Hip physical exam Flashcards
what are some musculoskeletal differential diagnosis?
lumbar exam
lumbar repeated movements (does a direction of preference emerge? centralization of symptoms?)
SI exam
knee exam
what are we looking for in our observation/postural examination?
visible swelling?
skin color
symmetrical WB?
assess balance (one legged standing)
LE alignment (compensated anteversion/retroversion, leg length discrepancy (coxa valga/vara))
what is seen with compensated anteversion?
toed in
what is seen with compensated retroversion?
toed out
what is the normal degrees of version?
10-20º forward (anteversion)
what is increased femoral anteversion?
> 20º
what is femoral retroversion?
<10º
what is femoral version defined as?
the angular difference between axis of femoral neck and transcondylar axis of the knee
what is the normal angle of inclination?
126-139º
what is considered coxa valga?
> 140º
what is considered coxa vara?
<125º
what should we be looking for in gait/ambulation?
antalgic?
trendelenbrug?
what is a maneuver to measure leg length discrepancy true vs apparent?
weber-barstow maneuver
starting position is supine knees bent, then patient lifts hips off bed, PT compares height of medial malleoli with the legs extended
what are ways to measure leg length discrepancy?
weber-barstow maneuver
prone knee flexion test for tibial shortening
measure from umbilicus to great toe on each leg
what movements do we take goniometric measurements of?
flexion, extension, abduction, adduction, ER, IR
what are normal values for hip flexion?
0-120º
what are normal values for hip extension?
0-30º
what are normal values for hip abduction?
0-45º
what are normal values for hip adduction?
0-30º
what are normal values for hip ER?
0-45º
what are normal values for hip IR?
0-45º
what is the capsular pattern at the hip?
limitation in flexion, abduction and IR
max loss IR, moderate loss flexion, and moderate loss abduction
minimal loss of extension = greater functional limitation than the same loss of flexion
what is a positive scour test/ quadrant test?
pain, grinding, catching or crepitation in the hip- concern for intra-articular pathology (OA, labral pathology, osteochondral defect, or osteonecrosis)
how is the scour test/quadrant test perfromed?
patient supine. PT flex to 90º and IR/add, then flex ER/add
what is the anterior labral tear test (FADIR) for?
the examination of the femoracetabular impingement syndrome or an anterior labral tear
how is the anterior labral tear test performed?
patient supine, flexion, adduction, internal rotation
what is important to remember with FABER test/Patrick’s test/Figure-four?
compare bilaterally for ROM and pain (with overpressure)
can be used as a comparable sign
if a patient has decreased ROM with FABER test what is it indicative of?
hypomobile SI or hip joint, or tight adductors/hip flexors
if a patient reports pain with FABER test what is it indicative of?
PSIS/buttocks- SI/lumbar spine pathology
GT/thigh- intra-articular hip joint pathology
knee- meniscal pathology
how is FABER test performed?
patient supine, flexion, abduction, ER
how many zones are there in the flexion-adduction test?
3
in a normal population what zone should a patient be able to adduct to in the flexion-adduction test?
1
if a patient can only get to zone 2 or 3 they may have pathologic changes (limitation secondary to pain, apprehension, or limited end rage) what could it be indicative of?
children: legg-calve-perthes disease and SCFE
adults: sinister pathology like fracture, cancer
what 3 muscles are being tested in the thomas test (3 muscle kendall test)?
iliopsoas: hip flex, and hip ER
rectus femoris: hip flex, and knee extension
TFL/ITB: hip flex, and hip abduction
during ober test what is indicative of a tight ITB?
< 10º hip add
for craig’s test what defines femoral anteversion?
more than 15º
for craig’s test what defines femoral retroversion?
less than 8º
what movements are assessed with MMT?
flexion/extension/abduction/adduction/ IR/ER of hip
flexion and extension of knee
what does a positive trendelenburg test indicate?
organic hip abductor weakness
hip compression load intolerance (hip OA or labral tear)
trohchanteric bursitis/ iliotibial band syndrome
S1 myotome involvement
what does the patellar-pubic percussion test test for?
fracture of hip
how is the patellar-pubic percussion test performed?
tap patella or use tuning fork- asses qualitatively the sound bilaterally
what is a positive patellar-pubic percussion test?
diminished percussion note on side of pain
what is a negative patellar-pubic percussion test?
no difference bilaterally
what is the FAIR test?
60º hip flexion
90º knee flexion
hip add to table
passive IR of hip to end range
what is a positive FAIR test?
pain at intersection of sciatic nerve and piriformis
what is the open pack position of the hip?
30º flex, 30º abd, slight (5º) ER
what is the closed pack position of the hip?
max extension
max IR
what joint play/accessory motion are we testing at the hip?
acetabulofemoral long axis distraction
acetabulofemoral caudal glide- hip at 90º
acetabulofemoral lateral distraction- hip at 90º
acetabulofemoral anterior glide femur
acetabulofemoral anterior glide femur in prone FABER position
acetabulofemoral inferomedial glide
what can we palpate on the hip in the anterior/lateral aspect?
ASIS/AIIS
iliac crest
greater trochanter
inguinal ligament
muscles: flexors/adductors/abductors
what can we palpate on the hip in the posterior aspect?
ischial tuberosities/PSIS
what are some activity limitation and participation restriction measures we can test?
6 minute walk test
self-paced walk test (20-m)
stair measure (9 stairs)
timed-up and go test (3-m)
