Hip Exam Competency

Question 1

What are the borders of the Femoral Triangle? And the contents?

Answer 1

Superiorly: Inguinal Ligament

Medially: Adductor Longus M.

Laterally: Sartorius M.

N.A.V.e.L (Femoral N., A., V., and Deep Inguinal Lymph Nodes)

Question 2

What are the degrees for normal range of motion associated with the movements of the hip?

Answer 2

Flexion: 90 degrees (knee extended), 120-135 (knee flexed)

Extension: 15-30 Degrees

ABduction: 45-50 Degrees

ADduction: 20-30 Degrees

INternal Rotation: 30-40 Degrees

EXternal Rotation: 40-60 Degrees

Question 3

Describe the different levels of grading when it comes to Muscle Strength Testing.

Answer 3

0/5: No movement at all
\+1/5: Slight Flicker
\+2/5: Movement WITHOUT Gravity
\+3/5: Movement WITH Gravity
\+4/5: Movement against Gravity and SLIGHT resistance
\+5/5: Full strength

Question 4

Which nerve innervates the: Iliopsoas Muscle, Gluteus Maximus M., Gluteus Medius and Minimus Ms., and the Adductor Longus M.?

Answer 4

1. Iliopsoas M. (Hip Flexion): Femoral N. (L2-L4)
2. Gluteus Maximus M. (Hip Extension): INFERIOR Gluteal N. (L5-S2)
3. Gluteus Medius and Minimus (ABduction of Hip): SUPERIOR Gluteal N. (L4-S1)
4. Adductor Longus M. (ADduction of Hip): Obturator N. (L2-L4)

Question 5

List the Contents and Pathology associated with the Central Hip Compartment.

Answer 5

CONTENTS: Labrum, Ligamentum Teres, Articular Surfaces

PATHOLOGY: Labral Tears, Ligamentum teres tears, Osteochondral defects, Chondromalacia/Osteoarthritis, Congenital hip dysplasia, Loose Bodies

Question 6

List the Contents and Pathology associated with the Peripheral Hip Compartment.

Answer 6

CONTENTS: Femoral Neck, Synovial Lining

PATHOLOGY: Loose Bodies, IMPINGEMENT syndrome (CAM and PINCER Types), SYNOVITIS

Question 7

List the Contents and Pathology associated with the Lateral Hip Compartment.

Answer 7

CONTENTS: Gluteus Medius, Gluteus Minimus, Piriformis, IT band, Trochanteric Bursae

PATHOLOGY: IT band Syndrome, Bursitis, Rotator Cuff teninopathies (Gluteus medius, Gluteus minimus, Piriformis)

Question 8

List the Contents and Pathology associated with the Anterior/Iliopsoas Hip Compartment.

Answer 8

CONTENTS: Iliopsoas insertion, Iliopsoas Bursae

PATHOLOGY: Psoas Tendonitis, Iliopsoas Bursitis

Question 9

Which compartments are you testing with the Log Roll test?

Answer 9

CENTRAL and PERIPHERAL

• Negative Test does NOT exclude Hip Pathology

Question 10

What are the Tests associated with the CENTRAL compartment? What does a positive sign indicate? (5)

Answer 10

1. C-Sign: Labral Pathology
2. Labral Loading: Labral or cartilaginous Pathology
3. Labral Distraction: Labral or cartilaginous Pathology (POSITIVE Test is IMPROVEMENT of pain)
4. Scour: Labral or Articular Cartilage Pathology (Load in and move around in a Figure-8 motion)
5. Apprehension FABER: Anterior Labral Pathology (Doc is applying a POSTERIOR force)

Question 11

What are the Tests associated with the PERIPHERAL compartment? What does a positive sign indicate? (2)

Answer 11

1. Ely’s Test: Patient is lying Prone, Passive Flex Pts Knees; POSITIVE test if the IPSILATERAL hip raises off the table (RECTUS femoris contracture)
2. Rectus Femoris Test: Rectus Femoris Contraction

Question 12

What are the Tests associated with the LATERAL compartment? What does a positive sign indicate? (6)

Answer 12

1. Jump Sign: Trochanteric bursitis
2. Straight Leg Raise Test: Lumbar Disc etiology (Pain from 15-30 Degrees) or Lateral Compartment Pathology (Pain Laterally above 15 Degrees)
3. Ober’s Test: TIGHT IT Band
4. Piriformis Test: Patient will ABduct against resistance (Piriformis Spams or Pathology)
5. Trendelenburg: Contralateral Gluteus Medius weakness, SUPERIOR GLUTEAL N. Pathology (Ex: Lift up Right leg and Right Hip drops, Left Superior Gluteal N. problem)
6. Patrick’s FABER: Gluteus Medius Pathology (Doc is pressing up and Pt is ABducting against resistance)

Question 13

What are the Tests associated with the ANTERIOR/ILIOPSOAS compartment? What does a positive sign indicate? (3)

Answer 13

1. Patrick’s FABER: Iliopsoas Insufficiency or Pathology (Doc presses down and Pt is ADducting against resistance)
2. Psoas Test: Psoas Contracture or Pathology (Flex Hip to 30 Degrees and have patient flex further against resistance)
3. Thomas Test: Hip Flexor Contraction (Same setup as Rectus Femoris Test)

Question 14

Tight hamstrings will lead to which type of Somatic Dysfunction @ the hip?

Answer 14

Extension Dysfunction