Osteopathic Testing of the Hip OSCE

Question 1

femoral triangle

Answer 1

borders:

• superior: inguinal ligament
• medial: medial border of adductor longus m
• lateral: medial border of sartorius m

contents: NAVeL
- femoral nerve
- femoral artery
- femoral vein
- empty space with lymph (femoral canal)

Question 2

what are the hip flexors?

Answer 2

• sartorius m
• iliopsoas m
• rectus femoris m
• tensor fascia lata m

Question 3

what are the extensors of the hip?

Answer 3

• gluteus maximus m
• biceps femoris m
• semitendinosus m
• semimembranosus m

Question 4

what are the hip abductors?

Answer 4

• gluteus medius m
• gluteus minimus m
• tensor fascia lata m

Question 5

what are the hip adductors?

Answer 5

• adductor longus m
• adductor brevis m
• adductor magnus m

Question 6

ROM for flexion of hip

Answer 6

90 deg with knee extended, 120-135 with knee flexed

Question 7

ROM for extension of hip

Answer 7

15-30 deg

Question 8

ROM for internal rotation of hip

Answer 8

30-40 deg

Question 9

ROM for external rotation of hip

Answer 9

40-60 deg

Question 10

ROM for abduction of hip

Answer 10

45-50 deg

Question 11

ROM for adduction of hip

Answer 11

20-30 deg

Question 12

what muscle and n are you testing for strength testing flexion?

Answer 12

• iliopsoas m

- femoral n

Question 13

what muscle and n are you testing for strength testing extension?

Answer 13

• gluteus maximus m

- inferior gluteal n

Question 14

what muscle and n are you testing for strength testing abduction?

Answer 14

• gluteus medius m

- superior gluteal n

Question 15

what muscle and n are you testing for strength testing adduction?

Answer 15

• adductor longus m

- obturator n

Question 16

what is the grading scale for strength testing?

Answer 16

-grade on a 5/5 cale with 5/5 being normal and 0/5 being no muscle contraction detected

Question 17

what structures are in the hip central compartment?

Answer 17

• labrum
• ligamentum teres
• articular surfaces

Question 18

what structures are in the hip peripheral compartment?

Answer 18

• femoral neck

- synovial lining

Question 19

what structures are in the hip lateral compartment?

Answer 19

• gluteus medius m
• gluteus minimus m
• IT band
• trochanteric bursae

Question 20

what structures are in the hip anterior compartment?

Answer 20

• iliopsoas insertion

- iliopsoas bursae

Question 21

a. Perform the flexion/extension evaluation of the hip joint for somatic dysfunction (prone and supine) and document appropriately.

Answer 21

• Student is standing at side of table facing patient and places patient in a supine position.
• Student assesses passive flexion of the hip joint by blocking linkage and noting 90 degrees
  expected
• Student assesses bilaterally.
• Student places patient in prone position and assesses passive extension of the hip joint by
  blocking linkage
• Student assess bilaterally
• Student states flexion dysfunction has ease of motion to flexion and restriction to extension
• Student states extension dysfunction has ease of motion to extension and restriction to
  flexion.
• Student notes a hip flexion or extension dysfunction would be noted in the objective portion
  of the chart noting side of laterality.

Question 22

b. Perform the internal rotation/external rotation evaluation of the hip joint for somatic dysfunction (prone and supine) and document appropriately.

Answer 22

• Student is standing at side of table facing patient and places patient in a supine position with hip and knee at 90 degrees.
• Student places patient in supine or prone position and assesses passive internal rotation of the hip joint by blocking linkage
• Student places patient in supine or prone position and assesses passive external rotation of the hip joint by blocking linkage
• Student states internal rotation dysfunction has ease of motion to internal rotation and restriction to external rotation.
• Student states external rotation dysfunction has ease of motion to external rotation and restriction to internal rotation.
• Student notes a hip internal or external rotation dysfunction would be noted in the objective portion of the chart noting side of laterality.

Question 23

c. Perform the adduction/abduction evaluation of the hip joint for somatic dysfunction (supine) and document appropriately.

Answer 23

• Student is standing at foot of table facing patient and places patient in a supine position with knee extended
• Student assesses passive abduction of the hip joint by blocking linkage.
• Student assesses passive adduction of the hip joint by blocking linkage by lifting the
  contralateral lower extremity and sweeping the ipsilateral leg into adduction.
• Student states abduction dysfunction has ease of motion to abduction and restriction to
  adduction.
• Student states adduction dysfunction has ease of motion to adduction and restriction to
  abduction.
  Student notes a hip adduction or abduction dysfunction would be documented in the objective portion of the chart noting side of laterality.

Question 24

grade scale of 0

Answer 24

no contraction

Question 25

grade scale of 1

Answer 25

twitch

Question 26

grade scale of 2

Answer 26

active movement w/o gravity

Question 27

grade scale of 3

Answer 27

active mvmt with gravity

Question 28

grade scale of 4

Answer 28

active movement with gravity and SOME resistance

Question 29

grade scale of 5

Answer 29

active movement with gravity and full resistance, no fatigue