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מס > Hip Testing: Active, Passive, Resistive, Mobility > Flashcards

Hip Testing: Active, Passive, Resistive, Mobility Flashcards

1
Q

Active Movement Testing

  • Supine
  • Prone
A 
Supine:
1. Active Hip Flexion with flexed knee
2. Active ER (roll out)
3. Active IR (roll in)
4. Active Abduction
5. Active Addiction
Prone:
6. Active hip extension with flexed knee
7. active IR with flexed knee
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2
Q

Passive Movement Testing

  • supine
  • prone
A 
Supine:
1. Passive Hip Flexion with flexed knee
2. Passive ER (roll out)
3. Passive IR (roll in)
4. Passive Abduction
5. Passive Addiction
Prone:
6. Passive hip extension with flexed knee
7. Passive IR with flexed knee
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3
Q

What is the Capsular Pattern For the Hip?

Edit it add in flexion

Also look up 30-30-er

A 
IR
Extension from 0
Abduction 
flexion
ER
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4
Q

Resisted Movement Testing

  • position of patient
  • type of testing
  • what we say
  • motions
A
  • patient in supine in the resting position (30-30-ER) to put noncontractile tissues on slack
  • isometric
  • “dont let me push you” (then you push to make them do this isometrically)
    8. Hip flexion
    9. Hip extension
    10. Hip abduction
    11. Hip abduction
    12. Hip ER
    13. Hip IR
    14. Knee Flexion
    15. Knee Extention
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5
Q

Mobility Testing (3)

A
  1. Longitudinal Distraction
  2. Lateral Distraction
  3. Ventral Distraction
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6
Q

Mobility Testing

Longitudinal Distraction

  • what is it
  • position
  • set up
  • mobilization
  • direction
A

inferior separation of femoral head from acetabulum, implication for hypomobility overall loss of movement (dont do if OA)

  • position: supine, resting position
  • set up: stabilize pelvis with aide or strap
  • mobilization: hands at distal thigh or ankle and distract in caudad/distal direction by shifting weight back
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7
Q

Mobility Testing

Lateral Distraction

  • what is it
  • position
  • set up
  • mobilization
  • direction
A

it is a distraction or glide laterally to take the femoral head out of the acetabulum, implication for hypomobility overall loss of movement

  • position: supine, resting position
  • set up: stabilize pelvis with aide or strap
  • mobilization: hands at proximal medial thigh with my ulnar border as close to the inguinal crease as possible. stand at pt side and pull back laterally.
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8
Q

Mobility Testing

Ventral Distraction

  • what is it
  • position
  • set up
  • mobilization
  • direction
A

anterior glide of the femoral head. implication for hypomobility: tight hip extension

-position: prone, trunkand pelvis on tx table
set up: do not need to stabilize in this position
mobilization: pt can have trunk/pelvis on tx table and other leg on floor, PT holds distal femur (knee in flexion) and other hand at proximal posterior of thigh close to the gluteal crease.
direction: push anteriorly: femur glides anteriorly in the acetabulum

FOR TIGHT EXTENSION

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9
Q

Tx of painful hip is direction dependent: T/F

A

it is not direction dependent (for tx of a stiff joint we do care about direction)

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10
Q

appropriate interventions:
1. pain before resistance: AROM limited more than 50% due to pain

  1. pain decreases
  2. pain decreases and ROM increases more than 50% range
  3. full range, no pain
  4. Resistance before pain
A
  1. grade 1 oscillation (then re-evaluate ROM)
  2. increase amplitude and repetitions (increase number of bouts of oscillations and increase the amt of movement that takes place in the joint within a pain free range)
  3. increase amplitude to grade 2 short of pain and do physiological movements as well
  4. now pain and resistance is at the same time so if it is a hard end feel it can only be grade 2 oscillations short of pain to reduce pain – if it is a capsular end feel we can stretch the joint capsule and use grade 3 or 4 to stretch to the end of the anatomical range into realm of pain only in subacute and chronic phase
  5. grade 3/4
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11
Q

Tx of Hip Pain (5)

