Hip Joint Exam Flashcards
What is the order of the Physical Therapy Examination for the HIp?
Medical History & patient interview systems review clearing related joints tests and measures -global (lower quarter) -hip joint/region specific
What is the therapist looking for in the Systems review of the HIP?
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
What joints should be cleared for a Hip Exam
Lumbar Spine and SI joint
Trunk flexion and extension
Knee
Flexion and extension ROM with overpressure
What Hip Joint/region specific test should be part of the Hip Examination
Active movements
resisted isometrics/MMT
passive movement
-physiological
-accessory
special tests
palpationHip Active Movements
Check willingness to move, synergy, presence of painful arc
Perform all active movements in standing except for ER and IR
What is a resisted isometric
Not a MMT…presence of pain is a positive test
What are resisted isometrics used for
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
How do we record resisted isometrics?
recorded based on strength and presence or absence of pain
RI: Strong/Painless
Normal
RI: Strong/Painful
Musculotendinous lesion
RI:Weak/Painless
Nerve compression, neuropathy, long standing muscle rupture or tendon avulsion
RI: Weak/Painful
serious pathology (neurological, muscular, or recent tear)
All movements Painful
Acute Condition or psychogenic
What position should the patient be in to perform Resisted Isometrics?
Perform in supine 90/90 position Flexion Extension Abduction Adduction Internal and External Rotation
Hip Manual Muscle Test
Remember that AROM can resisted isometrics/MMT can also reproduce joint symptoms…Newton’s 3rd law
Why might MMT be difficult with a strain of the hip flexors
In this case, active/resisted hip flexion causes pain, but passive flexion of the hip should not.
Pain with Internal Rotation at 90’ of flexion indicates what
Intrarticular pathology
Passive (Physiological) movements are measured in what position
Supine for all measurements
can repeat rotation measures in prone ling or sitting
If more ROM is available in the prone position for ER or IR then
A muscle restriction is likely present
Greater IR (Compared to ER) in both supine and prone may indicate what femoral condition
Femoral Anteversion
Greater External Rotation compared to Internal Rotation in both supine and prone may indicate what?
Femoral Retroversion
What are the special test that we are covering?
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
What is hip palpation used for?
Useful for sources of hip pain other than the joint itself.
Systematic Palpation of the region should cover the following joints
- Lubmbosacral joint and SacroIliac Joint
- Ischium, Iliac crest, pubic symphyss, lateral aspect of greater trochanter
- Muscle bellies
Anterior Hip Palpation includes
ASIS SIIS Pubic Tubercle (this summer) Adductor Magnus Rectus Femoris Iliopsoas bursa Femoral Triangle Inguinal Triangle Adductor Longus
Lateral Hip Palpation should include
Iliac Crest
Greater Trochanter
Lesser Trochanter
Psoas
Posterior Hip Palpation should include
Quadratus Laborum
Ischial Tuberosity
Sciatic Nerve
Piriformis
