Hip Examination Flashcards
Percentage of patients with knee OA that have Hip OA
40%
WOMAC
Lower extremity scale
Harris Hip Score
Scored by PT
Pain, Gait, Mobility, Deformity (ROM Loss)
LE Functional Scale
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
Pain location of OA in the hip
1) Greater Trochanter
2) Anterior Thigh
3) Knee Region
4) Groin
L1 Dermatome Point
Inguinal Line
L2 Dermatome Point
Anterior Proximal Thigh
L3 Dermatome Point
Anterior distal thigh
L4 Dermatome Point
Medial distal Leg
L5 Dermatome Point
Lateral Leg
S1 Dermatome Point
Lateral dorsum of foot
Ward’s Triangle
Weak part of neck of femur due to lack of trabeculae
Risks for Osteoporosis
Women >65 who weigh less than 140 at menopause or never used estrogens for >6 months
Kellgren Lawrence Radiographic grade
Scale of joint space narrowing
Baseline grade is important predictive factor for having a THA
Grade I Kellgren/Lawrence
Doubtful narrowing of joint space and possible osteophytic lipping
Grade II Kellgren/Lawrence
Definite Osteophytes, definite narrowing of joint space
Strong predictor of hip OA progression
Grade III Kellgren/Lawrence
Moderate multiple osteophytes, definite narrowing of joint space, some sclerosis and possible deformity of bony contour
.3 odds ratio of having a THA
Grade IV Kellgren/Lawrence
Large osteophytes, marked narrowing of joint space
5.3 odds ratio that pt. would have a THA
Sign of the Buttock
Positive is a Red Flag
Straight leg raise equal leg flexed or extended
Possible neoplasm, septic bursitis, sacral fx, ischiogluteal bursititis
GI Red Flags
Nausea, vomiting, abdominal pain, changes in bowel function, blood in stool, tests for psoas abscess
Vascular Red Flags
Throbbing, varicose veins, trophic changes, Hx. of heart disease
Infectious Red Flags
IBD such as Crohn’s, ulcerative colitis, diverticulitis, appendicitis, recent skin rashes
Cancerous
Previous hx of cancer, bone night pain, night sweats, palpate the lymph nodes
Gait component measures
Step length, stride length, fick angle, speed
Blind Stance WB
pt looks straight ahead and stands on two scales
FTPO
Only works if pain is abolished when leaning opposite
If pain is abolished when leaning away, lean to until pain
LE Alignment
Compensated Anteversion: Toe in Compensated Retroversion: Toe out Posterior Dislocation: Short/Adducted/IR Anterior Dislocation: Abducted/ER Intertrochanteric Fx: Short/ER
Weber-Barstow Maneuver
pt supine
Hip bridge then drop down
PT pulls legs out
Compare with thumbs on medial malleoli
Prone Knee Flexion Test for tibial shortening
pt prone
Neutral ankle
Look at level of plantar surface of feet
Flexion ROM
0-120°
Extension ROM
0-20°
Abduction ROM
0-45°
Adduction ROM
0-30°
IR ROM
0-45°
60-90° if anteverted
ER ROM
0-45°
Open Pack Position
30° flexion
30° abduction
Slight ER
This is a position of bony approximation
PROM
When AROM isnt full and pain free
Hip capsular pattern
Limitation in flexion, abduction, and IR
3 most commonly limited motions with hip OA
IR/ER
Flexion
Closed Pack Position
Full Extension
Full IR
Coxa Saltans Internal Snapping
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
Coxa Saltans External Snapping
1) ITB over Greater Trochanter
2) Gluteus Maximus over Greater Trochanter
Palpated lateral during hip flexion and extension
Coxa Saltans Intra-articular Snapping
Acetabular Labral Tear/Loose Body
-Often present with sharp pain in groin and anterior thigh especially with pivoting motions
Functional Step Up/Step Down Testing
Up with the bad
Down with the good
Activity Limitation and Participation Restriction Measures
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
Ortolani’s Test
-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
Causes of Intoeing Gait in Children
Femoral Anteversion
Internal tibial torsion
Metatarsus Adductus
Children Femoral Anteversion
Born with ~40°
2:1 Females to males
Derotational femoral osteotomy at 8-9 y/o
Derotational Femoral Osteotomy
Femoral anteversion >45°
Absent ER
Functional disability or severe cosmetic deformity
