MSK - the hip

Question 1

Name and describe 3 common arthrogenic hypotheses of the hip

Answer 1

1. Fracture red flag
   - mixed mechanism
   - age 3-14 and older age (osteoporosis)
   - deep, progressive pain
2. OA
   - insidious mechanism
   - common in over 55
   - deep ache, C-sign
3. Ligamentous/ intra-articular
   - traumatic episode or insidious with activity
   - under age 40
   - gives way, high level of pain, worse after activity

Question 2

What is a common arthrogenic/myogenic combo hypothesis and describe it

Answer 2

1. Deep gluteal pain syndrome
   - insidious/traumatic
   - over 40, women>men
   - ache after activity and at night

Question 3

Name and describe a common myogenic hypothesis of the hip

Answer 3

1. Tendonitis
   - caused by over-load
   - normally under 55
   - sharp pain with activity and post activity

Question 4

Name and describe a common neurogenic hypothesis of the hip

Answer 4

1. Lumbar spine vascular red flag
   - lower back pain
   - common in middle age
   - numbness and associated leg pain

Question 5

Name and describe 4 red flag arthrogenic conditions

Answer 5

1. Fracture
   - traumatic, insufficiency (osteoporosis),
   - high risk in smokers, females and steroid users
   - pain worse with activity
2. Septic arthritis
   - acute, atraumatic onset, progressive
   - high risk > 80, diabetes, THR, TKR
   - pain with leg movement
   - surgical emergency
3. Slipped capital femoral epiphysis
   - 11-14 year olds and high BMI
   - deep pain, aggravated with weight bearing
4. Perthes (children) / Osteonecrosis (adults)
   - death of femoral head due to insufficent vascular supply
   - pain usually insidious, deep pain aggravated with weight bearing
   - gradual loss of ROM

Question 6

What specific questions would you ask for the hip?

Answer 6

Have you experienced any problems with this area before?
Locking or catching
Pain when laying on side
Unable to put shoes on?

Question 7

What would you include in the observation section of an objective assessment of the hip?

Answer 7

• Weight-bearing
• Muscle bulk
• Posture
• Leg length differences
• Trendelenburg test - The patient is asked to stand on one leg for 30 seconds without leaning to one side the patient can hold onto something if balance is an issue. tests for weakness of the hip abductors

Question 8

What would you include in the observation section of an objective assessment of the hip?

Answer 8

1. Prone/posterior
   - lumbar spine
   - PSIS
   - base of sacrum to ischial tuberosity
2. Lateral
   - greater trochanter - palpate large circles around
3. Anterior
   - low abdomen
   - vascular pulses - between ASIS and pubis bone
   - hip joint line

Question 9

What would you observe from the observation and palpation if the patient had a fracture?

Answer 9

• decreased weight-bearing and a limp

- pain to palpation, deformity, assymetry, warmth

Question 10

What would you observe from the observation and palpation if the patient had OA?

Answer 10

• positive Trendelenburg test, C-sign pain

- joint line pain

Question 11

What would you observe from the observation and palpation if the patient had a ligamentous/intra-articular pathology?

Answer 11

• variable observation

- clicking, groin pain

Question 12

What would you observe from the observation and palpation if the patient had deep gluteal pain syndrome?

Answer 12

• positive Trendelenburg test

- pain to palpation

Question 13

What would you observe from the observation and palpation if the patient had tendinotis/opathy?

Answer 13

• stiff on 1st movement

- pain local to area

Question 14

What would you observe from the observation and palpation if the patient had lumbar spine pathology?

Answer 14

• LSp guarding

- pulses

Question 15

Name some arthrogenic tests

Answer 15

1. Log roll
2. FABER - flexion, abduction. external rotation
3. FADDIR - flexion, adduction. internal rotation