NMS 3: Hip Flashcards by Gabriel Zeigler

Forces acting across hip joint

Body weight, abductor muscles force, joint reaction force

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Abductors

Gluteus minimus/medius, TFL

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Hip Fracture

-Elderly
-Unable to bear weight (not always)
-History of fall on hip (95%)
-Most commonly caused by: Osteoporosis
-350,000 cases per year
-81% of cases are >75 years old
-Women experience 3/4 of all hip fractures (fall more, more often have osteoporosis-hormonal)

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Types of Hip Fracture

-Intracapsular: twice as common/more likely to develop complications
-Extracapsular: Refer out

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Stress Fractures

-Cause: Repetitive Stress
-Young and Active/Pain worse with weight bearing/anterior and deep

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Types of Stress Fracture

-Transverse: Potentially unstable; superior cortex
-Compression: Stable/Rest and elastic support for 2 weeks, then non-weight bearing exercise for 4-6 weeks; inferior cortex

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Congenital Hip Dislocation

-Newborn or child prior to walking-sometimes missed and presents as a non-painful limp
-Cause: Acetabular deformities and capsular tightness
-Evaulation: Ortolani’s Click test and Barlow
-May appear normal until 4-6 weeks of age

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Barlow Maneuver

Push the hip down and out, positive test will have the hip pop out

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Ortolani Maneuver

Meant to push the hip back into place

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Treatment of Hip Dislocation

-Pavlik Harness for infants to 6 months
-6-15 months-Spica Cast
-Surgery

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Traumatic Hip Dislocations

-Posterior: 90% of sports-related hip dislocations, forced in into a flexed/abducted hip
-Anterior: Forced into an extended/externally rotated leg
-Management: Relocation under anesthesia; rest and gradual return to non-weightbearing (not done in chiro office)

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Slipped Capital Epiphysis

-Most common hip condition in adolescents
-Overweight child OR rapidly growing adolescent with traumatic history
-Acute or chronic slippage
-May only present as knee pain
-Causes: Traumatic (50%), hormonal or in fast-growing adolescents

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Legg-Calve-Perthes Disease

-Male predominace of 4 or 5:1
-80% between 4-9 yeats
-Mid hip pain and associated limp with insidious onset
-Cause: Disruption of the vascular supply of femoral head, avascular necrosis-steroid use, alcoholism, pancreatitis…
-Evaluation: Positive Trendelenburg…
-Management: Monitor/Conservative care for 18 months, PT/Traction, Surgery (Femoral/Acetabular osteotomy with internal fixation)

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Trochanteric Bursitis

-40-60 years
-Subgluteus medius: Superior to greater troachanter
-Subgluteus maximus: Posterior to greater trochanter
-Gluteus minimus: Less often involved
-Well-localized lateral hip pain

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Causes of Trochanteric Bursitis

Anything that alters hip mechanics-LBP, leg length discrepancy, arthritic conditions, surgery, neurologic conditions with paresis

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Management of Trochanteric Bursitis

-Correction of abnormal biomechanics and appropriate adjustments, stretching of hip abductors, anti-inflammatory…

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Iliopectineal & Iliopsoas Bursitis

-Severe, acute anterior hip pain or groin pain with an antalgic gait
-May radiate down anterior aspect of the leg due to femoral nerve pressure
-May assume position of flexion and external rotation to alleviate pain
-Cause: Hip flexor tightness and repetitive activity

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Evaluation of Iliopectineal & Iliopsoas Bursitis

-Located 1-2cm below middle third of inguinal ligament
-Resisted hip flexion and iliopsoas
-Managment: Myofascial release of iliopsoas

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Ischial bursitis

-Weavers bottom or tailors seat
-Sitting for long periods on hard surfaces
-May have referral down posterior leg mimicking sciatica
-Cause: Direct blow to bursa or prolonged irritation, chronic hamstring strains, occasionally prolonged standing

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Evaluation & Management of Ischial bursitis