A
  1. Anterior-Posterior Technique (hand is posterior to greater trochanter) [side]
  2. Longitudinal (hand is superior to greater trochanter) [side]
  3. Medial-Lateral (supine)
  4. Caudad/Distal (supine)
  5. Cephalic/Proximal (supine)
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12
Q 
Tx of Painful Hip
Anteror-Posterior
-Rationale: 
-Position:
-Motion: 
-Grade:
A

-Rationale: pain relief
-Position: side lie, resting position (pillow btwn legs)
-Motion: thumbs posterior to greater trochanter with hands on thigh
-Movement: oscillation at a steady state, 1-2 per second for 20 seconds
-Grade: Grade 1 and 2
(of pushing a flys back you wouldnt bend his knees)

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13
Q 
Tx of Painful Hip
Longitudinal
-Rationale: 
-Position:
-Motion: 
-Grade:
A
  • Rationale: pain relief
  • Position: sidelie, pillow btwn legs, resting position
  • Motion: therapists thumbs superior to greater trochanter (stand above greater trochanter at an angle)
  • movement: superior to inferior direction along length of femur longitudinally
  • Grade: Grade 1 and Grade 2
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14
Q 
Tx of Painful Hip
Medial-Lateral
-Rationale: 
-Position:
-Motion: 
-Grade:
A
  • Rationale: pain relief [since not at hip, good for post surgery]
  • Position: supine, resting position, pillow under knees
  • Motion: therapist hands on distal femur and proximal tibia
  • Movement: medial to lateral (looks like IR)
  • Grade: 1 and 2
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15
Q 
Tx of Painful Hip
Caudad/Distal
-Rationale: 
-Position:
-Motion: 
-Grade:
A
  • Rationale: pain relief
  • Position: supine, resting position, pillow under knees
  • Motion: hands on distal femur
  • Movement: caudal/distal direction (you should feel the femoral condyles, it is similar to the distraction)
  • Grade: 1 and 2
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16
Q 
Tx of Painful Hip
Cephalic/Proximal
-Rationale: 
-Position:
-Motion: 
-Grade:
A
  • Rationale: pain relief [good for patients with pain at heel strike and WB on full leg hurts hip]
  • Position: supine, resting position, pillow under knees
  • Motion: hands on distal femur and proximal tibia
  • Movement: cephalic/proximal (do not just slide soft tissue)
  • Grade: 1 and 2
  • can also be done at tibia
  • grade 3 and 4 for weight bearing
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17
Q

Tx of Stiff Hip (4)

A
  1. Longitudinal Distraction Mobilization (restricted flexion)
  2. Lateral Traction Mobilization (restricted flexion/extension)
  3. Dorsal Glide Mobilization (restricted end of flexion)
  4. Internal Rotation Mobilization (grade 2 to calm, 3/4 to increase range)
18
Q

Tx of Stiff Hip
Longitudinal Distraction Mobilization

Rationale:

  • Position:
  • Motion:
  • Movement:
  • Grade:
A

Rationale: restricted flexion (it is an inferior glide and reaches the capsule’s posterior)

  • Position: supine, stabilize pelvis, hip flexed 90 degrees
  • Motion:
  • ——–hands around proximal hip (or strap around hip and therapist waist) with ulnar border at groin,
  • ——–option to put leg over my shoulder or flex their knee and wrap our hands around that
  • Movement: shift my weight backwards for
  • Grade: 3 or 4 (oscillations or sustained stretch)
19
Q

Tx of Stiff Hip
Lateral Distraction Mobilization

Rationale:

  • Position:
  • Motion:
  • Movement:
  • Grade:
A

Rationale: restricted flexion or extension

  • Position: supine with hip near end range of flexion/extension
  • Motion: hands around proximal medial thigh (medial groin near adductor tendon)–calf can be over my shoulder. can use a strap to pull his leg for the sustained stretch.
  • Movement: lateral distraction-shift weight backwards in the lateral direction
  • Grade: 3 or 4
20
Q

Tx of Stiff Hip
Dorsal Glide Mobilization

Rationale:

  • Position:
  • Motion:
  • Movement:
  • Grade:
A

Rationale: restricted hip flexion [at the end of the range, only used in treatment not in testing] (do not push on the patella)

