screening of the hip Flashcards
Suspicious Examination Findings - Symptoms
acute hip pain with fever
night sweats
night pain
symptoms unchanged by movement or position
symptoms related to period
Suspicious Examination Findings - potential causes
tumor
infection
Septic arthritis
osteomyelitis
endometriosis
Corticosteroid use has been reported in cases of
avascular necrosis (AVN) and fracture occurring at the hip joint
AVA direct causes
fracture of dislocation
radiation
SCFE
sickle cell disease
AVA indirect causes
corticosteroid use
chronic alc
autoimmune disease
smoking history
AVN pathogenesis in the hip
decrease blood flow to the proximal femur which can lead to structural failure and collapse
AVN clinical presentation
Primary pain distribution: groin > buttock > lateral thigh
Secondary/referred pain: knee > anterior thigh > lower leg
Clinical Testing for AVN
Lack of tests with high sensitivity
Tests with high specificity
<15 degrees hip extension (0.92)
< 60 degrees hip ER (0.73)
Pain with IR (0.86)
what is Breach birth
feet first position for birth
Breach birth issues
high association with dysplastic hips
Childhood Disorders for the hip
Developmental Dysplasia of the Hip
Legg Calve Perthes Disease
Slipped Capital Epiphysis
Legg Calve Perthes Disease
a childhood condition that occurs when the blood supply to femoral head of the hip joint is temporarily interrupted and the bone begins to die
the compromised bone may deform
4-10
Slipped Capital Epiphysis
occurs when there is a slippage of the proximal epi on the meta
treatment is often conservative
8- 15
hip dysplasia in younger adults
is often due to residue childhood and teenaged onset dysplasia
what we are looking for in a Pelvic Screen – History
Bowel issues
Bladder-related changes
Pregnancy and birth history.
Psychosocial and mood disorder history
Fear-avoidance characteristics
Fear-avoidance characteristics
avoidance of movements or activities based on the fear of increased pain or re-injury.
what is included in the Screening of the Lumbosacral Spine
Pelvic landmark palpation
Lumbar AROM Testing
Sensory
Motor exam
Special Tests
- Determine if spine is primary or contributing factor
Screening of the Lumbosacral Spine
Prone Instability Test
Thigh Thrust Test
Prone Instability Test
Presence of lumbar instability
SN = 72%, SP = 58%
Thigh Thrust Test
Sacroiliac joint irritability
Cluster of findings more useful for SIJ dysfunction
Lumbosacral Spine - Neural Tension Tests
SLR
active slump
prone knee flexion
Stress Fractures in the hip description
Mechanically induced fracture of the proximal femur or pelvis
Repetitive overload that overcomes normal structural properties
Example: overtraining, rapid volume increase
Loading that overcomes compromised structural properties
Example: fracture occurring with osteopenia
Differential Diagnoses with stress fracture in the hip
Acetabular labral tear
Hip flexor strain
Hip adductor strain
Iliopsoas bursitis
Osteochondral lesion
Hip OA
Osteochondral lesion
lesions are a tear or fracture in the cartilage covering one of the bones in a joint
types of stress fractures
Compression sided
Tension sided
Compression sided stress fracture in the hip
Inferior region of femoral neck
Conservative management
Tension sided stress fracture in the hip
Pulled apart – tension
Superior region of femoral neck
ORIF - surgery
Stress Fractures – Clinical Presentation pain
Groin & anterior thigh most common
Potential for lateral thigh and more rarely in gluteal region
Potential for medial knee pain
Often reproducible with end-range IR and overpressure (motion more limited in proximal/neck region)
May be reproducible with SLR or MMT for flexion and/or abduction
Stress Fractures – Clinical Presentation functional
Initially occurs as pain during or after strenuous activity (running)
Progresses to affect lower level activity (walking)
In acute stages, can be painful at rest or at night
Clinical Tests for a stress fracture
Patellar-pubic Percussion Test (femoral neck)
- he has not had luck with this test
Patellar-Pubic Percussion Test procedure
Patient in supine position
Stethoscope placed over pubic tubercle
Clinician listens through stethoscope as they tap the ipsilateral patella
Patellar-Pubic Percussion Test interpretation
Lack of sound propagation may indicate fracture
No noise: the fracture is stopping the sound from transmitting
Stress fracture diagnostic imaging
Plain Radiography (AP, frog-lateral)
Bone scan
MRI
stress fracture Plain Radiography (AP, frog-lateral)
Rule out other conditions (OA, tumor, etc.)
Examine for displacement
Stress Fracture Bone scan
Demonstrates increased focal uptake of radiotracer at site of fracture (“hot spot”)
May read negative for first 24 hours after occurrence development
Stress fracture MRI
Ideal in sensitive and specificity
Yields information about surrounding tissue (differential diagnoses)
FABER Test Interpretation
felx, ABD, ER: joint screen
Normal: equal ROM bilaterally with no symptom reproduction
Abnormal: ask where the pain is
Anterior/Inguinal pain: potential hip pathology
Posterior pain: may indicate potential SI joint dysfunction
Scour Test
joint screen
Normal: no interruption of motion, no pain
Abnormal: pain/discomfort, grating sensation, crepitis-like sound. This may indicate degenerative changes
what is a screen test used for
Screening test – not that specific just testing to see if the pain is originating from the hip
what is a screen test used for
Screening test – not that specific just testing to see if the pain is originating from the hip