Lean toward affected side with accompanying shortened stride length
-Padding/pillow or donut/Avoidance of activity

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Snapping Hip Syndrome

-Hip snapping (many w/o pain)
-If trauma, consider acetabular labrum tear
-Cause: tendons that snap over bony prominences or bursae
-Passes over the femoral head and hip capsule to a more medial position with hip extension

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Snapping Hip Syndrome Evaluation (By location)

-Lateral Hip: IT band snapping at greater trochanter
-Anterior Hip: Iliopsoas tendon or iliofeoral ligament over r joint capsule
-Posterior Hip: Biceps femoris tendon over ischial tuberosity

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Management

Usually benign and position dependent
-Strengthening rather than stretching the involved muscle is often helpful

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Transient Synovitis

-Child <10 years old complains of acute or gradual onset of inguinal pain with difficulty bearing weight
-Often a prior viral infection
-Evaluation: Decreased internal rotation, bone scan, ultrasound may have fluid in the joint
-Management: Non-weight bearing followed by crutch

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Adductor Strain

-Most common strain: Adductor longus -Usually an athlete involved in kicking, sprinting or jumping -Evaulation: Tenderness in adductor muscle group or at pubic attachement/resisted adduction painful -Management: Elastic figure-of-eight strapping with hip in slight extension, gentle stretching

Hamstring Strain

-Sudden pull or pop in posterior thigh after forceful knee extension -Cause: Overcontraction of hamstrings when in a position of stretch, avulsion of ischial apophysis possible in young adults

Hamstring Strain Recovery Timelines

-1st degree strain: within a couple of weeks -2nd degree: 4-6 weeks -3rd degree: 3-4 months -Long-term goal: Re-strengthening when 75% of normal ROM returns -Focus on prevention

Quadriceps Strain

-Sudden pulling pain in anterior thigh after: attempting to sprint, missing a kick, sudden stop -Cause: Sudden contraction of quads; Could be predisposed to tight quads/lack of strethcing, short leg -Evaulation: Pain w/ knee extension, possible rupture -Management: Ice, neoprene or elastic support wrap, crutches, stretching, surgery

Meralgia Paresthetica

-Numbness or tingling in the lateral thing -Compression of the lateral femoral cutaneous nerve at or slightly below inguinal ligament (d/t prolonged sitting, overweight, carries keys in front pockets) -Diabetes -Policeman who wear guns on belts, construction workers, soldiers -Skinny jeans

Meralgia Paresthetica Evaluation

-Mechanical/non-diabetic: Passive hip extension/flexion -Anterolateral thigh area -Management: Diabetic co-management, pregnancy, mechanical/non-diabetic: avoid prolonged sitting, lose weight if factor, empty pockets

Femoroacetabular Impingement

-Deep hip and groin pain in front of hip -Restricted range of hip motion -Can be acute following an injury…

Types of FAI

CAM (thickening of femoral neck) Pincer (thickening/elongation of hip joint)

Causes of FAI

-Injury as youth leading to malformation of hip bones or degenerative process -Possible labral damage that cause extra bone formation -More common in young and middle age patients

FADIR test

Flex hip 90, Adduct hip, Internal Rotation

FAI Treatment

-Adjust, mobilize hip joint, stretch any tight structures, improve soft tissue flexibility and length -Strengthen deep, intermediate, superficial hip muscles -Proprioception -If not, surgery

Hip Pointer

-Impact of attachment point of gluteus maximus -Either a contusion to the iliac creast or from separation of the muscle fibers -Hockey/Football players -Management: Ice, different padding to protect,

