Hip examination Flashcards
OBSERVATIONS
BBRSS, Muscle wastage, discolouration, alignment
OBSERVATION
Muscle Wasting
Quad and gluteal atrophy in LCP disease
Hamstring atrophy if tendinopathy/tear
OBSERVATION
Swelling
Trochanteric Bursitis - maybe d/t direct trauma fall
OBSERVATION
Bumps/Bruises?
Femoral neck Fx, Traumatic or metabolic
M/C elderly person espeically women (OP) can lead to AVN
OBSERVATIONS
Scars
Hip replacement
OBSERVATION
Alignment
Lateral pelvic tilt - Scoliosis
Hip drop with trendelenburg Sign with weakness/muscle tear in contralateral Gluteus medius causing lateral pelvic tilt
OBSERVATION
Redness?
Septic Arthritis with assoicated fever
More common in males than females
PALPATION
Lateral
GT - Insetion of internal/external rotators
Sits on the lateral aspects of femur. Can be px for pt with GTB.
PALPATION
Posterior
ISCHIAL TUBORSITY -
With Permission - If Pt compains of buttock pain, we can palpate the ischial tuberosity (Originate from ischial tuberoisty). Under the gluteal fold we can stick out thumb in.
PSIS - This landmark is useful for identifying the sacroiliac joint, Can be seen in some individuals with dimples
Sciatic Nerve
- Between the GT and Ischial Tuboristy you can find the Sciatic nerve between the structures
PALPATION
Anterior
Iliac Crest - gluteal insertion point
ASIS - Sartious muscle attaches
AIIS - Rectus femoris attaches
Inguinal Ligament - From the PSIS going medially in two and down two, it should feel a band like feel. Ask pt to lift head up and down to help locate the ligament
APROM - Active
What movements can be tested during the screen, what are the degrees within each movement
Flexion (Knee to chest) 110- 120*
ADduction (Lift one leg and ask pt to cross behind the lifted leg)- 30*
Abduction (Bring the leg as far off the bench as possible) 30-50*
Internal Rotation 20 - 35 (Bring the knee 90* and bring toe out as far as possible) 30-40*
External Rotation (Ask pt to bring heel inwards) 40-60*
Extension (lift leg off table (10-15*)
Passive ROM
How can you conduct Passive ROM?
Flexion (supine) - Assess the end feel by bringing the leg up to the chest
Extension (prone) - Fixate on sacrum while bringing the leg up
ABduction (supine) - Fixate pelvis on opposite iliac crest and move leg outwards as far as possible
ADduction (supine) - Cross leg over eachother and pick up other leg. Fixate on the same side on iliac crest and move into adduction
IR - Flex hip to 90* and bring the heel outwards as far as possible
ER - same set up but heel inwards as far as possible
ORTHO TESTS
Discuss the Cluster of Laslett
Cluster of laslet - SI Dysfunction
3 out of 5 need to be positive in order to rule in SI dysfunction
Distraction Test - supine.
- Stand on the sympotmatic side and place both hands on the ASIS
- Apply 3/5 moderate velocity thrusts and graudally increase pressure
Thigh thrust - supine
- flex the patients leg to 90 degrees while placing one hand on the pt’s sacrum and apply pressure down the pt’s femur creating shear force in the SI joint
- Apply 3/6 moderate velocity thrusts and gradually increase pressure
Compression test - side lying
- Pt laying on the symptomatic side have the legs bent at 45 degrees and knees at 90 degrees
- Place both hands on the anterior rim of the ilium
- Apply 3/5 moderate velocity thrusts and graudally increase pressure
Sacral thrust test - Prone
- Place both hands over the S2 spinal level
- Direction of pressure is going to be vertically downwards
- Apply 3/5 moderate velocity thrusts and graudally increase pressure
Looking for provation of pt’s familiar pain
ORTHO TESTS
Cluster of Laslett - Interpretation?
2 out of 4 are needed to diagnosis symptomatic SI joint, If first two tests are positive - SI is likely to be the source of pain, No further testing is needed
If no pain within first two tests then continue with third test, but further tests are positive. SI joint is likely the source of pain. If third test is not positive then continue with sacral thurst.
If no tests are positives then SI joint pain can be ruled out or can be unlikely
What test can be done for Intraarticular pathology?
Scour Test
Intraarticular hip pain e.g. FAI, DJD
To reproduce symptoms coming from the pain i.e.
Very sensitive so if negative, good to rule out
(Supine laying) Bring the pt’s leg into maximal flexion with ABduction and external rotation
Next, create an axial load through the hip and move the hip through ADduction and internal rotation
Can vary the angle of the hip
POS - Reproduction of the pain
Orthopaedic & Neurological Examination
Piriformis Syndrome Test?
FAIRs Test
FAIR Test is used for piriformis but also FAI
Have Pt lay on the unaffected side (side lying) with their upper hip flexed to 90, Maximal ADduction and upper knee flexed to 90 as well
Simply apply upward and lateral pressure to the shin while passively rotating the hip internally to 45* or as near as the pt can tolerate.
POS - If Pt reports pain at the sciatic nerve or piriformis.
Not POS if px is at the front of hip
Tests for FAI (Femoroacetabular Impingement or Labral Tear (Cam, Pincer, Mixed)
FADDIR’s Supine Test-
FAI (overgrowth of acetabular rim or thickening of femoral neck) or labral tear
Pt supine with hip and knee at 90 degree, then adduct & IR hip (one hand on medial lower leg & one on hip)
Look for reproduction of groin/hip pain (hip impingement), catching, popping & compare bilaterally
Orthopaedic & Neurological Examination
Tests for Hip/Femur Fx
Anvil - Tests for femoral fx
Pt lies supine and examiner lifts the extended leg from the table by a few degrees, then with the base of the fist the examiner applies a light blow to the inferior calcaneus
Localised px in the thigh or the hip indicates a pathology or femoral fx
ORTHO TESTS
Tests for Capsular or Muscular Dysfunction
Ely’s Heel to buttock Test - Tests for Tightness in the rectus femoris
Pt prone position, Examiner passively flexes each knee separately bring the heel to the buttock and note any resistance or asymmetry of movement
This procedure stretches the quadricep and tensions the upper lumbar nerve roots
If resistance when bringing the heel towards buttock this may indicate hypertonic or tight quadriceps
Pelvis is also noted to rise (hip flexion) from the table while performing the procedure
MUSCLE TESTS
How can we test INTERNAL ROTATION, if painful what can be indicated?
Include muscles tested & Normal ROM
Pt sitting on edge on bench
One hand on ankle and other on medial side of the knee for stabilzation, bring the ankle away from the body. Add resistance at the distal lower leg pushing medially
Muscles tested:
- Gluteus Medius/Minimus
- TFL
Normal ROM: 40*