  • Position: supine, hip near end of the flexion range, pelvis stabilized to the tx table
  • Motion: hold patients leg against your body and shift weight
  • Movement: push (down) longitudinally along the femur (at femoral condyles) in the posterior direction to stretch the posterior of the capsule
  • Grade:
21
Q

Tx of Stiff Hip
Internal Rotation Mobilization

Rationale:

  • Position:
  • Motion:
  • Movement:
  • Grade:
A

Rationale: physiological movement to increase IR
-Position: prone, hip extended and knee flexed
-Motion: create a barrier so as not to go past IR of hip limit
-Movement:
-Grade:
Grade 2: to calm the joint at the end of a tx session
Grade 3/4: to increase physiological IR by stretching the external rotators (it would b good to do lateral distraction first)

22
Q

FABERE Test (Patrick Test): Flexion, Abduction, External Rotation, Extension

  • rationale
  • position
  • possible findings (2)
A
  • Rationale: differentiate between hip joint and sacroiliac joint pain
  • Patient is put into a figure of four position, Place one hand on the pelvis and the other hand on the distal femur and create an opening
    1. If figure of four hurts we suspect the hip
    2. If one hand on the pelvis with the other on the knee, putting pressure on the pelvis makes the pain more intense we suspect the SI joint
23
Q

Trendelenberg Test

A

test the gluteus medius on the stance side: positive finding is pelvis drops on the other side
–Patient stands on the test leg and raises the other leg off the ground-and the pelvis on the non weight bearing side should tilt upward. The test is abnormal if the pelvis drops on the non weight bearing side.

24
Q

Leg Length Discrepency

A

–True leg length: measure from ASIS to the medial malleolus on the same side (Xray is the only true measurement – measure it on the film)

If the pelvis rotates it will give us a functional change in the leg length which is why this is apparent leg length and not true leg length

–Apparent leg length: measure from umbilicus to medial malleolus

25
Q

Elys Test

A
  • -Rectus femoris tightness
  • -Patient in supine and legs hang off the table. The good leg is flexed to the chest while the other leg hangs off the table. If the knee extends it is a sign of tightness in the rec fem.

(because flexion of the opposite leg rotates the pelvis posteriorly pulling the rectus femoris)
(some people do a prone knee bend test)

26
Q

Thomas Test

A

–Sit at edge of table and table up to buttocks and upper thigh and lie back down.
–Take both knees to their chest.
Person holds their R knee, bring the left leg down and see if it can make contact with the table.
–If it doesn’t come down: there is tightness in the illiopsoas
Now we straighten the knee. If the extended knee is able to drop down then we know there is tightness in the rectus femoris because there is now less stretch on the rectus femoris and so the hip was able to drop down when it is cancelled out. (If the hip stays up then it is only the illiopsoas that is tight.)
–If he abducts hip then tight TFL

27
Q

Ober Test

A

–Patient lays on their side and flexes the bottom leg for stability: Abduct and extend the upper leg with knee flexed to 90, Stabilize pelvis from anteriorly tilting, Slowly lower the upper limb.
Cradle leg that you’re testing, abduct and extend bring it back to a neutral position or slightly extended. Want to see that person goes further than neutral position.
—Positive: TFL tight if they do not adduct to neutral or if drift into hip flexion when you do it.

28
Q

Ortolani Click

A

tests for congenitally dislocated hip: put leg in flexion and ER, and as bring the leg to extension and ER, the femoral head slips out over the acetabular ridge and creates a click sound because it is dislocating out and comes back in (doctor does this test usually)

29
Q

Telescoping

A

test for congenitally dislocated hip: similar to the longitudinal distraction you hold onto the distal femur and the leg gets longer as you pull it down and it comes out of the acetabulum.