Soft Ball

-Can involve unicameral bone cyst

Medial border of the femoral triangle

Adductor longus

Lateral border of femoral triangle

Sartorius

Psoas muscle is deep to the _________ pulse

Femoral

Psoas bursa is deep to _________ to joint capsule fibers

Psoas anterior

Gluteus medius inserts into the _________ portion of the trochanter

Upper lateral

Hip Flexor

Iliopsoas, sartorius, rectus femoris

Hip Extensor

Gluteus maximus, hamstrings

Hip Abductor

Gluteus medius, gluteus minimus, TFL

Hip adductor

Adductor longus, adductor brevis, adductor magnus, pectineus, gracilis

Hip Ext Rotation

Obturator internus, obturator externus, gemelli, quadratus femoris, piriformis

Hip Internal Rotation

Gluteus medius, gluteus minimus, TFL

Hip Flexion ROM

A: 120/P: 140

Hip Extension

A: 15-20/P: 20-30

Hip Abduction ROM

A: 45/P: 50

Hip Adduction

A+P: 20-40 degrees

External Rotation

A+P 40-50 degrees

Internal Rotation

A+P 30-40 degrees

If you suspect a contracture with the iliopsoas muscle the best orthopedic test to use would be _________? A. Patricks Test b. Thomas test c. Obers test d. Phelps test

b. Thomas test

What does Nachlas Test indicate? a. Upper lumber nerve root irritation b. Contracture of IT Band c. Femoral Fracture d. SI lesion or lumbosacral pain

d. SI lesion or lumbosacral pain

A Positive Lewin Gaenslen test indicates? a. Meniscus tear b. SI joint lesion c. Tibial fracture d. Femoral fracture

b. SI joint lesion

What is the proper hand position for Ely Test? a. Opposite hip and ankle Flag question b. Opposite thigh and ankle c. Ipsilateral hip and ankle d. Sacral base and ankle

d. Sacral base and ankle

When performing the Thomas test, patient position begins with? a. Side lying Flag question b. Prone c. Standing d. Supine

d. Supine

What is the way to do Ober test? a. On side facing away from the doctor affected side up b. On side facing away from doctor affected side down c. On side facing toward doctor with affected side down d. On side facing toward the doctor with affected side up

a. On side facing away from the doctor affected side up

When performing the Anvil test, patient describes a localized pain in the thigh, this indicates? a. Fibular fracture question b. Tibial fracture c. Femoral fracture d. Calcaneal fracture

c. Femoral fracture

Doctor hand placement for Patrick test is? a. One hand on each ASIS with arms crossed Flag question b. One hand on knee and one hand on ipsilateral ASIS c. One hand on ASIS and one hand on pubic bone d. One hand on knee and one hand on contralateral ASIS

d. One hand on knee and one hand on contralateral ASIS

When performing Allis sign from the foot of the table you observe one knee is higher than the other what does this indicate? a. Flexed ilium b. Tibial length discrepancy c. Pronation d. Extended ilium

b. Tibial length discrepancy

Positive Patrick test indicates? a. SI joint disease b. Hip joint disease c. Thoracolumbar pathology d. Sacrococcygeal joint disease

b. Hip joint disease

What hip condition is the most irritable and gives rise to a positive Ober test? a. Transient Synovitis b. Legg Calves Perthes c. Stress fracture d. Snapping Hip Syndrome

a. Transient Synovitis

Patient is side lying with affected hip up. Doctor places one hand on the knee and the other hand grabs the ankle lightly with the other hand and holds the knee at a 90 degree angle. The thigh is abducted and extended in the coronal plane. Then the knee is dropped. What test is this? a. Gaenslen test b. Patrick Faber c. Ober d. Leguarre test

c. Ober

When the Ely Test indicates upper lumbar discomfort what is the problem? a. Stretch of lumbar root adhesions b. Sciatica c. Femoral nerve traction d. Sprain/strain

a. Stretch of lumbar root adhesions

Besides assessing for SI pain and Lumbosacral pain what other condition can Nachlas Test assess for? a. Sprain/strain question b. Denervation c. Intervertebral Foramen Encroachment d. Subluxation

d. Subluxation

Which of the following indicates a positive Ober test? a. Severe pain in the knee b. Leg remains abducted c. Severe pain in the SI-joint d. Leg unable to remain abducted

