Hip joint exam Flashcards
What is the correct order of items you need to do on a joint exam?
Inspection, palpation, range of motion, neurovascular exam, specialty tests
Do you perform all examinations bilaterally?
YES
What are you looking for upon inspection?
Asymmetry, swelling, bruising, general appearance, gait
What are you palpating and looking for?
Greater trochanter, ASIS, iliac crests
Looking for tenderness, tissue texture abnormalities, temperature
What are the range of motions at the hip?
Flexion, extension, abduction, adduction, internal and external rotation
The strength test values
Assessed 0/5 - 5/5
5/5 = normal, 0/5 = no contraction
What is the normal value for a strength test?
5/5 - full active motion against resistance from me with no fatigue
What is included in the neurovascular exam?
Reflexes, sensation, pulses, capillary refill
What are the specialty tests for the hip joint?
Log roll, FAIR, thomas test, FABER, jump sign, Ober test, Labral loading and distraction, Scour test, straight leg raise
How would you perform a log roll?
Patient supine, internally and externally rotate their thigh
+ test = pain or clicking
How would you perform a FAIR test?
Patient lateral recumbent - Flexion, Adduction, internal rotate of hip
+ test = pain in sciatic/gluteal region
What is a FAIR test testing?
Piriformis syndrome (sciatic impingement)
How would you perform a Thomas test?
Patient supine with legs hanging off of the table, have them flex one knee to their chest and if their extended leg is unable to fully extend or comes off of the table = + test
What is a Thomas test testing?
Hip flexors - iliopsoas
How would you perform a FABER test?
Flexion, ABduction, external rotation with patient supine - have knee crossed onto other leg and push down
+ test = pain
How would you perform a jump sign and what is it testing?
Press against the greater trochanter when patient is sitting and if there is pain, they may have trochanteric bursitis
How would you perform the Ober test?
Patient lateral recumbent, top hip extended, knee flexed and Adduct it
+ test = pain or inability to adduct
How would you perform a labral loading/distraction test?
Patient supine, flex hip and flex knee and load into it or pull away
How would you perform a Scour test?
Patient supine, flex and externally rotate hip and load in to it
What are labral loading/distraction and the Scour test testing?
Labral tears and cartilagenous injuries
How would you perform a straight leg raise test?
Patient supine, flex their hip (raise leg) and keep knee extended
+ test = if they resist or feel pain
What is a normal ROM for hip flexion?
90
What is a normal ROM for hip extension?
15-30
What is a normal ROM for hip abduction?
45-50
What is a normal ROM for hip adduction?
20-30
What is a normal ROM for hip internal/external rotation?
30-40
What is the patellar reflex testing?
L4
What is the achilles reflex testing?
S1
What is the scale for reflex testing?
0/4 - 4/4
0/4 = absent reflex
+2/4 = normal
+4/4 = Hyperactive and not normal
How would you do a dermatome/sensory test?
Have patients close eyes, ask if they can feel this bilaterally, on knee cap, down leg and on to medial and lateral foot sides
Where would you check for pulses?
Posterior tibialis - behind medial mallelous
Dorsalis pedis - on dorsal foot
What is the scale for pulses?
0/3 - 3/3
+2/3 = normal
+3/3 = bounding
What tests would be positive on someone with piriformis syndrome?
Log roll (external rotation) and FAIR test Pain in gluteal region
With a log roll, pain in the groin or anterior side could possibly mean what?
FAI, AVN, SCFE or clicking = labral tear
Intra-articular pathologies
To test if piriformis syndrome is causing sciatic nerve irritation, what test you would perform?
FAIR - lateral recumbant, flex top hip and knee, adduct and internally rotate
Positive findings for the FABER test with pain in groin could mean what?
Intra-articular things like FAI, Labral tear or osteoarthritis
Positive findings for the FABER test with pain in the buttock region could mean what?
Sacroilitis
Describe the OBER test
Pt lateral recumbant, top hip extended, knee flexed and adducted
What can a positive ober test mean?
Trochanteric bursitis
What does performing the log roll with a negative finding rule out?
Intra-articular things
If the labral load and scour tests were positive for pain and the labral distraction was positive for IMPROVEMENT of pain what could that suggest?
Cartilagenous involvement
Pain with a SLR between 30-60 degrees indicates what?
Lumbar disc herniation between L4-S1