30
Q

Test for Fracture of hip or femur

A

—Place patient in supine and place the stethoscope over the pubis symphesis
–Tap the patella on the symptomatic side and repeat on the asymptomatic side (can do a finger tap, a reflex hammer, or a tuning fork)
–Positive finding: difference in auscultation between sides
because the fracture will disrupt the travel of the sound and the sound will get diminished
–Note: this is not the gold standard for fracture, if suspect a fracture send for xray (also if had a fracture and you touch it they will jump)

31
Q

Noble Compression Test

A
  • -Rationale: implication of the IT band (ITB friction syndrome where the band gets irritated with movement often in runners)
  • —Position: Patient is supine, Flex hip with knee flexed to 90 degrees, Apply pressure with thumb to lateral femoral condyle (distal attachment of the IT band), maintain pressure while patient extends knee
  • —Positive finding: pain over the lateral femoral condyle at 30 degrees (it is a tender area, but the positive finding is a reproduction of the symptoms)
32
Q

Craigs Test

A

Rationale: to measure the degree of anteversion of the femur (the angle that the head and neck of the femur make with the perpendicular to the condyles is the angle of anteversion, if it is more than 15 degrees then it is excess toe in

—Normal: 8-15 degrees. If above 15 degrees it is an anteverted hip and toed in (IR). If it is less than 8 degrees then it is a retroverted hip and toe out (ER).

  • Patient is in prone with the knee flexed to 90 degrees.
  • Find the greater trochanter by IR/ER the femur and put the trochanter in the most lateral position, want the top of the greater trochanter to be lateral to the table.
  • Use the goniometer to measure the angle of anteversion between the leg and the vertical
    1. Pivot: at the
    2. Stationary Arm: along the vertical
    3. Moving Arm: along the tibia
33
Q

Test For Hip LAbrum Tear or DJD

A

scour test is done for pt who has pain in sitting, click/popping in gait, click in PROM

34
Q

Hip Scour Test

A

quadrant test” because it uses a combination of movements. It can implicate labral tears and it is 75% sensitivity.
( If it is clear with no pain it is thought you can clear the TFL, Sartorius, illiopsoas muscle and bursa, pectinius, adductor and femoral neck)
-Patient in supine
-Flex hip and knee and load through the knee/femoral condyles and also compress into the hip joint in an arc going from IR to ER (similar position to the posterior glide)
–Positive finding: pain or apprehension
(This test for labral tear can also test for arthritis: does not give a good delineation between the two but does tell you something is going on within the capsule.)

35
Q

Anterior Labral Test

A

anterior labral tears are more common than posterior labral tears
(FADDIR Test: flexion, adduction, internal rotation)
–Patient in supine, Starting position is full hip flexion, external rotation, and abduction→ending position is extension, internal rotation and adduction
—This is stressful on anterior aspect of the hip
—Positive finding: If labrum is torn there will be pain with or without a click (a reproduction of the patients symptoms)

36
Q

Posterior Hip Labrum Test

A
  • -Patient is positioned in prone
  • -Move the painful hip into just short of full extension, apply ER and Extension force (note that temptation is to put them into IR when you put them into full extension but we want ER)
  • -Positive Finding: pain
37
Q

sign of the buttock

A

passive movement testing

  1. Limited SLR
  2. Limited Hip Flexion with Knee Flexed
  3. Non Capsular Pattern at the Hip (capsular is IR, Extension from 0, Abduction, flexion and ER)
38
Q

children conditions that get capsular pattern (7)

A
  1. perthes (cause AVN femoral head)
  2. TB of hip
  3. SCFE
  4. Synovitis (cannot WB on it)
  5. Coxa Cara (deforms alignment)
  6. Hemophelia (bleed into joint)
  7. Congenital Dislocation (hip dysplasia)
39
Q

Adult conditions that get capsular pattern (7)

A
  1. OA
  2. loose body sometimes
  3. RA
  4. ankylosing spondylitis (inflammatory)
  5. Ostetis Deformans/Pagets disease (bones become enlarged and get arthritis)
  6. acetabular protrusion (laterally is diplaced, loses depth)
  7. synovitis (also in children)
40
Q 
reasons to have sign of buttock
(7)
-limited SLR
-limited hip with knee flexion
-non capsular pattern
A
  1. osteomyelitis of upper femur
  2. septic SI arthritis
  3. ischiorectal abscesss
  4. septic bursitis
  5. neoplasm of upper femur
  6. iliac neoplasm
  7. fx of sacrum

מס (7 decks)

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