b. Leg remains abducted

What is proper hand position for Nachlas Test? a. Hand on ankle and hand on sacral base Flag question b. Hand on ankle and hand on contralateral buttock c. Hand on ankle and hand on thigh d. Hand on ankle and hand on ipsilateral buttock

d. Hand on ankle and hand on ipsilateral buttock

Which side should the patient be lying on for the Lewin Gaenslen test? a. patient should be supine b. affected side c. side unimportant d. unaffected side

d. unaffected side

Allis sign not only can be positive for a hip dislocation but also assess? a. Fracture Flag question b. Total Leg Length c. Tibial Dysplasia d. Pelvic Obliquity

c. Tibial Dysplasia

A positive Anvil test may present as? a. Pain in the shoulder Flag question b. Pain at the distal humerus c. Pain in the lower lumbars d. Pain in the thigh

d. Pain in the thigh

Which of the following orthopedic tests for SI joint lesion? a. Lewin Gaenslen b. Anvil c. Ely d. Thomas

a. Lewin Gaenslen

When Hibb produces a positive test for SI pain, which test should be performed next? a. Obers Test question b. Anvil Test c. Leguarre Test d. Allis sign

c. Leguarre Test

Supine patient flexes knee to abdomen and opposite knee lifts off the table with a lordosed lumbar spine, this is a positive sign for which test? a. Anvil test question b. Ober test c. Thomas test d. Tredelenburg test

c. Thomas test

What does Nachlas Test indicate? a. Femoral Fracture b. Contracture of IT Band c. Upper lumber nerve root irritation d. SI lesion or lumbosacral pain

d. SI lesion or lumbosacral pain

What hip orthopedic test assesses for contracture of the Iliotibial band? a. Thomas test b. Lewin Gaenslen c. Ober d. Hibb

c. Ober

A positive Thomas test indicates? a. Neck rotation contracture b. Neck flexion contracture c. Hip flexion contracture d. Hip extension contracture

c. Hip flexion contracture

In performing Allis sign, the patient is? a. Supine b. Sitting c. Standing d. Prone

a. Supine

What is the action that is performed during Yeoman test with the thigh? a. Hyperextension b. Abduction c. Adduction d. Flexion

a. Hyperextension

Thomas test is an assessment for ________? a. Intracapsular coxa pathologic conditions b. Iliotibial band contracture c. Contracture of the Gracilis muscle d. Flexion contracture involving the iliopsoas muscle

d. Flexion contracture involving the iliopsoas muscle

Thomas test is done with the patient in what position? a. Prone b. Seated c. Side lying d. Supine

d. Supine

In Yeomans test, the proper procedure calls for which of the following? a. The affected side’s heel is approximated to the contralateral buttock b. The affected side’s thigh is hyperextended c. The affected side’s thigh is internally rotated d. The affected side’s heel is approximated to the ipsilateral buttock

b. The affected side’s thigh is hyperextended

The Thomas test indicates contracture of which muscle? a. Iliopsoas b. Piriformis c. Quadratus Lumborum d. Biceps femoris

a. Iliopsoas

Using Thomas test to test for right iliopsoas contracture _______ thigh is flexed? a. Right b. Both c. Neither d. Left

d. Left

Patrick test is indicative of _______? a. Osteoarthritis of the hip joint b. Iliotibial band contracture c. Intracapsular coxa pathologic conditions d. Hip fracture

c. Intracapsular coxa pathologic conditions

In performing Allis sign, the patient is? a. Supine b. Prone c. Standing d. Sitting

a. Supine

When performing Yeoman test, a patient complains of pain in their anterior hip area this indicative of? a. Lesion of anterior SI Ligaments b. Tight hip Flexors c. Sciatica d. Hip fracture

a. Lesion of anterior SI Ligaments

When pain radiates during the Nachlas Test it indicates? a. Sciatica b. Lumbosacral or SI pain c. Disc Lesion d. Femoral Fracture

