Hip Exam and Interventions LAB Flashcards
Describe normal/excessive ante version and retroversion of the femur
- Normal: 15-25º anteversion
- Excessive: >25º anteversion
- Retroversion: ≤10º anteversion
Describe normal, Cora vara, and Cora valga of the femur
- Normal femoral angle: 125º
- Cora Vara: <125º
- Cora Valga: >125º
Describe the Fulcrum test
- Applies stress to the femur
- Attempts to aggravate ay fracture sites
- Place forearm under distal femur and place free hand on top of knee
- Apply opposing forces (trying to bend the femur)
What are the muscle length tests for the hip
- Thomas test: pt holds one knee in supine while PT pushes down on opposite knee
- Piriformis test: pt supine and PT places leg into a figure 4 position
- Ober’s test: pt sidelying & PT stabilizes hip while pulling the top leg into extension
- Ely’s test: pt prone & PT flexes one leg into max flexion (heel to butt); assess quads and femoral nerve
- Craig’s test: pt prone & PT flexes leg to about 90º and IR the hip (heel goes laterally); palpate for MOST prominence of the greater trochanter then measure the angle of the tibia, test for ante/retro version
Describe the FABER test
- Ask pt to cross leg above knee
- Observe pts AROM w/o pelvic rotation
- Measurement methods: lateral patella to table OR inclinometer
- Add overpressure
- Need the PAIN location
Describe the femoral grind/Scour test
- Pt supine
- Start ~90º elevation of leg/knee
- Posterior compression with small arc IR/ER
- Move from slight ABD to slight ADD & back
- Attempts to compress the femoral neck on the acetabular rim
Describe the resisted SLR (Stinchfield’s test)
- SLR to 30 degrees
- Apply Resistance into extension
- Positive if Pain: KEY is the pain location is thought to differentiate b/w Groin/Thigh = Hip joint and Buttock/LBP = SIJ or LBP
Describe the FADIR test
- CAUTION: if suspect labral pathology begin with a low amplitude arc and gradually increase the arc size
- Pt supine, elevate leg and bend knee
- Add more IR + ADD
- Attempts to cause a pinch of the anterior labrum
- MUST locate pain: buttock = piriformis?; anterior/deep hip = labrum
Describe McCarthy sign
- Start in FADIR and go to EABER (Extension-Abduction-External Rotation)
- POS: Click or Clunk or anterior pain
- Can stabilize C/L knee to chest
Describe the anterior labral test
- Pt supine
- PT slightly elevates leg/knee
- IR hip and compress hip through the knee with free hand
Describe the posterior labral test
- Pt supine
- PT elevates leg/knee to ~90º
- IR hip and compress the hip through the knee with free hand
Describe the Log Roll and Dial tests
- First Observe the resting position: Compare L/R for amount of ER
- Dial = IR and then let the leg roll back to passive starting position
- Anything > 45 ER = suggests capsular laxity or illiofemoral laxity
- Log Roll = Roll the leg IR/ER
- Clicks or noise is indicative of labral tear
Describe the Barlow test
- Assesses for developmental dysplasia/congenital hip dislocation
- Bad test
- Axial compression + ADD bilaterally
- Cause a sublux/dislocation clunk
Describe the Ortolani test
- Assesses for developmental dysplasia/congenital hip dislocation
- Good test
- Distraction + ABD bilaterally
- Cause a relocation clunk
What is the Altman criteria for hip OA
- If hip IR ≥ 15º AND
- Pain with hip IR
- Morning stiffness 60min
- Age >50
Interventions for hip OA
- Manual therapy
- Exercise
What are the indications for a posterior hip glide
- Improve flexion and IR
Describe how to perform a hip manipulation
- Start in loose packed position: leg elevated 15-30º flexion and 15-30º ABD
- Absorb the weight of the leg
- Quick and short pull
- Tips: have pt put contralateral heel in table hole and/or ask pt to hold on
What does CASSS stand for (movement control exam)
- Control refers to the smoothness, coordination, and timing of movement
- Amount refers to the amplitude of movement at each joint
- Symmetry is observed in bilateral tasks or comparing unilateral performance between limbs
- Speed is the length of time
- Symptoms most commonly refer to pain but also can include mechanical symptoms, reports of instability, or fatigue
Describe the lateral step-down test
- Poorly controlled “Dynamic Knee Valgus”
- Trunk Pelvis (Hip) Control (1 point each)
- 2 or more points on the lateral step down test
- 7 point scale: 0-1 = good; 2+ = moderate
- 15 cm step: 60º knee flexion, relationship to DF
Conservative treatment of FAI
- Phase 1/Symptom Modulation: modalities, mobilizations, TRA’s & Multifidus
- Key is dynamic control
Describe the Beighton hyper mobility exam
- 5 items
- Traditional cutoff is 5/9 for hyper mobility but it is now recommended to be 7/9 (better)
What are the 5 items on the Beighton hyper mobility exam
- Passive 5th MCP extension (positive = >90º)
- Passive elbow extension with shoulder at 90º (positive = >10º hyperextension)
- Passive extension of knee in supine (positive = >10º hyperextension)
- Thumb to flexor side of forearm (positive = whole thumb touches side of forearm)
- Trunk flexion (positive = Forward Flexion with
the knees straight so the hands rest easily on the floor)
Clinical conditions of hypermobility
- Ehlers-Danlos syndromes (EDS)
- Marfan’s Syndrome
- Osteogeneses Imperfecta