Hip Examination Flashcards
What are the flexor muscles of the hip? What nerves innervate them?
Iliopsoas Sartorius TFL Rectus Femoris Adductor Longus Pectineus
femoral nerve
What are the extensor muscles of the hip? What nerves innervate them?
Gluteus Maximus Adductor Magnus (posterior) Biceps femoris(long) Semitendinosis Semimembranosus
inferior gluteal, obturator, and sciatic nerves
What are the external rotators of the hip? What nerves innervate them?
Gluteus Maximus Piriformis Obturator Internus Gemellus Superior Gemellus Inferior Quadratus Femoris
Inferior gluteal nerve and nerves to piriformis, obturator, gemellus superior and inferior, and quadratus femoris.
What are the adductor muscles of the hip? What nerve innervates them?
Pectineus
Adductor Longus
Adductor Brevis
Adductor Magnus (anterior/posterior)
Obturator nerve
What are the abductor muscles of the hip? What nerve innervates them?
gluteus medius (all) gluteus minimus (all) TFL
superior gluteal nerve
What type of joint is the hip? how many degrees of freedom does it have?
multiaxial ball and socket joint
3 degrees of freedom
What are normal ROM for hip: flexion? extension? abduction? adduction? ER? IR?
flexion- 110-120 degrees extension- 10-15 degrees abduction- 20-50 degrees adduction- 20 degrees external rotation- 40-60 degrees internal rotation- 20-40 degrees
What’s the closed pack postion of the hip?
full extension, slight abduction, slight IR
What’s the loose pack postion of the hip?
30 degrees flexion, 30 degrees abduction, slight ER
What’s the capsular pattern of the hip?
flexion, abduction, IR
What’s a normal angle of inclination?
What forces will be experienced with coxa vara/valga
125 degrees
105 or less = coxa vara
increased downward sheer across femoral neck, decreased compression, and decreased functional length of hip abductor muscles
140 or more = coxa valga
increased limb length, decreased sheer, increased compression over decreased available weight bearing surface, increased functional length of hip abductor muscle
What is normal anteversion? How do you test it?
8-15 degrees
craig’s test.
pt prone, feel for where greater trochanter is most lateral and measure bisection of tibia against vertical.
What are general observations you need to make for someone with hip complaint?
age, sex, weight, fitness level, independence, assistive device.
What should you ask in the subjective examination?
Where is the pain?
What position makes it increase or decrease?
What does it feel like?
Describe how it changes during a 24 hour period.
Motion problems?
Mechanism of Injury?
What is the possible source of groin pain?
hip
What is the possible source of anterior medial thigh pain?
hip
What is the possible source of posterior pain?
Lumbar spine
What is the possible source of lateral thigh pain?
Lumbar spine
What is the possible sources of lateral hip pain?
trochanteric bursitis
gluteus medius strain
L4 Nerve root pain
Classically, what pain is in the anterior groin area and radiates to the medial thigh?
hip
groin
what is the “c-sign” characteristic of?
joint pathology (often misunderstood as a lateral disorder)
Stiffness in the AM or after sitting that disappears within half an hour is characteristic of what?
osteoarthritis
Stiffness in the AM that usually lasts longer than 1 hour is characteristic of what?
rheumatoid arthritis
Hip stiffness in the am and stiffness after sitting and pain with WB can be characteristic of what?
avascular necrosis
What do you want to know in the subjective examination of recent trauma?
mechanism of injury force direction weight bearing age of the patient pain popping swelling function
What do you want to know in the subjective examination of chronic pain?
pain positions previous history chronic effusion weakness gait clicking, grinding, or popping function
What are some red flags?
unexplained weight loss, fatigue
fever
loss of appetite
bowel/bladder changes
night pain unrelated to movement
severe pain
hip pain in men 18-24 yoa of unknown etiology-testicular cancer
pain at mcBurney’s point (1/3-1/2 distance from R ASIS to umbilicus tenderness coupld be appendicitis)
blumberg’s sign- rebound tenderness for visceral pathology (supine, push down deep and slow perpendicular to an abdomincal region away from painful region, then lift up quickly, positive sign= pain on release)
What are the systemic causes of hip pain?
RA Crohn's disease Reiter's syndrome SLE psoriasis bone tumors inflammatory bowel or PID sickle cell anemia hemophelia urogenital problems ankylosing spondylitis
How do you screen for a sports hernia?
Positive signs =
palpation of a marble sized lump along the path of the inguinal ligament
pain with exertion, cough, menstruation
radiating pain into the groin, ipsilateral thigh, flank, or lower abdomen
pain with cutting, turning, stride out
nontraumatic causes of hip pain? and how should you examine this?
use a pain diagram and have patient elaborate on each area
- osteoarthritis
- overuse injuries (muscle strain/ stress fracture)
- femoral anterior impingement
- inflammation (bursitis, tendonitis)
- hernia(inguinal, femoral)
- gout
- referred pain (lumbar spine, SIJoint, knee)
- Infectious diseases
- vascular diseae (avascular necrosis)
- childhood disorders (congenital dysplagia, legg-calve-perthes disease, SCFE)
- systemic
- myofascial pain
- neurological (nerve entrapment)
What are examples of traumatic injuries?
acetabular labral tears femoral subluxation/dislocation femoral fracture pelvic fracture avulsion fractures soft tissue contusions myositis ossificans