b. Lumbosacral or SI pain

A patient limps into your office complaining of persistent inguinal pain. They cannot report a recent injury or precipitating event. You suspect some kind of pathologic intrascapular coxa condition. What orthopedic test would you like to do? a. Gaenslesn test b. Bowstring Sign c. Ober test d. Patrick test

d. Patrick test

Allis sign not only can be positive for a hip dislocation but also assess? a. Pelvic Obliquity b. Fracture c. Total Leg Length d. Tibial Dysplasia

d. Tibial Dysplasia

What does Trendelenburg test assess for? a. Weak hip abductors b. Femoral Fracture c. Lumbar Nerve Root Irritation d. SI pain

a. Weak hip abductors

What is the movement of the knee in Ober Test? a. 45 degree flexion b. 90 degree flexion c. No movement d. 30 degrees flexion

b. 90 degree flexion

What signifies a positive Ober Test? a. When dropped the leg does not fall b. Foot is pushed to opposite buttock with Lumbar pain c. Foot is pushed to ipsilateral buttock with SI pain d. When dropped the leg falls

a. When dropped the leg does not fall

What is another name for the Trendelenburg Test? a. Unilateral Leg Raise b. Bilateral Leg stand c. Bilateral leg raise d. Unilateral leg stand

d. Unilateral leg stand

Which hip orthopedic test could not be used to assess for hip dislocation? a. Hip telescoping test b. Thomas test c. Trendelenburg test d. Allis sign

b. Thomas test

Which item is not associated with a contracted iliopsoas muscle a positive indication Incorrect of the Thomas test? a. Lordosed spine upon approximation of knee to abdomen question b. Pain in the groin and thigh c. Limp antalgic gait d. Inability to extend the knee

d. Inability to extend the knee

If you suspect a contracture with the iliopsoas muscle the best orthopedic test to use would be _________? a. Patricks test question b. Obers test c. Phelps test d. Thomas test

d. Thomas test

What does Yeoman test indicate? a. Posterior SI Ligaments b. Lumbar nerve root irritation c. Weak hip abductors d. Anterior SI Ligaments

d. Anterior SI Ligaments

In Nachlas Test, what direction is the foot bent? a. Foot to contralateral buttock b. Foot moved lateral c. Foot moved medial d. Foot to ipsilateral buttock

d. Foot to ipsilateral buttock

Supine patient flexes knee to abdomen and opposite knee lifts off the table with a lordosed lumbar spine, this is a positive sign for which test? a. Thomas test b. Ober test c. Tredelenburg test d. Anvil test

a. Thomas test

When performing Hibb test the patient complains of pain in their SI joint area this indicative of? a. Sciatica question b. Weak hip abductors c. Femoral fracture d. SI Lesions

d. SI Lesions

When the Ely test indicates femoral radicular pain what is the problem? a. Stretch of the lumbar root adhesions b. Femoral fracture c. Traction of the femoral nerve d. Sprain strain

c. Traction of the femoral nerve

You are reviewing a patients MRI that was done on their hip. You notice osteonecrosis in the right femoral head. What hip orthopedic test would be indicative of such a finding? a. Patrick Test b. Anvil test c. Jansens test d. Yoeman test

a. Patrick Test

Trendelenburg test is done with the patient ________? a. Prone b. Standing c. Seated d. Supin

b. Standing

When performing the Anvil test, patient describes localized pain in the foot, this indicates? a. Calcaneal fracture b. Femoral fracture c. Proximal fibular fracture d. Proximal tibial fractur

a. Calcaneal fracture

What is proper hand position for Nachlas Test? a. Hand on ankle and hand on ipsilateral buttock b. Hand on ankle and hand on thigh c. Hand on ankle and hand on sacral base d. Hand on ankle and hand on contralateral buttoc

c. Hand on ankle and hand on sacral base

Patient position for the Gaenslens test is as follows? a. Supine affected leg raised with contralateral neutral leg position b. Supine affected side femur abducted externally rotated c. Supine leg flexed to abdomen with contralateral neutral leg position d. Supine leg flexed with contralateral leg extension

