OSCE 3 - Hip Flashcards
borders of femoral triangle
Borders: Superiorly – Inguinal Ligament
Medially – Medial border of Adductor Longus
Laterally – Medial border of Sartorius
external rotators of hip
sartorius
glut. med.
glut. max
Hip ROM
Flexion- 90 knee extended, 120 ‐135 knee flexed Extension 15‐30 Abduction 45‐50 knee extended Adduction 20‐30 Internal rotation 30‐40 External rotation 40‐60
HIP flexion muscles and nerves
iliopsoas muscles
femoral nerve L2-4
verntal rami of lumbars L1-2
extension muscles and nerves
glut max
inf. gluteal L5, S1, S2
abduction
glut. med and min.
sup. gluteal L5, S1
adduction
adductor longus m.
obturator n. L2-4
Muscle grading on 5/5 scale
0 - no muscular contraciton
1 - barely detectable flicker/ trace of contraciton
2 - active movement w/ gravity eliminated
3 - active movement against gravity
4 - active movement against gravity and some resistance
5 - against full resistance w/o evidence of fatigue
hip compartments
central
peripheral
lateral
anterior/ iliopsoas
central contents
Labrum
Ligamentum Teres
Articular surfaces
peripheral contents
femoral neck
synovial lining
lateral contents
Gluteus medius
Gluteus minimus
Iliotibial Band
Trochanteric bursae
Deep
superficialanterior/ iliopsoas contents
Iliopsoas insertion Iliopsoas Bursae
Log roll
nonspecific to central and peripheral compartments
roll the patient’s leg into internal and external rotation
+ test = pain
indicates: central or peripheral compartment pathology
central compartment tests
c-sign labral loading labral distraction scour apprehension: FABER (1 of 3)
c sign
cups just above trochanter
indicates labral pathology
labral loading
patients hip and knee at 90 degrees, loading into femur towards innominate
+ test = pain
indicates: labral or cartilaginous pathology
labral distraction
distracting femur away from innominate
+ test = IMPROVEMENT of pain
indicates: labral or cartilaginous pathology
scour
flexing and externally rotating patient’s hip
- loading into socket and articualting through annular range of motion
+ test = pain
indicates: labral or articular cartilage pathology
apprehension: FABER for CENTRAL compartment
patient’s hip is flexed, aBducted and externally rotated
- doctor induces further external rotaiton by applying POSTERIOR force at knee
+ test = anterior subluxation of hip or apprehension/ pain
indicates: anterior labral pathology
can also be + with impingement
peripheral compartment tests
Ely’s test
rectus femoris test
ely’s test
patient prone, passively flex patient’s knees
+ test = ipsilateral hip raises off table
indicates: rectus femoris contracture
rectus femoris test
patient supine
one hip flexed up to the chest
other leg bent over edge of table
+ test = knee flexion
lateral compartment tests
jump sign straight leg raise test ober's test piriformis test trendelenburg patrick's FABER
jump sign
patient seated, pressure applied to greater trochanter
+ test = patient withdraws/ jumps with pressure
indicates: trochanteric bursitis
straight leg raise test
raise leg wtih knee extended, onspecific test
+ test = pain
indicates: pain from 15-30 = lumbar disc etiology
pain laterally >15 degrees - lateral compartment pathology (as IT band passes over greater trochanter
ober’s test
patient lateral recumbent w// doctor standing behind patient
doctor abducts top leg and lowers leg to table while stabilizing hip
+ test = inability to adduct
indicates: IT band contracture
piriformis test
patient supine with hip and knee flexed, one ankle crossed over contralateral knee. patient abducts against resistance
+ test = pain over posterior aspect of greater trochanter
indicates: piriformis spasm or pathology
trendelenburg
patient standing, doctor behind
patient lefts one foot off ground
+ test = weakness/ inability to hold hips level
indicates: contralateral glut. med. weakness (superior glut. nerve)
Patrick’s FABER for lateral compartment
patient’s hip flexed, aBducted and externall rotated
doctor braces contralateral ASIS, patient externally rotates/ aBducts against resistance
+ test = pain or weakness
indicates: glut. med pathology
anterior/ iliopsoas compartment
Patrick’s FABER
Psoas Test
Thomas Test
Patrick’s FABER for ANTERIOR compt.
patient’s hip flexed, abducted externall rotated, doctor braces contralateral ASIS
patient internally rotates/ aDducts against resistance
+ test = anterior or medial groin pain/ weakness
indicates: iliopsoas insufficiency or pathology
Psoas Test
flex hip to 30 degrees while patient further flexes against resistance
+ test = pain/ instability or snapping
indicates: psoas contracture or pathology
thomas test
patient supine, pulls knee to chest
one leg lowered to table to test flexibility of hip flexors
+ test = inability to fully extend/ extended leg raises off table
indicates: hip flexor contraction
catching, locking a s/s of
central compartment
peripheral
instability or.. Pain Lumbar Spine Groin/ Medial Pelvic Rim Anterior to Posterior (L5-S1) radicular pattern In the a.m. or after a run
central compartment pathology
central compartment potential patohlogies
Labral tears Ligamentum Teres Disruption Osteochondral defects Chondromalacia/ Osteoarthritis Loose Bodies
Pain with hip movement
Deep Hip
Groin
Limited range-of-motion
peripheral compt.
peripheral compt. pathologies
Loose Bodies Impingement syndrome Pincer Type CAM Type Synovitis
Weakness Difficulty with lifting leg to climb stairs Pain Lateral hip Pelvic rim Radiating down leg to knee Knee pain Instability
s/s of lateral compartment
lateral compartment pathologies
IT Band Syndrome Bursitis Rotator cuff Tendonopathies Gluteus Medius Gluteus Minimus
Pain
Anterior hip
Medial Groin
Anterior deep thigh
s/s of anterior compt.
iliopsoas compt. pathologies
Psoas Tendonitis
Iliopsoas Bursitis
Snapping hip
Can be internal or external Internal Psoas “snaps” over femoral head External IT band “snaps” over trochanter
