Test #2 Hip Flashcards
What do you look for during a visual inspection?
- swelling
- ecchymosis
- deformity
What is Trendelenberg?
- the patient stands on the injured leg
- flexes the contralateral hip to 90 degrees
- observe the movement of the pelvis
What is a positive Trendelenberg test?
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
What are the prone ROM test?
Passive hip extension
Passive bilateral IR
Resisted hip extension
Resisted hip IR
Resisted knee extension
Resisted knee flexion
Passive hip extension
- 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
Passive hip bilateral IR
- patient = prone; knees 90 degrees
- examiner = stand at end of treatment table
- Passively internally rotate bilateral hips bringing the ankles/lower legs laterally
Resisted hip extension
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)
Resisted knee extension
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
Resisted knee flexion
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
Resisted hip IR
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
Resisted hip ER
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
Supine ROM tests
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
Passive hip flexion
Patient = supine
Examiner = testing side
- bring hip into full available hip flexion
Passive hip ER
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
Passive hip IR
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
Passive hip adduction
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
Passive hip abduction
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
Passive hip abduction pain
- 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
Resisted hip flexion
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
Resisted hip abduction
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
Resisted hip adduction
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
Resisted hip adduction: muscles tested at each degree
Zero degrees: adductor longus/gracilis
45 degrees: pubic symphysis
90 degrees: pectineus
What are the extra tests?
Femoral Nerve Tension Test
Circumduction Test
Impingement Tests
Prone Impingement Test
Fulcrum Test
Hamstring Syndrome
Piriformis Syndrome
Thomas Test
Femoral nerve tension test!
Patient = side-lying with the affected side up
Examiner = behind the patient
-
Circumduction Test!
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
Impingement Test (axal OP) !
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
Impingement Test (axal OP) positive test
In the femoroacetabular impingement or labral pathology, this test could provoke groin pain or buttock pain
Impingement Test (IR OP)!
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
Impingement Test (IR OP) positive test
In femoroacetabular impingement or labral pathology this could provoke groin pain
Prone Impingement Test!
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
Fulcrum Test
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.
What is a positive fulcrum test?
Test is considered positive for stress fracture if the client reports pain
Hamstring syndrome test
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
What is a positive Hamstring syndrome test?
Positive test is a reproduction of their symptoms in the buttock or back of the thigh suggesting possible compression of the sciatic nerve
Piriformis test
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
Thomas test
- 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
Bones in the pelvis
Ilium
* Ishium
* Pubic
Bones in the hip
Femur
Pelvis
* Ilium
* Ishium
* Pubic
Sacrum
Coccyx
Osteology- Angle of Inclination
Normal = 130 degrees
Coxa Vara = < 125 degrees
Coxa Valga = > 125 degrees
Osteology- Femoral Anteversion
Normal Anteversion =15 - 25 degrees
Excessive Anteversion = > 25 degrees
- Toe In
Retroversion = < 10 degrees
- Toe Out
What are the bursae of the hip?
Trochanteric
Iliopsoas
Ischiogluteal
Groin & Anterior Thigh Pain Pathologies
- Sports Hernia
- Stress Fracture
- Femoroacetabular Impingement
- Labral Tear
- Muscle Strain
- Hip Pointer
Femoroacetabular Impingement (FAI)
+ anterior impingement test
+ FABER
Labral Tear
+++ 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
Stress Fracture
Onset of pain with weight bearing activities
- immediate resolution with stopping weight bearing
(-) basic clinical examination
(+++) hop test
(+) fulcrum test
(+) scanning
Sports Hernia “Athletic Pubalgia”
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
Adductor/Hip Flexor Strain (Groin Strain)
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
Quadriceps Strain
Stretching or tearing of the quadriceps muscle(s)
- Pain & limited knee flexion
- ++ pain resisted knee extension
Hip Pointer
Contusion (bruising) of iliac crest or abdominal musculature
result of direct blow
Myositis Ossificans
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
Buttock & Posterior Thigh Pain Pathologies
- Sacroiliac Joint Dysfunction
- Proximal Hamstring Rupture
- Hamstring Syndrome
- Piriformis Syndrome
- Muscle Strain
Hamstring Syndrome
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
Piriformis Syndrome
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
Hamstring Strain
Stretching or tearing of the
hamstring muscle(s)
Nonpainful sitting
(-) SLR and/or slump
(-) SIJ Provocation
(+) resisted knee flexion
(+) palpation
Trochanteric Bursitis
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
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