Hip Examination

Question 1

Percentage of patients with knee OA that have Hip OA

Answer 1

40%

Question 2

WOMAC

Answer 2

Lower extremity scale

Question 3

Harris Hip Score

Answer 3

Scored by PT

Pain, Gait, Mobility, Deformity (ROM Loss)

Question 4

LE Functional Scale

Answer 4

20 functional activities

Each rated 0 (Unable to perform) to 4 (No Difficulty)

Sensitive to change–>9 points minimal level of detectable change

Out of 80 points

Question 5

Pain location of OA in the hip

Answer 5

1) Greater Trochanter
2) Anterior Thigh
3) Knee Region
4) Groin

Question 6

L1 Dermatome Point

Answer 6

Inguinal Line

Question 7

L2 Dermatome Point

Answer 7

Anterior Proximal Thigh

Question 8

L3 Dermatome Point

Answer 8

Anterior distal thigh

Question 9

L4 Dermatome Point

Answer 9

Medial distal Leg

Question 10

L5 Dermatome Point

Answer 10

Lateral Leg

Question 11

S1 Dermatome Point

Answer 11

Lateral dorsum of foot

Question 12

Ward’s Triangle

Answer 12

Weak part of neck of femur due to lack of trabeculae

Question 13

Risks for Osteoporosis

Answer 13

Women >65 who weigh less than 140 at menopause or never used estrogens for >6 months

Question 14

Kellgren Lawrence Radiographic grade

Answer 14

Scale of joint space narrowing

Baseline grade is important predictive factor for having a THA

Question 15

Grade I Kellgren/Lawrence

Answer 15

Doubtful narrowing of joint space and possible osteophytic lipping

Question 16

Grade II Kellgren/Lawrence

Answer 16

Definite Osteophytes, definite narrowing of joint space

Strong predictor of hip OA progression

Question 17

Grade III Kellgren/Lawrence

Answer 17

Moderate multiple osteophytes, definite narrowing of joint space, some sclerosis and possible deformity of bony contour

.3 odds ratio of having a THA

Question 18

Grade IV Kellgren/Lawrence

Answer 18

Large osteophytes, marked narrowing of joint space

5.3 odds ratio that pt. would have a THA

Question 19

Sign of the Buttock

Answer 19

Positive is a Red Flag
Straight leg raise equal leg flexed or extended

Possible neoplasm, septic bursitis, sacral fx, ischiogluteal bursititis

Question 20

GI Red Flags

Answer 20

Nausea, vomiting, abdominal pain, changes in bowel function, blood in stool, tests for psoas abscess

Question 21

Vascular Red Flags

Answer 21

Throbbing, varicose veins, trophic changes, Hx. of heart disease

Question 22

Infectious Red Flags

Answer 22

IBD such as Crohn’s, ulcerative colitis, diverticulitis, appendicitis, recent skin rashes

Question 23

Cancerous

Answer 23

Previous hx of cancer, bone night pain, night sweats, palpate the lymph nodes

Question 24

Gait component measures

Answer 24

Step length, stride length, fick angle, speed

Question 25

Blind Stance WB

Answer 25

pt looks straight ahead and stands on two scales

Question 26

FTPO

Answer 26

Only works if pain is abolished when leaning opposite | If pain is abolished when leaning away, lean to until pain

Question 27

LE Alignment

Answer 27

``` Compensated Anteversion: Toe in Compensated Retroversion: Toe out Posterior Dislocation: Short/Adducted/IR Anterior Dislocation: Abducted/ER Intertrochanteric Fx: Short/ER ```

Question 28

Weber-Barstow Maneuver

Answer 28

pt supine Hip bridge then drop down PT pulls legs out Compare with thumbs on medial malleoli

Question 29

Prone Knee Flexion Test for tibial shortening

Answer 29

pt prone Neutral ankle Look at level of plantar surface of feet

Question 30

Flexion ROM

Answer 30

0-120°

Question 31

Extension ROM

Answer 31

0-20°

Question 32

Abduction ROM

Answer 32

0-45°

Question 33

Adduction ROM

Answer 33

0-30°

Question 34

IR ROM

Answer 34

0-45° 60-90° if anteverted

Question 35

ER ROM

Answer 35

0-45°

Question 36

Open Pack Position

Answer 36

30° flexion 30° abduction Slight ER This is a position of bony approximation

Question 37

PROM

Answer 37

When AROM isnt full and pain free

Question 38

Hip capsular pattern

Answer 38

Limitation in flexion, abduction, and IR

Question 39

3 most commonly limited motions with hip OA

Answer 39

IR/ER | Flexion

Question 40

Closed Pack Position

Answer 40

Full Extension | Full IR

Question 41

Coxa Saltans Internal Snapping

Answer 41

1) Iliopsoas over lesser trochanter or anterior acetabulum 2) Iliofemoral ll over femoral head Both commonly cause snap at 45 when extending from flexed position

Question 42

Coxa Saltans External Snapping

Answer 42

1) ITB over Greater Trochanter 2) Gluteus Maximus over Greater Trochanter Palpated lateral during hip flexion and extension

Question 43

Coxa Saltans Intra-articular Snapping

Answer 43

Acetabular Labral Tear/Loose Body | -Often present with sharp pain in groin and anterior thigh especially with pivoting motions

Question 44

Functional Step Up/Step Down Testing

Answer 44

Up with the bad | Down with the good

Question 45

Activity Limitation and Participation Restriction Measures

Answer 45

6 minute walk test Self-Paced Walk Test- 400m walk Stair Measure- 20 steps on 6 inch block timed Timed Up and Go Test- Stand walk 3m and back and sit

Question 46

Ortolani's Test

Answer 46

-Infant supine -Grasp thighs with thumbs medially and fingers laterally at greater trochanter -Gentle traction, abduction, and med directed pressure on greater trochanter -Looking for reduction Valid first 1-3 weeks of birth for dislocated/subluxed hips

Question 47

Causes of Intoeing Gait in Children

Answer 47

Femoral Anteversion Internal tibial torsion Metatarsus Adductus

Question 48

Children Femoral Anteversion

Answer 48

Born with ~40° 2:1 Females to males Derotational femoral osteotomy at 8-9 y/o

Question 49

Derotational Femoral Osteotomy

Answer 49

Femoral anteversion >45° Absent ER Functional disability or severe cosmetic deformity