Hip pain

Question 1

Hip ROM and primary muscles involved

Answer 1

Flexion: 90 or 120-135. Done by iliopsoas m.
Extension: 15-30. Done by gluteus maximus.
Abduction: 45-50. Done by gluteus medius and minimus.
Adduction: 20-30. Done by adductor longus m.
Internal rotation: 30-40. Doesn’t specify primary muscle.
External rotation: 40-60. Done by sartorius, gluteus medius and maximus.

Question 2

Log roll

Answer 2

Pretty simple… roll the patients leg into internal and external rotation.
(+) test = pain.

Indicates central or peripheral compartment pathology. Specifically, it can indicate piriformis syndrome, or slipped capital femoral epiphysis.

Question 3

C-sign

Answer 3

Patient will come in holding their hip, and forming a “C” with their hands. The C is cupping around the labrum.
(+) test = labral pathology.

Question 4

Labral loading/distraction

Answer 4

Flex the patients knee and hip to 90.
Loading: (+) test = pain
Distraction: (+) test = relief of pain

Question 5

Scour

Answer 5

Flex and ER patient’s hip, while simultaneously loading into the hip.

(+) test = pain.

Question 6

Apprehension FABER

Answer 6

FABER= Flexed, abducted and externally rotated.
In this test, you add further external rotation by applying a downward force over the externally rotated knee.

(+) test = Pain/apprehension

Question 7

Rectus femoris test

Answer 7

Patient is supine. One hip is flexed up to the chest, while the other leg is bent over the edge of the table. (+) test = occurs when the knee of the hanging leg is flexed < 90 degrees. This indicates rectus femoris contraction…

Question 8

Jump sign

Answer 8

Patient jumps when you palpate the greater trochanter. This indicates trochanteric bursitis.

Question 9

Straight leg raise test

Answer 9

Patient is supine, slowly go through passive flexion of the leg. Need to monitor where they have pain!

Pain at < 15: IT band contracture, or sports hernia.

Pain between 30-60: Lumbosacral radiculopathy or sciatic neuropathy.

Pain > 70: Low back pain due to muscle strain or joint disease.

Question 10

Piriformis test/Patrick’s FABER

Answer 10

Patient is in the FABER position. Physician braces contralateral ASIS, while patient ER/abducts against resistance. In non-medical terms, they try to put their knee to the table.

(+) test = pain either in the gluteus medius region, piriformis region or iliopsoas region.

Question 11

Thomas test

Answer 11

Patient pulls both knees to chest, then lowers the other leg towards the table.
(+) test = extended leg raises off the table (Sarah)
Indicates hip flexor contraction.
Not to be confused with Thompson test (squeezing the gastrocnemius and looking for plantarflexion. This can be positive in people who take fluoroquinolone, b/c this can tear the calcaneal tendon).

Question 12

Ober test

Answer 12

Evaluates the tensor fascia lata, gluteus medius or gluteus maximus.

tensor fascia lata: hip and knee are extended and abducted, then allow the patient to passively adduct with gravity. (+) test = not fully adducting, indicates a tight IT band.

Question 13

Developmental dysplasia of the hip

Answer 13

Ortolani test: Grab trochanter and lift thigh to bring dislocated femoral head back into the acetabulum. (+) test = audible clunk

Barlow test: Reverse of Ortolani. Performed to discover any hip instability. Grasp thigh and gently adduct with gentle outward force. Femoral head will dislocate. Barlow= Bust out!

Question 14

Legg-Calvé-Perthes disease

Answer 14

Idiopathic (unknown) avascular o=necrosis of hip in children 3-12 yo. Common in obese kiddos, will present with acute onset of pain, decreased ROM or stiffness. Kids shouldn’t have hip pain.
Will have positive trendelenburg test.

Question 15

Slipped Capital Femoral Epiphysis

Answer 15

Acute pain, due to femoral epiphysis that slipped posteriorly. This is bad b/c it can stop growth.

Question 16

Trendelenberg sign

Answer 16

Have patient stand on right foot… if left hip drops, this is a positive test! Remember, the leg that is on the ground has the defective gluteus medius. Normally, the right gluteus medius/minimus should contract to keep the pelvis from dropping. But when this is defective, we see the pelvis drop to one side (+ Right Trendelenberg sign)

Question 17

Anterior hip pain

Answer 17

Meralgia paresthetica and sports hernia

Question 18

Anterolateral hip pain

Answer 18

A good test for this is the FABER test. 
Femoracetabular impingement
Hip labral tear
Legg Calve perthes disease 
Osteoarthritis 
Osteonecrosis
Septic hip
Slipped capital femoral epiphysis

Question 19

Lateral hip pain

Answer 19

External snapping hip

Greater trochanteric bursitis

Question 20

Posterolateral hip pain

Answer 20

Gluteal muscle tear

Iliac crest apophysis avulsion

Question 21

Posterior pain

Answer 21

Hamstring strain
Ischiofemoral impingement
Piriformis syndrome (positive log roll)
Sacroiliac joint dysfunction