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musculo > Hip physical exam > Flashcards

Hip physical exam Flashcards

1
Q

what are some musculoskeletal differential diagnosis?

A

lumbar exam
lumbar repeated movements (does a direction of preference emerge? centralization of symptoms?)
SI exam
knee exam

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2
Q

what are we looking for in our observation/postural examination?

A

visible swelling?
skin color
symmetrical WB?
assess balance (one legged standing)
LE alignment (compensated anteversion/retroversion, leg length discrepancy (coxa valga/vara))

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3
Q

what is seen with compensated anteversion?

A

toed in

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4
Q

what is seen with compensated retroversion?

A

toed out

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5
Q

what is the normal degrees of version?

A

10-20º forward (anteversion)

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6
Q

what is increased femoral anteversion?

A

> 20º

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7
Q

what is femoral retroversion?

A

<10º

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8
Q

what is femoral version defined as?

A

the angular difference between axis of femoral neck and transcondylar axis of the knee

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9
Q

what is the normal angle of inclination?

A

126-139º

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10
Q

what is considered coxa valga?

A

> 140º

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11
Q

what is considered coxa vara?

A

<125º

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12
Q

what should we be looking for in gait/ambulation?

A

antalgic?
trendelenbrug?

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13
Q

what is a maneuver to measure leg length discrepancy true vs apparent?

A

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

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14
Q

what are ways to measure leg length discrepancy?

A

weber-barstow maneuver
prone knee flexion test for tibial shortening
measure from umbilicus to great toe on each leg

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15
Q

what movements do we take goniometric measurements of?

A

flexion, extension, abduction, adduction, ER, IR

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16
Q

what are normal values for hip flexion?

A

0-120º

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17
Q

what are normal values for hip extension?

A

0-30º

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18
Q

what are normal values for hip abduction?

A

0-45º

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19
Q

what are normal values for hip adduction?

A

0-30º

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20
Q

what are normal values for hip ER?

A

0-45º

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21
Q

what are normal values for hip IR?

A

0-45º

22
Q

what is the capsular pattern at the hip?

A

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

23
Q

what is a positive scour test/ quadrant test?

A

pain, grinding, catching or crepitation in the hip- concern for intra-articular pathology (OA, labral pathology, osteochondral defect, or osteonecrosis)

24
Q

how is the scour test/quadrant test perfromed?

A

patient supine. PT flex to 90º and IR/add, then flex ER/add

25
Q

what is the anterior labral tear test (FADIR) for?

A

the examination of the femoracetabular impingement syndrome or an anterior labral tear

26
Q

how is the anterior labral tear test performed?

A

patient supine, flexion, adduction, internal rotation

27
Q

what is important to remember with FABER test/Patrick’s test/Figure-four?

A

compare bilaterally for ROM and pain (with overpressure)
can be used as a comparable sign

28
Q

if a patient has decreased ROM with FABER test what is it indicative of?

A

hypomobile SI or hip joint, or tight adductors/hip flexors

29
Q

if a patient reports pain with FABER test what is it indicative of?

A

PSIS/buttocks- SI/lumbar spine pathology
GT/thigh- intra-articular hip joint pathology
knee- meniscal pathology

30
Q

how is FABER test performed?

A

patient supine, flexion, abduction, ER

31
Q

how many zones are there in the flexion-adduction test?

A

3

32
Q

in a normal population what zone should a patient be able to adduct to in the flexion-adduction test?

A

1

33
Q

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?

A

children: legg-calve-perthes disease and SCFE
adults: sinister pathology like fracture, cancer

34
Q

what 3 muscles are being tested in the thomas test (3 muscle kendall test)?

A

iliopsoas: hip flex, and hip ER
rectus femoris: hip flex, and knee extension
TFL/ITB: hip flex, and hip abduction

35
Q

during ober test what is indicative of a tight ITB?

A

< 10º hip add

36
Q

for craig’s test what defines femoral anteversion?

A

more than 15º

37
Q

for craig’s test what defines femoral retroversion?

A

less than 8º

38
Q

what movements are assessed with MMT?

A

flexion/extension/abduction/adduction/ IR/ER of hip
flexion and extension of knee

39
Q

what does a positive trendelenburg test indicate?

A

organic hip abductor weakness
hip compression load intolerance (hip OA or labral tear)
trohchanteric bursitis/ iliotibial band syndrome
S1 myotome involvement

40
Q

what does the patellar-pubic percussion test test for?

A

fracture of hip

41
Q

how is the patellar-pubic percussion test performed?

A

tap patella or use tuning fork- asses qualitatively the sound bilaterally

42
Q

what is a positive patellar-pubic percussion test?

A

diminished percussion note on side of pain

43
Q

what is a negative patellar-pubic percussion test?

A

no difference bilaterally

44
Q

what is the FAIR test?

A

60º hip flexion
90º knee flexion
hip add to table
passive IR of hip to end range

45
Q

what is a positive FAIR test?

A

pain at intersection of sciatic nerve and piriformis

46
Q

what is the open pack position of the hip?

A

30º flex, 30º abd, slight (5º) ER

47
Q

what is the closed pack position of the hip?

A

max extension
max IR

48
Q

what joint play/accessory motion are we testing at the hip?

A

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

49
Q

what can we palpate on the hip in the anterior/lateral aspect?

A

ASIS/AIIS
iliac crest
greater trochanter
inguinal ligament
muscles: flexors/adductors/abductors

50
Q

what can we palpate on the hip in the posterior aspect?

A

ischial tuberosities/PSIS

51
Q

what are some activity limitation and participation restriction measures we can test?

A

6 minute walk test
self-paced walk test (20-m)
stair measure (9 stairs)
timed-up and go test (3-m)

musculo (19 decks)

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