Quiz 2 (hip) Flashcards
Hip capsular pattern
flexion, abduction, medial rotation (order may be altered)
Hip resting position
30 degrees flexion, 30 degrees abduction and slight lateral rotation
Specific history question for hip
Can the patient sleep on the affected side?
Hip joint pain referral
In the groin and anterior or medial side of thigh, but may refer to knee or back
Intra-articular hip pain description
Sharp and stabbing and there may be locking, clicking or catching
Causes of intra-articular pain
Labral tear, loose body, OA
Cause of intra-articular clicking
Labral tear, loose body, instable capsule
Lateral hip pain cause
Trochanteric bursitis, torn gluteus medius tendon or active TFL TrP
Internal snapping
Iliopsoas tendon over femoral head or iliopectinal eminence
Iliofemoral ligament moving over the femoral head
External snapping
Tight IT band or gluteus maximus tendon snapping over greater trochanter
Which hand does a cane go in?
On the unaffected side
3 positions to do adduction/abduction
Foot of non-test leg can be on a chair, on table with foot bent or on table with leg straight
4 ways for internal and external rotation
Supine with both legs straight
Supine with hip and knees at 90 degrees
Prone with knees flexed to 90 degrees
Sitting
Faber’s Test is also known as
Patrick’s test, Jansen’s test, Figure 4
Faber’s Test (Patient position, test action, positive response, indicated)
Patient: supine
Examiner: Place heel of test leg above knee of non-test leg, then slowly lower test leg in abduction. Stabilize opposite ASIS. Can gently push down on knee.
PR: Leg remains above non-test leg
Indicates: Hip joint pathology (lateral pain), iliopsoas spasm (groin pain) or sacroiliac joint pathology (posterior pain)
Hip provocation test (Patient position, test action, positive response, indicated)
Patient: standing with non-test foot against medial shine of test leg
Examiner: Push down on patient’s iliac crest and rotates body both ways on hip
PR: pain in hip
Indicates: hip joint (intra-articular) pathology
Log Roll Test (Patient position, test action, positive response, indicated)
Patient: supine w/ both legs straight
Examiner: Passively rotates femur medially and laterally as far as possible and compares
PR: Restriction and/or pain in the hip (could have excessive mobility and/or pain)
Indicates: Hip joint pathology. If mobility is excessive on affected side - likely due to capsular instability
(if click occurs with this test, most often there is a labral tear but could be loose body or capsular instability)
Snapping hip sign (Patient position, test action, positive response, indicated)
Patient: supine
Examiner: Supports patient’s hip in abduction, flexion and lateral rotation. Patient actively extends hip (examiner supports legs weight)
PR: Snaps anteriorly/internally at the hip (must snap to be positive)
Indicates: Iliopsoas tendon snapping over femoral head or iliopectineal eminence (could be iliofermoral ligament over femoral head)
(if also sharp pain in groin and anterior thigh may indicate labral tear or loose body)
How to modify snapping hip sign for lateral snapping and what does it indicate?
The patient must extend the medial rotation
Indicates tight IT band or glute max tendon
Rocobado leg length discrepancy test (Patient position, test action, positive response, indicated)
Patient: supine with knees bent and flat feet (heels lined up)
Examiner: Patient lifts buttock then lowers to standardize position. Examiner stands at the feet and looks at the hight of the knees, then stands beside patient and looks to see if one knee if further forward than the other
PR: One knee is further forward than the other or one knee is higher than the other
Indicates: Femur is longer, tibia is longer
*pelvis must be level for test to be of value
Sign of the buttock test (Patient position, test action, positive response, indicated)
Patient: supine
Examiner: examiner keeps patient’s knee straight and passively flexes the patient’s hip. If pain occurs, knee is flexed without moving the hip
PR: pain in buttock remains even when knee is flexed
Indicates (FISSON):
Fractured sacrum
Ischial bursitis
Septic bursitis
Septic SI arthritis
Osteomyelitis
Neoplasm of ilium or upper femur
Thomas test (Patient position, test action, positive response, indicated)
Patient: supine
Examiner: patient hugs non-test knee to chest. Examiner checks for excessive lumbar curve. Test leg should be relatively flat on table (there may be a small space)
PR: straight leg raises off table and/or excessive lumbar curve (if hip abducts on straight leg, due to tight TFL)
Indicate: Tight hip flexors/hip flexion contracture (iliopsoas)
Rectus femoris test (Patient position, test action, positive response, indicated)
Patient: starts in standing with one knee hugged to chest and buttock against table
Examiner: lowers patient to supine so that non-test leg is still hugged to chest and test leg is dangling. If knee is less than 90 degrees, examiner passively flexes knee and palpates to see if rec fem is tight
Modification: patient in supine, test knee bent and foot off side table) Must fully flex hip when lying on table.
PR: Knee is less than 90 dregrees of flexion and rec fem is tight on palpation
Indicates: Tightness of rec fem (if palpated), or tight joint capsule
TFL Test/J sign (Patient position, test action, positive response, indicated)
Patient: same as rec fem test
Examiner: lowers patient patient to supine so that non-test leg is still hugged to chest and test leg is dangling
PR: hip abducts
Indicates: tightness of TFL/IT band
Ober’s test (Patient position, test action, positive response, indicated)
Patient: side lying with test leg striaght
Examiner: patient hugs bottom leg to chest for stability. Examiner passively abducts and extends test leg, stabilizing pelvis. Then slowly lowers the leg to table, preventing crest from dropping towards thigh
PR: top leg remains abducted and does not fall to table
Indicates: tightness of TFL/IT band
Trendelenburg test (Patient position, test action, positive response, indicated)
Patient: standing
Examiner: asks patient to stand on one leg. Patient places hands on shoulders for balance
PR: pelvis on opposite side falls
Indicates: weakness of gluteus medius or unstable hip on affected side
Piriformis test (Patient position, test action, positive response, indicated)
Patient: side lying with test leg up
Examiner: patient’s bottom leg is slightly flexed at hip and knee for stability. Examiner flexes test hip to 60 degrees and applies downward pressure. Examiner stabilizes pelvis
PR: Pain in muscle if piriformis is tight/strained. Pain in buttock and or down post leg to back of knee if sciatic nerve is pinched
Indicates: piriformis strain, piriformis syndrome if pai down leg
Sign of buttock cause
FISSON
-Fractured sacrum
-Ischial bursitis
-Septic sacroiliac arthritis
-Septic bursitis
-Osteomyelitis of the upper femur
-Neoplasm of ilium or upper femur
Sign of buttock signs/symptoms
-Positive sign of the buttock test
-Fever if due to septic bursitis, septic SI arthritis or osteomyelitis
Trochanteric bursitis signs/symptoms
-Pain over greater trochanter
-Tenderness on palpation of great trochanter
-Unable to lie on affected side
-Altered gait
Psoas bursitis signs/symptoms
-Pain to groin or anterior thigh with referral along front of the thigh to patella
-Passive hip adduction at 90 degrees of hip flexion most painful
-Unable to cross legs in sitting
-Empty end feel
Gluteal bursitis signs/symptoms
-Pain in lateral or posterior trochanter and referred to outer thigh
-Some passive movement painful at full ROM
-Empty end feel
Ischial bursitis signs/symptoms
-Tenderness at or above ischial tuberosity
-Pain present immediately when patient sits down, ceases when patient gets up
-Empty end feel
Muscular lesion signs/symptoms
-Local tenderness on palpation of affected muscle
-Pulling sensation when affected muscle is stretched
-Pain on resisted movements
-Bruising or hematoma
-Swelling on site on injury
-Altered gait
