Lecture 10: Approach to Hip Complaint

Question 1

What is an early symptom of hip disease?

Answer 1

difficulty putting on shoes

1st lose: external rotation, then abduction/adduction, then flexion

Question 2

What are the most common conditions affecting the hip?

Answer 2

• trochanteric/gluteus medius bursitis
• osteoarthritis
• fractures of the femur

Question 3

Hip Flexion and associated nerves

Answer 3

Iliopsoas M.

• Femoral N (L2-L4) and ventral lumbar rami (L1/L2)

Question 4

Hip Extension and associated nerves

Answer 4

Gluteus Maximus M.

• Inferior Gluteal N (L5-S2)

Question 5

Hip ABduction and associated nerves

Answer 5

• Gluteus Medius/Minimus M.

- Superior Gluteal N (L5/S1)

Question 6

Hip ADduction and associated nerves

Answer 6

• Adductor Longus M.

- Obturator N (L2-L4)

Question 7

Labral Loading and Distracting

Answer 7

• L: load flexed knee/hip into femur
• D: distract femur AWAY from innominate

positive = pain (Distract: improvement of pain)

indicates: labral/cartilaginous pathology

Question 8

Scour Test

Answer 8

• flex/externally rotate patients hip and load/articulate through annular range of motion

positive = pain

indicates: labral/articular cartilage pathology

Question 9

Apprehension: FABER (1/3)

Answer 9

• posterior force on flexed, abducted, externally rotated knee –> induce further external rotation

positive = anterior subluxation of hip or apprehension/pain

indicates: labral pathology

Question 10

Central Compartment Special Tests (4)

Answer 10

1. Labral Loading
2. Labral Distraction
3. Scour
4. Apprehension: FABER (1/3)

Question 11

Peripheral Compartment Special Test

Answer 11

Rectus Femoris Test

Question 12

Rectus Femoris Test

Answer 12

• patient holding one knee, lets other drop to table (supine)
• positive = knee flexion < 90 degrees
  indicates: rectus femoris contraction

Question 13

Lateral Compartment Special Tests (5)

Answer 13

1. PACE/FAIR Test
2. Jump Sign
3. Straight Leg Raise Test
4. Piriformis Test
5. Patrick’s: FABER (2 of 3)

Question 14

PACE/FAIR Test

Answer 14

• supine w/knees and hips flexed
• patient abducts/externally rotates against physician

Positive = pain/reproduction of symptoms

Indicates: piriformis pathology

Question 15

Jump Sign

Answer 15

• seated, pressure to greater trochanter

Positive = withdraw or jump with pressure

Indicates: Trochanteric Bursitis

Question 16

Straight Leg Raise Test

Answer 16

• supine, passively flex patients hip w/knee extended

Positive = pain over lateral leg (> 15 degrees)

Indicates:

1. 30-60 degrees: sciatic neuropathy
2. > 70 degrees: mechanical lower back pain

Question 17

Piriformis Test

Answer 17

• supine w/knee and hip flexed against contra knee
• patient aBducts against resistance
• Positive: pain over posterior aspect of greater trochanter

Indicates: piriformis spasm/pathology

Question 18

Patrick’s FABER (2 of 3)

Answer 18

• patient hip flex, abducted, externally rotated
• brace contralateral ASIS, patient externally rotates/abducts against resistance

Positive = pain/weakness

Indicates: Gluteus Medius pathology

Question 19

Anterior/Iliopsoas Compartment Special Tests (2)

Answer 19

1. Patrick’s: FABER (3 of 3)

2. Thomas Test

Question 20

Patrick’s: FABER (3 of 3) test

Answer 20

• patient hip flexed, abducted, externally rotated
• brace contralateral ASIS
• patient internally rotates/adducts against resistance

Positive = ant/med groin pain/weakness

Indicates: iliopsoas insufficiency or pathology

Question 21

Thomas Test

Answer 21

• supine, pull knees to chest
• lower one leg = test flexibility of hip flexors

Positive = inability to fully extend/extended leg raises off table

Indicates: hip flexor contraction