Test #2 Hip Flashcards

1
Q

What do you look for during a visual inspection?

A
  • swelling
  • ecchymosis
  • deformity
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2
Q

What is Trendelenberg?

A
  • the patient stands on the injured leg
  • flexes the contralateral hip to 90 degrees
  • observe the movement of the pelvis
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3
Q

What is a positive Trendelenberg test?

A

If the pelvis on the NON-STANCE side falls, then the test is considered positive for weakness or instability of the gluteus medius on the STANCE SIDE

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4
Q

What are the prone ROM test?

A

Passive hip extension ​

Passive bilateral IR​

Resisted hip extension ​

Resisted hip IR ​

Resisted knee extension ​

Resisted knee flexion

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5
Q

Passive hip extension

A
  • patient = prone
  • examiner = opposite side
  • Stabilize the patient’s ipsilateral ischial tuberosity with one hand (proximal)
  • Grasp the patient’s distal femur from lateral with your other hand and passively extend the hip
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6
Q

Passive hip bilateral IR

A
  • patient = prone; knees 90 degrees
  • examiner = stand at end of treatment table
  • Passively internally rotate bilateral hips bringing the ankles/lower legs laterally
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7
Q

Resisted hip extension

A

Patient = prone
examiner = testing side
- Grasp the malleoli with your distal hand

  • Place your proximal hand on the posterior side of the distal femur ​
  • Apply resistance to the distal thigh while asking the patient to hold in extension
  • Ask the patient to simultaneously kick into your other hand (knee extension) ​
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8
Q

Resisted knee extension

A

Patient = prone
Examiner = testing side
- Grasp the malleoli with your distal hand

  • Place your proximal hand on the posterior side of the distal femur
  • Bring the knee into 45-90 degrees of knee flexion
  • Stabilize the posterior thigh
  • Provide isometric resistance at the distal tibia for knee extension ​
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9
Q

Resisted knee flexion

A

Patient = prone
Examiner = testing side
distal hand

  • Place your proximal hand on the posterior side of the distal femur
  • Bring the knee into 45-90 degrees of knee flexion
  • Stabilize the posterior thigh
  • Provide isometric resistance at the distal tibia for knee flexion
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10
Q

Resisted hip IR

A

Patient = prone; knees flexed 90 degrees
Examiner = end of the treatment table
- Place your hands on the lateral aspect of the distal tibia bilaterally ​

  • Apply isometric resistance to hip IR by having the patient press his/her lower legs into your hands ​
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11
Q

Resisted hip ER

A

Patient = prone; knees flexed 90 degrees
Examiner = end of the treatment table
- Place your hands on the medial aspect of the distal tibia bilaterally in such a way that your forearms are crossed

  • ​Apply isometric resistance to hip ER by having the patient press his/her lower legs into your hands
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12
Q

Supine ROM tests

A

Passive hip flexion ​

Passive hip IR ​

Passive hip ER ​

Passive hip abduction ​
Knee extended & knee flexed​

Passive hip adduction ​

Resisted hip flexion ​

Resisted hip adduction ​
0 vs 45 vs 90 degrees​

Resisted hip abduction

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13
Q

Passive hip flexion

A

Patient = supine
Examiner = testing side
- bring hip into full available hip flexion

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14
Q

Passive hip ER

A

Patient = supine
Examiner = testing side
- Grasp the patient’s posterior thigh just above the knee with your distal hand

  • flex the patient’s hip and knee to 90 degrees.
  • Support the lower leg with your forearm and support the medial knee with your hand.​
  • Move the hip into full available external rotation
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15
Q

Passive hip IR

A

Patient = supine
Examiner = testing side
- Grasp the patient’s posterior thigh just above the knee with your distal hand

  • flex the patient’s hip and knee to 90 degrees.
  • Support the lower leg with your forearm and support the medial knee with your hand.​
  • Move the hip into full available external rotation
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16
Q

Passive hip adduction

A

Patient = supine
Examiner = opposite side
- The clinician bends the knee of the nonaffected leg and cross the leg over the affected leg

  • Place your proximal hand on the ipsilateral ASIS to stabilize the pelvis (opposite side being tested)
  • Cradle the lower leg and knee with your distal hand and bring the hip into adduction.
  • Ensure the hip remains in neutral rotation
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17
Q

Passive hip abduction

A

Patient = supine
Examiner = testing side
- Grasp the patient’s leg at the mid-calf with your distal hand​

  • Place your proximal hand over the ASIS
  • Abduct the hip keeping the knee straight until you feel movement of the ASIS ​
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18
Q

