Hip/Knee/Ankle SPE Flashcards
What are some of the structures you can observe and palpate on the hip joint?
ASIS Iliac crest Greater trochanter Pubic tubercles PSIS Ischial tuberosity Sacroiliac joint Inguinal ligament Femoral artery Sartorius m. Adductor longus m. Sciatic n.
Action of iliopsoas m.
Hip flexor
Action of sartorius m.
Hip flexor (also abduction and external rotation)
Action of rectus femoris m.
Hip flexor
Action of adductor longus m.
Hip adductor
Action of gluteus medius m.
Hip abductor (and external rotation)
Action of gluteus maximus m.
Hip extensor (also abduction and external rotation)
Action of hamstrings mm.
Hip extensors (biceps femoris m., semitendinosus m., semimembranosus m.)
Action of tensor fascia lata m.
Hip flexor (and abduction)
Normal ROM for hip flexion
90 degrees with knee extended, 120-135 degrees with knee flexed
Normal ROM for hip extension
15-30
Normal ROM for abduction of the hip
45-50 with knee extended
Normal ROM for adduction of the hip
20-30
Normal ROM for internal rotation of the hip
30-40
Normal ROM for external rotation of the hip
40-60
When performing strength testing on the hip, what are 5 possible muscles you can test?
Iliopsoas m.
Gluteus maximus m.
Gluteus medius m. + gluteus minimis m.
Adductor longus m.
Which muscle would you strength test for hip flexion?
Iliopsoas m.
Femoral n. L2-L4 + ventral rami of L1-L2
Which muscle would you strength test for hip extension?
Gluteus maximus m.
Inferior gluteal n. L5, S1-S2
What muscle would you strength test for abduction of the hip?
Gluteus medius and minimis mm.
Superior gluteal n. L5, S1
Which muscle would you strength test for hip adduction?
Adductor longus m.
Obturator n. L2-4
What are the 5 grades on the strength testing scale?
0/5 = no contraction detected
1/5 = barely detectable trace of contraction
2/5 = active movement w/o gravity
3/5 = active movevment against gravity
4/5 = active movement + gravity + resistance
5/5 = active movement + full resistance w/o fatigue
What is “normal” on the strength grading scale?
+5/5 = active movement against full resistance without evidence of fatigue
What dermatomes and nerves are you checking with sensation testing in the hip region?
Dermatomes L1-3
Nerves:
Anterior femoral cutaneous n.
Lateral femoral cutaneous n.
Posterior femoral cutaneous n.
What are the central compartmental structures in the hip?
Labrum
Ligamentum teres
Articular surfaces
What are the peripheral compartmental structures of the hip joint?
Femoral neck
Synovial lining
What are the lateral compartmental structures of the hip joint?
Gluteus medius Gluteus minimis Piriformis IT band Trochanteric bursae
What are the anterior/iliopsoas compartmental structures of the hip joint?
Iliopsoas insertion
Iliopsoas bursae
What is the log roll orthopedic test for the hip and what is a positive result?
Nonspecific to central and peripheral compartments
Roll patient’s leg into internal and external rotation
Postive test = pain –> central or peripheral compartment pathology
What is the classic sign that someone has a hip injury in the central compartment? What does this typically indicate?
C-sign; patient characteristically points to source of pain by cupping just above the trochanter with thumb and index finger
Indicates labral pathology
Explain the test, a positive result, and what this indicates:
Labral loading (hip)
Flex patient’s knee and hip to 90 degrees, load into the femur towards the innominate
+ test = pain –> labral or cartilaginous pathology
Explain the test, a positive result, and what this indicates:
Labral distraction (hip)
Distract patient’s femur away from innominate
+ test = improvement of pain –> labral or cartilaginous pathology
Explain the test, a positive result, and what this indicates:
Scour (hip)
Flex and externally rotate patient’s hip. Load into socket and articulate through annular ROM
+ test = pain –> labral or articular cartilage pathology
Explain the test, a positive result, and what this indicates:
Apprehension: Faber (hip)
Patient’s hip is flexed, abducted, and externally rotated; physician induces further external rotation by applying posterior force at the knee
+ test = anterior subluxation of hip or apprehension/pain –> labral pathology or impingement
Explain the test, a positive result, and what this indicates:
Ely’s test (hip)
Patient prone; passively flex patient’s knees
+ test = ipsilateral hip raises off table –> rectus femoris contracture
Explain the test, a positive result, and what this indicates:
Rectus femoris test (hip)
Patient supine. One hip flexed up to the chest, other leg bent over edge of table
+ test = knee flexion less than 90 degrees –> rectus femoris contraction ipsilaterally
Explain the test, a positive result, and what this indicates:
Jump sign (hip)
Patient is seated, pressure is applied to greater trochanter
+ test = patient withdraws with pressure –> trochanteric bursitis
Explain the test, a positive result, and what this indicates:
Straight leg raise (hip)
Raise the leg with knee extended, nonspecific test
+ test = lateral pain with less than 15 degree extension –> lateral compartment pathology