Hip Pain/Exam

Question 1

What can you palpate on the hip?

Answer 1

Iliac crest at L4, ASIS, greater trochanter, pubic tubercle

Question 2

Trochanteric Bursitis

Answer 2

Presentation: lateral hip pain, especially when laying on affected side; localized tenderness over greater trochanter

Question 3

Osteonecrosis of hip

Answer 3

decreased blood supply to hip
Presentation: groin pain, pain with activity, pain at rest
Management: medications, osteotomy, grafting, surgical fixation

Question 4

Legg-Calve-Perthes disease

Answer 4

idiopathic avascular necrosis of hip; affects children
Presentation: acute onset of pain w/ limping, decreased ROM or stiffness
Management: non weight bearing w/ sling; surgery

Question 5

Slipped Capital Femoral Epiphysis (SCFE)

Answer 5

femoral epiphysis has slipped posteriorly
Presentation: obese adolescent presents w/ hip pain w/ limping and impaired internal rotation
Management: non-weight bearing w/ crutches or wheelchair; refer to orthopedic surgeon

Question 6

Femoroacetabular Impingement

Answer 6

abnormal contact between anterior femoral head and acetabular rim
Presentation: pain w/ increased prolonged sitting, leaning forward
Management: physical therapy, intra-articular injection, arthroscopy

Question 7

Acetabular Labral Tear

Answer 7

Presentation: anterior hip pain with activity
Management: joint injection, hip arthroscopy

Question 8

Septic Arthritis

Answer 8

infection of joint
Presentation: pain in joint along w/ fever, inflammation at joint, decreased ROM
Management: broad spectrum antibiotics

Question 9

Piriformis Syndrome

Answer 9

entrapment of sciatic N.
Presentation: buttock pain and parasthesia; wallet sign (pain when sitting on wallet)
Management: physical therapy, nerve pain medications

Question 10

Meralgia Paresthetica

Answer 10

compression of lateral femoral cutaneous N. passing through inguinal L.
Presentation: numbness/tingling or decreased sensation over lateral hip and thigh
Management: conservative therapy, nerve block

Question 11

Hip Flexion (knee straight)

Answer 11

90

Question 12

Hip Flexion (knee flexed)

Answer 12

120-135

Question 13

Hip Extension

Answer 13

15-30

Question 14

Hip Internal rotation

Answer 14

30-40

Question 15

Hip External rotation

Answer 15

40-60

Question 16

Hip Abduction

Answer 16

45-50

Question 17

Hip Adduction

Answer 17

20-30

Question 18

Patellar reflex

Answer 18

L3/L4

Question 19

Achilles reflex

Answer 19

S1

Question 20

Flexion muscles/nerves

Answer 20

iliopsoas M.
Femoral N. (L2-L4)
Ventral rami of lumbars (L1-2)

Question 21

Extension muscles/nerves

Answer 21

gluteus maximus M.

Inferior Gluteal N. (L5-S2)

Question 22

Abduction muscles/nerves

Answer 22

gluteus medius and minimus Ms.

Superior Gluteal N. (L5-S1)

Question 23

Adduction muscles/nerves

Answer 23

adductor longus M.

Obturator N. (L2-4)

Question 24

Great toe dermatome

Answer 24

L5

Question 25

Posterolateral calf/little toe dermatome

Answer 25

S1

Question 26

Central compartment

Answer 26

labrum ligamentum teres articular surfaces

Question 27

Peripheral compartment

Answer 27

femoral neck | synovial lining

Question 28

Lateral compartment

Answer 28

``` gluteus medius gluteus minimus piriformis IT band Trochanteric bursae ```

Question 29

Anterior compartment

Answer 29

iliopsoas insertion | iliopsoas bursae

Question 30

Log Roll

Answer 30

roll pt's leg into internal and external rotation (+) = pain Indicates: central or peripheral compartment pathology

Question 31

C-Sign

Answer 31

Central compartment pt points to source of pain with 2 fingers or cups just above trochanter Indicates: labral pathology

Question 32

Labral Loading

Answer 32

Central Compartment Flex the pt's knee and hip to 90 and load into the femur (+) = pain Indicates: labral or cartilaginous pathology

Question 33

Labral Distraction

Answer 33

Central Compartment distract pt's femur away from joint (+): improvement of pain Indicates: labral or cartilaginous pathology

Question 34

Scour

Answer 34

Central compartment Flex and externally rotate hip; load into socket and articulate through ROM (+) = pain Indicates: labral or articular cartilage pathology

Question 35

Apprehension: FABER

Answer 35

Central compartment pt's hip flexed, abducted, and externally rotated; physician induces further external rotation by applying posterior force at knee (+) = anterior subluxation of hip or apprehension/pain Indicates: labral pathology

Question 36

Rectus Femoris Test

Answer 36

Peripheral compartment Pt supine w/ one hip flexed and other leg bent over edge of table (+) = < 90 degree knee flexion Indicates: rectus femoris contraction

Question 37

Jump Sign

Answer 37

Lateral Compartment pt seated and pressure applied to greater trochanter (+) = pt withdraws or jumps w/ pressure Indicates: trochanteric bursitis

Question 38

Straight Leg Raise Test

Answer 38

Lateral Compartment passively flex pt's hip w/ knee extended (+) = pain over lateral leg, especially at >15 degrees Indicates: IT Band contracture positive signs usually between 30-60 if caused by lumbosacral radiculopathy and/or sciatic neuropathy Positive signs >70 is more likely mechanical low back pain due to muscle strain or joint disease

Question 39

Piriformis Test

Answer 39

Lateral Compartment pt supine w/ hip and knee flexed, one ankle crossed over contralateral knee; pt abducts against resistance (+) = pain over posterior aspect of greater trochanter Indicates: piriformis spasm or pathology

Question 40

Patrick's: FABER (lateral)

Answer 40

Lateral compartment pt's hip flexed, abducted, and externally rotated; physician braces contralateral ASIS, pt externally rotates/abducts against resistance (+) = pain or weakness Indicates: gluteus medius pathology

Question 41

Patrick's: FABER (anterior)

Answer 41

Anterior compartment pt's hip flexed, abducted, and externally rotated; physician braces contralateral ASIS, pt internally rotates/adducts against resistance (+) = anterior or medial groin pain/weakness Indicates: iliopsoas insufficiency/pathology

Question 42

Thomas Test

Answer 42

Anterior compartment pt supine and pulls knees to chest; one leg lower to table (+) = inability to fully extend, extended leg raised off table Indicates: hip flexor contraction