Hip Joint Exam

Question 1

What is the order of the Physical Therapy Examination for the HIp?

Answer 1

Medical History & patient interview
systems review
clearing related joints
tests and measures
  -global (lower quarter)
  -hip joint/region specific

Question 2

What is the therapist looking for in the Systems review of the HIP?

Answer 2

Systemic disorders–constitutional symptoms
Other RED FLAGS–changes in bowel/bladder
–severe pain; right pain unrelated to movement
Viscerogenic pain
–ovarian cysts, ectopic pregnancy, inguinal hernias, diverticulitis
Vasculogenic Pain
–vascular claudication

Question 3

What joints should be cleared for a Hip Exam

Answer 3

Lumbar Spine and SI joint
Trunk flexion and extension
Knee
Flexion and extension ROM with overpressure

Question 4

What Hip Joint/region specific test should be part of the Hip Examination

Answer 4

Active movements
resisted isometrics/MMT
passive movement
    -physiological
    -accessory
special tests 
palpation

Question 5

Hip Active Movements

Answer 5

Check willingness to move, synergy, presence of painful arc

Perform all active movements in standing except for ER and IR

Question 6

What is a resisted isometric

Answer 6

Not a MMT…presence of pain is a positive test

Question 7

What are resisted isometrics used for

Answer 7

Provides some information about the integrity of neuromuscular unit
—remember newton’s 3rd law; joint reaction force inn response to muscle forces, so pain may ne related to articular pathology

Question 8

How do we record resisted isometrics?

Answer 8

recorded based on strength and presence or absence of pain

Question 9

RI: Strong/Painless

Answer 9

Normal

Question 10

RI: Strong/Painful

Answer 10

Musculotendinous lesion

Question 11

RI:Weak/Painless

Answer 11

Nerve compression, neuropathy, long standing muscle rupture or tendon avulsion

Question 12

RI: Weak/Painful

Answer 12

serious pathology (neurological, muscular, or recent tear)

Question 13

All movements Painful

Answer 13

Acute Condition or psychogenic

Question 14

What position should the patient be in to perform Resisted Isometrics?

Answer 14

Perform in supine 90/90 position
Flexion
Extension
Abduction
Adduction
Internal and External Rotation

Question 15

Hip Manual Muscle Test

Answer 15

Remember that AROM can resisted isometrics/MMT can also reproduce joint symptoms…Newton’s 3rd law

Question 16

Why might MMT be difficult with a strain of the hip flexors

Answer 16

In this case, active/resisted hip flexion causes pain, but passive flexion of the hip should not.

Question 17

Pain with Internal Rotation at 90’ of flexion indicates what

Answer 17

Intrarticular pathology

Question 18

Passive (Physiological) movements are measured in what position

Answer 18

Supine for all measurements

can repeat rotation measures in prone ling or sitting

Question 19

If more ROM is available in the prone position for ER or IR then

Answer 19

A muscle restriction is likely present

Question 20

Greater IR (Compared to ER) in both supine and prone may indicate what femoral condition

Answer 20

Femoral Anteversion

Question 21

Greater External Rotation compared to Internal Rotation in both supine and prone may indicate what?

Answer 21

Femoral Retroversion

Question 22

What are the special test that we are covering?

Answer 22

Passive SLR…Patric or FABER (flexion, abduction, external rotation)…Log rolling…FADDIR (Impingement test)…Quadrant (Scour) Test…Active SLR with resistance…Trendelenburg test….sign of th buttock

Question 23

What is hip palpation used for?

Answer 23

Useful for sources of hip pain other than the joint itself.

Question 24

Systematic Palpation of the region should cover the following joints

Answer 24

• Lubmbosacral joint and SacroIliac Joint
• Ischium, Iliac crest, pubic symphyss, lateral aspect of greater trochanter
• Muscle bellies

Question 25

Anterior Hip Palpation includes

Answer 25

ASIS
SIIS
Pubic Tubercle (this summer)
Adductor Magnus
Rectus Femoris
Iliopsoas bursa
Femoral Triangle
Inguinal Triangle
Adductor Longus

Question 26

Lateral Hip Palpation should include

Answer 26

Iliac Crest
Greater Trochanter
Lesser Trochanter
Psoas

Question 27

Posterior Hip Palpation should include

Answer 27

Quadratus Laborum
Ischial Tuberosity
Sciatic Nerve
Piriformis