Lecture 5: Hip

Question 1

3 joints of the hip

Answer 1

sacroiliac
Hip Joint - femoral acetabular
pubic symphysis

Question 2

Ligaments of the sacroiliac joint

Answer 2

Anterior longitudinal lig
Iliolumbar (from the iliac bone to L4)
Anterior sacroiliac lig (from the sacrum to the iliac bone)
Sacrospinous (from the sacrum to the ischial spine)
Sacrotuberosus (from the sacrum to the ischial tuberosity)
Supraspinous lig
Posterior sacroiliac lig

Question 3

Ligaments of the hip

Answer 3

Iliofemoral
Ischiofemoral
Pubofemoral

Question 4

What is the strongest ligament of the hip

Answer 4

Iliofemoral

Question 5

What movement does the iliofemoral ligament prevent

Answer 5

Extension and External Rotation

Question 6

What movement does the Ischiofemoral ligament prevent

Answer 6

Adduction and internal rotation

Question 7

What movement does the pubofemoral ligament prevent

Answer 7

Abduction and Extension

Question 8

What prevents/limits hip flexion

Answer 8

No ligament for flexion: mostly joint capsule and soft tissue limits flexion

Question 9

Causes of anterior hip pain

Answer 9

Labral tear
Femoroacetabular impingement (FAI)
OA
Ligament tear
Muscle strain – iliopsoas, adductors

Question 10

Causes of lateral hip pain

Answer 10

Gluteal tendinopathy: worsens with activity
Gluteus medius bursitis: pain over trochanter

Question 11

Causes of posterior hip pain

Answer 11

Sacroiliac joint dysfunction
Referred pain from lumbar spine
Posterior labral tear

Question 12

ROM of the Hip

Answer 12

Flexion: 110-120
Extension: 10-15
Abduction: 30-50
Adduction: 25-30
External Rotation: 40-60
Internal Rotation: 30-40

Question 13

Tests for FAI and labral tear

Answer 13

FADDIR
Anterior and Posterior labral test

Question 14

Test for sacroiliac joint dysfunction

Answer 14

FABER
Cluster of Laslett

Question 15

Test for deep gluteal/piriformis syndrome

Answer 15

FAIR test

Question 16

Test for gluteal tendinopathy

Answer 16

Adduction test
Greater Trochanter palpation
Single leg stance

Question 17

Test of tight ITB

Answer 17

Ober’s test

Question 18

Test for iliopsoas tightness

Answer 18

Thomas test

Question 19

Test for rec fem contracture

Answer 19

Ely’s test
90/90 straight leg raise

Question 20

Hip OA diagnosis

Answer 20

Following criteria should be used to classify adults over the age of 50 with hip OA
- Moderate anterior or lateral hip pain during WB activities
- Morning stiffness less than 1 hour in duration after wakening
- Hip internal rotation range of motion less than 24 degrees or internal rotation and hip flexion 15 degrees less than non painful side, and/or increased hip pain associated with passive hip internal rotation

Radiographic evidence: joint space narrowing, marginal osteophytes, subchondral sclerosis and bone cysts

• Age >45
• Pain on palpation over the ligamentum inguinale
• Reduced ER
• Reduced IR
• Reduced ADD
• Loss of abduction muscle strength
• High WOMAC score
• Activity related pain
• Has either no morning joint related stiffness or morning stiffness that lasts no longer than 20 minutes

Question 21

Why does a trendelenburg sign occur

Answer 21

Weak Glute med or unstable hip

Question 22

Sign of positive trendelenburg sign

Answer 22

stand on one leg. Positive if the pelvis on the non-stance side drops when the patient stands on the affected leg

Question 23

Diagnosis of Gluteal tendinopathy

Answer 23

• Pain and tenderness primarily at the greater trochanter
• Pain is frequently insidious, tends to worsen over time and is sometimes associated with changes in training load or physical activity
• Contralateral pelvic drop and dynamic valgus can be indicative of weak glute medius
• Lateral hip pain
• Single leg stand for 30 seconds
• Positive FABER test
• Greater trochanter palpation
• single leg stance test
• Positive Adduction test

Question 24

FAI diagnosis

Answer 24

• Moderate to marked hip or groin pain related to certain movements or positions
• Pain reported in the thigh, back or buttock
• Stiffness
• Restricted hip ROM
• Clicking and/or catching
• Locking or giving way
• Decreased ability to perform activities of daily living and sports
• Pain exacerbates into end of range hip flexion
• Positive FADIR test
• Reproduction of pain with hip flexion
• Assessment of ascending and descending stairs
• There needs to be symptoms to be diagnosed with FAI

Question 25

Labral tear diagnosis

Answer 25

• A constant dull pain with periods of sharp pain that worsens during activity. Walking, pivoting, prolonged sitting and impact activities aggravate symptoms
• Some patients describe night pain
• A variety of mechanical symptoms have been reported, including clicking, locking or catching
• ROM is usually not restricted however at extremes, invokes pain
  o These specific movements may cause pain the groin
• Flexion, adduction and internal rotation (FADDIR) of the hip joint are related to anterior superior tears
• Passive hyperextension, abduction and external rotation are related to posterior tears (postural labral test)
• FADIR, FABER, Anterior and Posterior labral test

Question 26

4 steps for Cluster of Laslett

Answer 26

Distraction
Compression
Thigh thrust
Sacral thrust
(2 positive)