral Lig: Posterior; Limits Ext, IR & ADD when hip is flexed
34
Q

What is the non-arthritic CPG

A
  • Diagnoses: FAI, Labral tear, Osteochondral lesion, Loose bodies, Ligamentum teres rupture
  • Hip Dysplasia
  • Femoral neck abnormalities
  • FAI
  • Hip instability
35
Q

What is the arthritic CPG

A
  • Diagnoses: OA is most common cause of hip pain in older adults
  • Age > 50
  • Pain with WB (anterior or lateral)
  • Morning stiffness <1 hr after wakening
  • Hip IR <24º
  • Hip IR and hip flexion 15º less than the non-painful side
36
Q

FAI illness script

A
  • Pain is aching or sharp
  • Pain with sitting
  • Positive FADIR test
  • Limited IRR <20º at 90º flexion
  • Mechanical symptoms of pops, clicks, locking, & snapping
37
Q

Describe the 2 types of FAI

A
  • Symptoms: classic “C” to show where the pain is around the hip
  • Cam: beard on the femoral neck, younger teens to 20’s, Males 2x (femoral neck)
  • Pincer: more common in middle age active females (acetabulum)
38
Q

What typical age gets labral tears

A
  • Age >30
  • Most prevalent is anterior superior
39
Q

What are the 4 phases of post-op hip FAI scope

A
  • Phase I: protective phase
  • Phase II: post-op guidelines (linear 4-8 wks/complex 6-12 wks, goal is ADLs
  • Phase III: post-op guidelines (linear 8-12 wks/complex 12-20 wks), goal is recreational asymptomatic
  • Phase IV: post-op guidelines (near 12-16 wks/complex 20-28 wks), goal is pain free competitive state
40
Q

What is the updated hip OA criteria

A
  • Age >50
  • Moderate anterior or lateral hip pain during WB activities
  • Morning stiffness less than 1hr
  • Hip IR <24º or IR & hip flexion 15º < the non-painful side
  • And/or increased hip pain with passive IR
41
Q

What is the hip OA PT CPG

A
  • Unilateral hip pain
  • Age ≤ 58
  • Pain ≥ 6/10
  • 40m SPWT score of ≤25.9 sec
  • Duration of symptoms of ≤1 yr
42
Q

Lower quarter hip interventions

A
  • Multimodal interventions
  • Therapeutic exercise
  • Manual therapy (Alone)
  • Neuromuscular Re-education
  • Manual therapy
  • Flexibility, Strengthening & Endurance

Advanced Orthopedics (29 decks)

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