Passive hip abduction pain

A
  • Maintain this position and passively flex the knee.
    - If the groin pain disappears, the lesion is likely in the gracilis muscle.
    - If the pain persists, it is likely in the adductor longus, adductor brevis, or pectineus
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19
Q

Resisted hip flexion

A

Patient = supine; knee flexed to 45 and 90 degrees
Examiner = testing side
- Stabilize the ipsilateral shoulder with your proximal hand

  • Place your distal hand on the patient’s anterior thigh directly above the knee ​
  • Keeping your elbow straight provide isometric resistance to hip flexion ​
  • Pain provoked is likely due to a lesion in the iliopsoas or the rectus femoris ​
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20
Q

Resisted hip abduction

A

Patient = supine with the hips and knees extended
Examiner: either side
- Place your hands on the outside distal femur bilaterally
- Apply isometric resistance to abduction

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21
Q

Resisted hip adduction

A

Patient = supine; hips and knees @ 0 degrees flexion
Examiner = either side
- Place your hands on the inside of the distal femur in such a way that your forearms are crossed ​

  • Apply isometric resistance to adduction ​
  • Assess the quality of the contraction, the quantity of strength, and any provocation of symptoms ​
  • Repeat test at 45 degrees and 90 degrees of hip flexion​
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22
Q

Resisted hip adduction: muscles tested at each degree

A

Zero degrees: adductor longus/gracilis​

45 degrees: pubic symphysis ​

90 degrees: pectineus ​

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23
Q

What are the extra tests?

A

Femoral Nerve Tension Test ​

Circumduction Test​

Impingement Tests​

Prone Impingement Test​

Fulcrum Test​

Hamstring Syndrome ​

Piriformis Syndrome ​

Thomas Test​

24
Q

Femoral nerve tension test!

A

Patient = side-lying with the affected side up
Examiner = behind the patient ​
-

25
Q

Circumduction Test​!

A

Patient = supine
Examiner = testing side
- Place your cranial hand on the patient’s contralateral ASIS to stabilize the pelvis ​

  • With your caudal hand on the patient’s posterior distal femur, bring the hip into flexion/abduction/external rotation ​
  • Move the hip in a scouring motion from flexion/abduction/external rotation to flexion/adduction/internal rotation​
26
Q

Impingement Test (axal OP) ​!

A

Patient = supine
Examiner = testing side
- Use both hands to bring the patient’s hip into flexion, adduction, and IR ​

  • At the end of the movement, axial compression is given in line with the femur ​
27
Q

Impingement Test (axal OP) ​positive test

A

In the femoroacetabular impingement or labral pathology, this test could provoke groin pain or buttock pain ​

28
Q

Impingement Test (IR OP)!

A

Patient = supine
Examiner = testing side
- Grasp the lower leg of the patient, just above the ankle, with the distal hand

  • Place the other hand anterolateral just proximal to the patient’s knee​
  • Use both hands to bring the hip into flexion, adduction, and IR​
  • At the end of the movement, overpressure is given in the direction of internal rotation ​
29
Q

Impingement Test (IR OP) positive test

A

In femoroacetabular impingement or labral pathology this could provoke groin pain​

30
Q

Prone Impingement Test​!

A

Patient = prone
Examiner = testing side
- With your cranial hand stabilize the ischial tuberosity​

  • Passively take the affected limb into extension, ER, and abduction ​
  • Assess for provocation ​
31
Q

Fulcrum Test​

A

Patient = The patient sits in a relaxed sitting position
- Clinician places one forearm under client’s thigh to be tested.

  • With the other hand applies downward pressure to the proximal knee.
  • Repeat test up the the femur to test the entirety of the femur. ​

32
Q

What is a positive fulcrum test?

A

Test is considered positive for stress fracture if the client reports pain

33
Q

Hamstring syndrome test

A

Patient = supine
Examiner = testing side
- Flex the patient’s hip to 80-90 degrees ​

  • Extend the knee to 15 degrees of dorsiflex the foot/ankle ​
  • Ask the patient to resist knee flexion (dig into your shoulder) ​
  • Assess for provocation
34
Q

What is a positive Hamstring syndrome test?

