Quiz 2 (hip)

Question 1

Hip capsular pattern

Answer 1

flexion, abduction, medial rotation (order may be altered)

Question 2

Hip resting position

Answer 2

30 degrees flexion, 30 degrees abduction and slight lateral flexion

Question 3

Specific history question for hip

Answer 3

Can the patient sleep on the affected side?

Question 4

Hip joint pain referral

Answer 4

In the groin and anterior or medial side of thigh, but may refer to knee or back

Question 5

Intra-articular hip pain description

Answer 5

Sharp and stabbing and there may be locking, clicking or catching

Question 6

Causes of intra-articular pain

Answer 6

Labral tear, loose body, OA

Question 7

Cause of intra-articular clicking

Answer 7

Labral tear, loose body, instable capsule

Question 8

Lateral hip pain cause

Answer 8

Trochanteric bursitis, torn gluteus medius tendon or active TFL TrP

Question 9

Internal snapping

Answer 9

Iliopsoas tendon over femoral head or iliopectinal eminence
Iliofemoral ligament moving over the femoral head

Question 10

External snapping

Answer 10

Tight IT band or gluteus maximus tendon snapping over greater trochanter

Question 11

Which hand does a cane go in?

Answer 11

On the unaffected side

Question 12

3 positions to do adduction/abduction

Answer 12

Foot of non-test leg can be on a chair, on table with foot bent or on table with leg straight

Question 13

4 ways for internal and external rotation

Answer 13

Supine with both legs straight
Supine with hip and knees at 90 degrees
Prone with knees flexed to 90 degrees
Sitting

Question 14

Faber’s Test is also known as

Answer 14

Patrick’s test, Jansen’s test, Figure 4

Question 15

Faber’s Test (Patient position, test action, positive response, indicated)

Answer 15

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)

Question 16

Hip provocation test (Patient position, test action, positive response, indicated)

Answer 16

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

Question 17

Log Roll Test (Patient position, test action, positive response, indicated)

Answer 17

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)

Question 18

Snapping hip sign (Patient position, test action, positive response, indicated)

Answer 18

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)

Question 19

How to modify snapping hip sign for lateral snapping and what does it indicate?

Answer 19

The patient must extend the medial rotation
Indicates tight IT band or glute max tendon

Question 20

Rocobado leg length discrepancy test (Patient position, test action, positive response, indicated)

Answer 20

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

Question 21

Sign of the buttock test (Patient position, test action, positive response, indicated)

Answer 21

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

Question 22

Thomas test (Patient position, test action, positive response, indicated)

Answer 22

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)

Question 23

Rectus femoris test (Patient position, test action, positive response, indicated)

Answer 23

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

Question 24

TFL Test/J sign (Patient position, test action, positive response, indicated)

Answer 24

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

Question 25

Ober’s test (Patient position, test action, positive response, indicated)

Answer 25

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

Question 26

Trendelenburg test (Patient position, test action, positive response, indicated)

Answer 26

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

Question 27

Piriformis test (Patient position, test action, positive response, indicated)

Answer 27

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

Question 28

Sign of buttock cause

Answer 28

FISSON
-Fractured sacrum
-Ischial bursitis
-Septic sacroiliac arthritis
-Septic bursitis
-Osteomyelitis of the upper femur
-Neoplasm of ilium or upper femur

Question 29

Sign of buttock signs/symptoms

Answer 29

-Positive sign of the buttock test
-Fever if due to septic bursitis, septic SI arthritis or osteomyelitis

Question 30

Trochanteric bursitis signs/symptoms

Answer 30

-Pain over greater trochanter
-Tenderness on palpation of great trochanter
-Unable to lie on affected side
-Altered gait

Question 31

Psoas bursitis signs/symptoms

Answer 31

-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

Question 32

Gluteal bursitis signs/symptoms

Answer 32

-Pain in lateral or posterior trochanter and referred to outer thigh
-Some passive movement painful at full ROM
-Empty end feel

Question 33

Ischial bursitis signs/symptoms

Answer 33

-Tenderness at or above ischial tuberosity
-Pain present immediately when patient sits down, ceases when patient gets up
-Empty end feel

Question 34

Muscular lesion signs/symptoms

Answer 34

-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