NMS 3: Hip Flashcards
Forces acting across hip joint
Body weight, abductor muscles force, joint reaction force
Abductors
Gluteus minimus/medius, TFL
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)
Types of Hip Fracture
-Intracapsular: twice as common/more likely to develop complications
-Extracapsular: Refer out
Stress Fractures
-Cause: Repetitive Stress
-Young and Active/Pain worse with weight bearing/anterior and deep
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
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
Barlow Maneuver
Push the hip down and out, positive test will have the hip pop out
Ortolani Maneuver
Meant to push the hip back into place
Treatment of Hip Dislocation
-Pavlik Harness for infants to 6 months
-6-15 months-Spica Cast
-Surgery
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)
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
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)
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
Causes of Trochanteric Bursitis
Anything that alters hip mechanics-LBP, leg length discrepancy, arthritic conditions, surgery, neurologic conditions with paresis
Management of Trochanteric Bursitis
-Correction of abnormal biomechanics and appropriate adjustments, stretching of hip abductors, anti-inflammatory…
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
Evaluation of Iliopectineal & Iliopsoas Bursitis
-Located 1-2cm below middle third of inguinal ligament
-Resisted hip flexion and iliopsoas
-Managment: Myofascial release of iliopsoas
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
Evaluation & Management of Ischial bursitis
Lean toward affected side with accompanying shortened stride length
-Padding/pillow or donut/Avoidance of activity
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
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
Management
Usually benign and position dependent
-Strengthening rather than stretching the involved muscle is often helpful
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
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
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
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
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
