Hip Pain

Question 1

What should be included during inspection of the hip?

Answer 1

Observe gait and stance
Observe how patient climbs on the exam table
Consider looking at leg length discrepancy
Observe the C sign

Question 2

What should be palpated during hip exam

Answer 2

Make sure iliac crest is level with L4
ASIS
Greater trochanter of femur
Pubic tubercle

Question 3

What is ROM for hip:
Ab and adduction
Flexion and extension
Internal and external rotation

Answer 3

Abduction:45-50
Adduction: 20-30
Flexion: Knee extended 90; knee flexed 120-135
Extension: 15-30
Internal rotation: 30-40
External rotation: 40-60

Question 4

Specialty tests for the hips are helpful for finding a diagnosis, but they are not extremely […] or […]

Answer 4

Sensitive or specific

Question 5

Name this test:
We passively move hip into flexion, abduction, and external rotation.

Checking for labral tear, loose bodies, chondral lesions, femoroacetabular impingement, OA, SIJ dysfunction, iliopsoas bursitis

Answer 5

FABER test

Question 6

Name this test
We passively move hip into flexion, adduction, and internal rotation

Checking for labral tear, loose bodies, chondral lesions, femoral acetabular impingement

Answer 6

FADIR test

Question 7

Name this test:
Just passively rotate supine LE

Checking for piriformis syndrome, and SCFE

Answer 7

Leg roll test

Question 8

Name this test:
Raise the straight leg against applied resistance above patella

Checking for sports hernia, SCFE, femoral acetabular impingement

Answer 8

Straight leg raise

Question 9

Name this test:
To evaluate TFL, patient lies lateral recumbent, and with the hip and knee extended, you passively adduct w/ gravity.

To evaluate medius, patient lateral recumbent, hip is held in extension and 45-90° of knee flexion

To evaluate maximus, shoulders are rotated back towards the table with hip in flexion and knee in extension

Checking for external snapping hip, greater trochanteric pain syndrome

Answer 9

Ober test

Question 10

Name this test:
Patient stand with feet shoulder width apart and lifts one leg. Look for a drop of the iliac crest on side of lifted leg.

Looking for labral tear, transient synovitis, Legg-Calve-Perthes disease

Answer 10

Trendelenburg test

Question 11

How do you perform the Thomas test and what are you looking for?

Answer 11

Patient supine uses arm to aid in hip flexion with knee flexed. The contralateral leg should rest comfortably on the table.

Looking for: tendinopathy, rectus femoris tear, fractures

Question 12

How do you perform the FAIR test and what is it for?

Answer 12

Patient LE is lateral recumbent with shoulders on table. Do flexion, adduction, and internal rotation of hip.

Looking for piriformis syndrome

Question 13

How do you perform the PACE test and what is it for?

Answer 13

If you do not get a positive FAIR test, do PACE test.
Simply abduct and externally rotate leg against resistance. Since the knee is flexed, you are causing the piriformis to contract fully.

Also just looking for piriformis syndrome

Question 14

What tests should you do to check for developmental dysplasia of the hip in a newborn?

Answer 14

Do Barlow test first: abduct hip with a posterior force and feel for laxity or chunking. If chunking occurs, then do Ortolani test in order to put femoral head back into acetabulum

Ortolani test: Take hips in external rotation and apply anterior force

Question 15

What are some differentials if patient presents with anterior hip pain?

Answer 15

Meralgia paresthetica

Sports hernias

Question 16

What are some differentials if patient presents with anterolateral hip pain?

Answer 16

Femoroacetabular impingement
Hip labral tear
Legg-Calve-Perthes disease
OA
Osteonecrosis of hip
Septic hip
Slipped capital femoral epiphysis

Question 17

What are some differentials if patient presents with lateral hip pain?

Answer 17

External snapping hip

Greater trochanteric bursitis

Question 18

What are some differentials if patient presents with posterolateral hip pain?

Answer 18

Gluteal muscle tear

Iliac crest apophysis avulsion

Question 19

What are some differentials if patient presents with posterior hip pain?

Answer 19

Hamstring strain
Ischiofemoral impingement
Piriformis syndrome
SIJ dysfunction

Question 20

What is the most common cause of lateral hip pain over greater trochanter?

Tendinopathy of what two muscles could result from the above pathology?

Answer 20

Trochanteric bursitis

Gluteus medius and minimus

Question 21

What specialty tests should I do if checking for trochanteric bursitis?

Answer 21

FABER and Ober test

Question 22

What could cause osteonecrosis of the hip?

Answer 22

Medications like long-term steroid use, serious medical conditions like sickle cell anemia or SLE, trauma, or transplantation

Question 23

What is the likely diagnosis if a child between the ages of 3-12 who recently went through a growth spurt presents with osteonecrosis of hip?

What is the distinguishing clinical presentation to eliminate a SCFE differential?

Answer 23

Legg-Calve-Perthes disease

Limp should come first, then pain after in above disease

Question 24

What is the disease characterized by a posterior slip of the femoral epiphysis?

What are some causes or risk factors for this pathology?

Answer 24

Slipped capital femoral epiphysis (SCFE)

Causes include obesity in adolescent, growth spurt, or endocrine disorder

Question 25

What is femoroacetabular impingement?

What specialty tests could be used to diagnose?

Answer 25

Pain on anterolateral hip/groin due to abnormal contact between the anterior femoral head and acetabular rim

Specialty tests include C sign, positive FABER and FADIR tests

Question 26

If a patient presents with pain on the anterior aspect of the hip, and had recently been involved in MVA, and is positive for Thomas test, what would be a likely diagnosis?

What could treat above pathology?

Answer 26

Acetabular labral tear

Could do joint injection and hip arthroscopy

Question 27

If a young adult presents complaining of joint pain, fever, flu-like symptoms, etc., and admits to frequently abusing drugs intravenously, what is a likely diagnosis?

What would need to occur in order to determine route of treatment?

Answer 27

Septic arthritis

Joint fluid aspiration would be needed in order to determine what antibiotics to use

Question 28

What is piriformis syndrome, and what could be causing it?

What specialty tests could be performed to aid in diagnosis?

Answer 28

Entrapment of the sciatic nerve resulting in pain in buttock. May develop after trauma to puttock or the piriformis muscle causing strain and scarring around the nerve

Leg roll test should elicit pain
Also do FAIR and PACE test

Question 29

What is happening in meralgia paresthetica, and what could be causing it?

Specialty test?

Answer 29

Compression of the lateral femoral cutaneous nerve as it passes through the inguinal ligament.

Caused by tight fitting clothes, obesity, diabetes, and pregnancy

Positive FABER test.

Question 30

Elderly woman presents to clinic with hip pain after her caretaker found her lying on the ground. What is the likely diagnosis?

Answer 30

Hip fracture