d. Supine leg flexed with contralateral leg extension

When the Ely Test indicates upper lumbar discomfort what is the problem? a. Femoral nerve traction b. Stretch of lumbar root adhesions c. Sprain/strain d. Sciatica

b. Stretch of lumbar root adhesions

Upon hyperextension and contralateral leg flexion the patient complains of pain near the SI joint on the extended leg side, this is a positive test for? a. Anvil question b. Thomas c. Gaenslens d. Ober

c. Gaenslens

What does Ely Test indicate? a. SI joint pain b. Lumbar nerve radicular pain and femoral inflammation c. Sciatica d. Femoral fracture

b. Lumbar nerve radicular pain and femoral inflammation

In order to evaluate a patient for Allis sign the patients feet must be? a. Flexed Flag question b. Hanging off the table c. Flat on the table d. Extended

c. Flat on the table

Patient is side lying with affected hip up. Doctor places one hand on the knee and the other hand grabs the ankle lightly with the other hand and holds the knee at a 90 degree angle. The thigh is abducted and extended in the coronal plane. Then the knee is dropped. What test is this? Select one: a. Patrick Faber b. Ober c. Leguarre test d. Gaenslen test

b. Ober

c. Thomas test

A Positive Lewin Gaenslen test indicates? a. Tibial fracture b. Meniscus tear c. Femoral fracture d. SI joint lesion

d. SI joint lesion

Hip pain when abducting and externally rotating the femur indicates? a. Positive Braggards test b. Positive Sicards test c. Positive Patrick test d. Positive Thomas tes

c. Positive Patrick test

Which of the following indicates a positive Ober test? a. Severe pain in the knee b. Severe pain in the SI-joint c. Leg unable to remain abducted d. Leg remains abducted

d. Leg remains abducted

The Gaenslens test assess the function of the sacroiliac joint which of the items Incorrect below is NOT a function of the SI joint? a. Locomotion b. Lumbar lateral flexion c. Spinal and thigh movement d. Changes in position such a standing to sitting

b. Lumbar lateral flexion

A Positive Lewin Gaenslen test is? a. SI pain b. Knee pain c. Lumbosacral pain d. Hip pain

a. SI pain

What is the proper hand position for Ely Test? a. Opposite hip and ankle b. Opposite thigh and ankle c. Ipsilateral hip and ankle d. Sacral base and ankle

d. Sacral base and ankle

What test assesses for weakness of the adductors? a. Trendelenburgs Test b. ElysTest c. Yeomans Test d. Ober

d. Ober

A patient with Allis sign would most likely be limited to this motion? a. Extension b. External rotation c. Flexion d. Internal rotation

d. Internal rotation

What does Allis sign observe for? a. Leg length discrepancies b. Hip Extension c. Leg fractures d. Hip flexion

a. Leg length discrepancies

You are reviewing a patients MRI that was done on their hip. You notice osteonecrosis in the right femoral head. What hip orthopedic test would be indicative out of such a finding? a. Patrick Test b. Anvil test c. Jansens test d. Yoeman test

a. Patrick Test

Trendelenburg test is done with the patient ________? a. Prone b. Standing c. Seated d. Supine

b. Standing

When performing the Anvil test, patient describes localized pain in the foot, this indicates? a. Calcaneal fracture b. Femoral fracture c. Proximal fibular fracture d. Proximal tibial fracture

a. Calcaneal fracture

d. Supine leg flexed with contralateral leg extension

When the Ely Test indicates upper lumbar discomfort what is the problem? a. Femoral nerve traction b. Stretch of lumbar root adhesions c. Sprain/strain d. Sciatica

b. Stretch of lumbar root adhesions

c. Gaenslens

What does Ely Test indicate? a. SI joint pain b. Lumbar nerve radicular pain and femoral inflammation c. Sciatica d. Femoral fracture

b. Lumbar nerve radicular pain and femoral inflammation