L1 Hip Intro Flashcards
Resting position of hip joint
least tension on capsule and ligaments
30° of flexion, 30° of abduction, slight ER
Closed pack position of hip
full extension, IR, and abduction
causes most amount of tension/stability within ligaments
Capsular pattern of hip
flexion, abduction, IR
Most congruent position of hip
flexion, abduction, ER
Flexion norm of hip
120°
Extension norm of hip
15-20°
Abduction norm of hip
40°
Adduction norm of hip
30°
External Rotation norm of hip
30-60°
Internal Rotation norm of hip
30-45°
What action produces the most force on the hip?
Running
Walking up stairs causes more than just walking
Legg-Calve Perthes age/sex
3-12 y/o
boys > girls
Slipped Capital Femoral Epiphysis age/sex
11-13 girls, 13-15 y/o boys
Labral lesions age
18-40 y/o
Femoral/pelvic stress fractures age/sex
Young, female
Osteoid osteoma age/sex
5-25 y/o, 2:1 M vs F
Hip Osteoarthritis age/sex
> 50 y/o
Gluteal Tendinopathy age/sex
> 40 y/o, female
Synovial Chondromatosis age/sex
30-50 y/o, 2:1 M vs F
Colon Cancer Red Flags
> 50 y/o, rectal bleeding, black stool, weight loss, family hx, pain not relieved with position changes
Pathological Fx of Femoral Neck Red Flags
female >70 y/o, hip/groin/thigh pain, history of all from standing, severe/constant pain that is worse with any movement, shortened and externally rotated LE
AVN of femoral head Red Flags
long term steroid use, alcohol abuse, trauma, hx of AVN on opposite side, gradual onset of pain, use of glucocorticoids
Inguinal hernia red flags
-new lump in groin or other abdominal area
-may ache, non-tender to palpation
-increases in size with standing and coughing
-usually reducible by posture or manual
Irreducible hernia red flags
bowel obstruction, nausea, vomiting, appears ill, fever
need to refer to ER immediately
When to refer (red flag S/S)
trauma
inability/unwillingness to bear weight
severely antalgic gait
observed deformity
pain not relieved with rest
systemic/constitutional symptoms
Systemic S/S
disturbs sleep
deep aching or throbbing
reduced by pressure
constant or waves of pain/spasm
not aggravated by mechanical stress
Mechanical S/S
generally lessens at night
sharp or superficial ache
usually decreases with cessation activity
aggravated by mechanical stress
Snapping sensation
extra-articular
low pitched and feels deep
IT band moving over the greater trochanter and iliopsoas moving over underlying bony prominences
Clicking/popping
intra-articular
high pitched sound
indicates labral tears, ligamentum teres tears, loose bodies, general instability
Giving way/giving out/weakness indicates
instability, fracture, pain inhibition
Observation for Hip
Gait
Posture
Transfers
Lumbar Clearing Tests
AROM = flexion, extension, lateral flexion, lumbar extension
Important with lumbar clearing
- Overpressure should not be applied in the case of acute/severe pain OR if AROM and/or repeated movements produced symptoms
- Repeated movement testing not needed for quadrant testing (extension)
Bony end feel
bone spur/OA, stops before normal ROM
Soft capsular end feel
soft tissue edema
Springy end feel
rebound movement, torn meniscus
Empty end feel
pain before mechanical limitation, acute fracture
Spasticity end feel
upper motor neuron lesion
Squat test
feet shoulder width apart, as deep as they can go
SN = .75
SP = .41
Patrick’s Test (FABER)
patient is supine
PT stabilizes contralateral ASIS
foot of limb to be tested placed just proximal to opposite patella
testing limb overpressured into abduction/ER
positive if it recreates their anterior/groin pain
SN = .57, SP = .71, +LR = 1.9
FADIR Test
passively flex, adduct, and IR to end range
psoitive if it recreates their symptoms
indicative of FAI
SN = .78, SP = .10, -LR. =2.3