A

Positive test is a reproduction of their symptoms in the buttock or back of the thigh suggesting possible compression of the sciatic nerve ​

35
Q

Piriformis test

A

Patient = side-lying with hip in flexion, adduction, and internal rotation ​
Examiner = testing side; stabilize ASIS
- With your other hand, resist internal rotation just below the knee ​

36
Q

Thomas test

A
  • The patient sits at the end of the table, hugs the contralateral knee to their chest, and lays back on the table ​
  • Clinician stands or kneels to the side being assessed ​
  • The back of the thigh should contact the table, if not a tightness of the hip flexors is present ​
37
Q

Bones in the pelvis

A

Ilium
* Ishium
* Pubic

38
Q

Bones in the hip

A

Femur
Pelvis
* Ilium
* Ishium
* Pubic
Sacrum
Coccyx

39
Q

Osteology- Angle of Inclination

A

Normal = 130 degrees
Coxa Vara = < 125 degrees
Coxa Valga = > 125 degrees

40
Q

Osteology- Femoral Anteversion

A

Normal Anteversion =15 - 25 degrees

Excessive Anteversion = > 25 degrees
- Toe In

Retroversion = < 10 degrees
- Toe Out

41
Q

What are the bursae of the hip?

A

Trochanteric
Iliopsoas
Ischiogluteal

42
Q

Groin & Anterior Thigh Pain Pathologies

A
  • Sports Hernia
  • Stress Fracture
  • Femoroacetabular Impingement
  • Labral Tear
  • Muscle Strain
  • Hip Pointer
43
Q

Femoroacetabular Impingement (FAI)

A

+ anterior impingement test
+ FABER

44
Q

Labral Tear

A

+++ passive IR in 90 degrees hip flexion (supine)

(+) pain: passive IR in 90 degree hip flexion
(+) pain: passive IR in hip extension

Resistive tests = negative

45
Q

Stress Fracture

A

Onset of pain with weight bearing activities
- immediate resolution with stopping weight bearing

(-) basic clinical examination
(+++) hop test
(+) fulcrum test
(+) scanning

46
Q

Sports Hernia “Athletic Pubalgia”

A

Cluster of 5 signs and symptoms:
* Subjective complaint of deep groin/lower abdominal pain

  • Pain is exacerbated with sport specific activity (sprinting,
    cutting, kicking, sit-ups) and is relieved with rest
  • Palpable tenderness over the pubic ramus at the insertion of
    the RA and/or conjoined tendon
  • Pain with resisted adduction at 0, 45, and/or 90 degrees of
    hip flexion
  • Pain with resisted abdominal curl-u
47
Q

Adductor/Hip Flexor Strain (Groin Strain)

A

Differentiation for adductors:
o Add Longus: +++ resisted hip adduction at 0 degrees of hip flexion

o Pubic Symphysis: +++ resisted hip adduction at 45 degrees of hip flexion

o Pectineus: +++ resisted hip adduction at 90 degrees hip flexion

48
Q

Quadriceps Strain

A

Stretching or tearing of the quadriceps muscle(s)

  • Pain & limited knee flexion
  • ++ pain resisted knee extension
49
Q

Hip Pointer

A

Contusion (bruising) of iliac crest or abdominal musculature
result of direct blow

50
Q

Myositis Ossificans

A

Irritated tissue produces calcified formations that resemble cartilage or bone

Causes
* Single severe impact
* Repeated impact to soft tissue
* Improper care of a contusion

Presentation
* Pain
* Muscle weakness
* Soreness
* Swelling
* (+) palpation

51
Q

Buttock & Posterior Thigh Pain Pathologies

A
  • Sacroiliac Joint Dysfunction
  • Proximal Hamstring Rupture
  • Hamstring Syndrome
  • Piriformis Syndrome
  • Muscle Strain
52
Q

Hamstring Syndrome

A

Possibly preceded by:
* Episodes of hamstring injury
* Previous low back pain or
surgery

Triad:
* Painful sitting
* Positive SLR and/or slump
* Painful resisted knee flexion

Negative SIJ provocation tests

53
Q

Piriformis Syndrome

A

Follows direct trauma to gluteal
region

Compression of sciatic nerve

+ SLR and/or slump
Painful sitting
Negative SIJ provocation
(-) resisted knee flexion

Extra Tests:
* (+) resisted IR in F, Add, ER (FADER)
* (+) passive ADD in sidelying with hip flexed 60 degrees
* (+) tenderness at sciatic notch

54
Q

Hamstring Strain

A

Stretching or tearing of the
hamstring muscle(s)

Nonpainful sitting
(-) SLR and/or slump
(-) SIJ Provocation
(+) resisted knee flexion
(+) palpation

55
Q

Trochanteric Bursitis

A

Inflammation/irritation of the
bursa

Pain in the lateral hip
pain may radiate down to the
knee

Palpation reveals tenderness
over the lateral aspect of the
greater trochanter

56
Q

p

A