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Physical Exam > The Hip > Flashcards

The Hip Flashcards

1
Q

What does C sign mean?

A

sign of intraarticular hip pain

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2
Q

Gait

A
  • Trendelenberg: sign of glut med weakness, hip goes “towards” the weak or painful hip
  • Lurch: body lean over painful hip

*These reduce torque/force over hip by moving COG closer to the painful hip joint

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3
Q

Normal ROM

A
  • flexion: 120-135
  • extension: 30
  • IR: 35
  • ER: 45
  • Abduction: 45-50
  • Adduction: 20-30

*Loss of passive internal rotation= hip OA

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4
Q

Neuro Exam- MMT

A
  • hip flexors (L2)
  • KE (L3)
  • DF (L4)
  • EHL (L5)
  • PF (S1)
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5
Q

Neuro Exam- Sensation

A
  • check lateral thigh if meralgia parenthetic suspected
  • inguinal ligament (L1)
  • anterior/medial thigh (L2)
  • medial knee (L3)
  • medial malleolus (L4)
  • 1st dorsal webspace (L5)
  • lateral foot (S1)
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6
Q

Neuro Exam- Reflexes

A
  • Patellar (L4)
  • Medial hamstring (L5)
  • Achilles (S1)
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7
Q

What 2 tests can you do if you suspect a radiculopathy?

A
  • SLR
  • Femoral stretch test

*90% of radiculopathies go below the knee

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8
Q

What does the Thomas Test evaluate?

A

evaluates for hip flexion contracture/tightness

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9
Q

How to perform the Thomas Test?

A
  • patient supine, brings both knees to chest
  • then lower one leg to table
  • positive test if patient unable to lower leg to table and/or arches thoracic spine when lowering leg

*this may be a cause of internal hip snapping

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10
Q

Trendelenberg Sign

A
  • stand behind patient and ask them to raise one leg

- positve test is when pelvis drops on the side of the elevated leg–> indicated weak glut med on the contralateral side

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11
Q

What does the Ober Test evaluate?

A

-evaluates for IT band tightness

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12
Q

How to perform the Ober test?

A
  • have patient lay on side, passively flex knee to 90 and abduct the hip, keep hip joint at neutral, then release leg
  • positive test is when leg stays abducted or does not fall as far as the other leg
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13
Q

What are the tests for intra-articular hip pathology?

A
  • FABER test: make a “4”; positive test is groin pain in ipsilateral hip or pain in contralateral SI joint
  • Resisted straight leg raise: positive test is groin pain
  • Log Roll test: positive test is groin pain
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14
Q

Apparent vs. true leg length discrepancy?

A
  • apparent: measured from umbilicus to medial malleolus; caused by pelvic obiquity
  • true: measure from ASIS to medial malleolus
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15
Q

What’s a significant leg length difference?

A

at least 2-3cm

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16
Q

How to tell if the leg length difference comes from the femur or tibia?

A
  • patient lays supine on table with knee flexed 90 degrees
  • If one knee is HIGHER= tibia
  • If one knee is more ANTERIOR= femur
17
Q

What is the first physical exam finding in hip OA?

A

-decreased passive internal rotation

18
Q

Bursitis exam finding?

A

Reproduction of pain with palpation over bursa

19
Q

Trochanter bursitis causes?

A
  • glut med weakness
  • L5 radio–> leads to abductor weakness
  • tight IT band
  • leg length discrepancies
20
Q

Lateral hip pain

A

Think trochanteric bursitis

21
Q

What is Femoroacetabular Impingement (FAI)?

A
  • Abutment of femoral head against acetabulum due to osseous abnormality
  • A/w early hip arthritis and labral tears
22
Q

What is the symptoms of FAI?

A
  • Insiduous onset of groin pain usually worse with hip flexion, mechanical symptoms (clicking, locking)
  • Groin pain with hip flexion (i.e. sitting), but walking is fine
23
Q

What are the three types of FAI?

A
  • CAM- think young athletic men; extra bone of the femoral head
  • Pincer- think middle aged women; extra bone of the acetabulum
  • Mixed- most common
24
Q

Exam of FAI?

A
  • Inpingement test: patient supine, passively IR hip, flex to 90, and adduct; basically flex hip and knee towards opposite shoulder
  • positive test is groin pain
25
Q

Imaging for FAI?

A
  • X-ray: “bump on femoral head”

- MR arthrogram: good to evaluate for associated labral tears

26
Q

What are symptoms of hip labral tears?

A

Similar to FAI; groin pain with certain motions and mechanical symptoms

27
Q

What are the special tests for hip labral tears?

A
  • impingement test
  • scour test: maximally flex hip and provide axial load while internally and externally rotating the femur
  • Fitzgerald test (anterior labrum): flexion/abduction/ER to extension/adduction/IR
  • -Fitzgerald test (posterior labrum): flexion/adduction/IR to extension/abduction/ER

*Need MR arthrogram to assess hip labrum

28
Q

Muscle strain during which type of muscle contraction?

A

-fast eccentric (lengthening)–> greatest force

29
Q

Hamstring strain

A

exam reveal pain over muscle belly or origin; palpable defect in muscle; pain with resisted knee flexion

*Need to rule out an avulsion fracture–> tendon pulls off a piece of bone

30
Q

Adductor strain

A

exam reveals tenderness over adductor muscle group and pain with resisted adduction

31
Q

Avulsion fracture

A
  • Many common sites around the hip/pelvis
  • treatment: conservative (rest, ice, ROM, strengthening after full ROM) vs. surgical (high level athletes, displaced apophysis)
32
Q

What is snapping hip syndrome?

A

-inflammation of muscle from overuse leads to tightness and “snapping” of muscle tendon over bony prominence

33
Q

How to distinguish internal vs. external snapping hip?

A
  • Internal: snapping from subluxation of iliopsoas tendon; exam reveals pain with resisted hip flexion, +Thomas test (evaluated hip flexor tightness)
  • External: snapping from IT band subluxation over greater trochanter; exam reveals +Ober test, +tenderness over greater trochanter if bursitis present
34
Q

What is Osteitis pubis?

A
  • Inflammation of pubic symphysis caused by overuse of adductors in athletes, complication of invasive pelvic surgery, childbirth, trauma, etc.
  • Exam reveals pain with resisted adduction, + hop test, tenderness to palpation over pubic symphysis
  • X-rays show peri-articular sclerosis, widening of pubic symphysis
35
Q

What are the 2 types of femoral neck stress fracture?

A
  • Compression type: inferior aspect of femoral neck (conservative)
  • Tension type: “S”uperior aspect of femoral neck (“S”urgery)
36
Q

What are the symptoms of femoral neck stress fracture?

A
  • groin pain progressively worse with activity of ADLs

- Can’t run though a stress fracture! Gets worse.

37
Q

What are the 2 physical exam tests for a femoral neck stress test?

A
  • Fulcrum test: patient seated, place one hand under thigh and apply a downward force on knee; + test is groin pain
  • Patellar Pubic percussion test: place stethoscope over pubic symphysis and tap each patella; + test is sound of tapping decreased on affected side
38
Q

Athletic pubalgia/Sports hernia

A
  • tearing of muscle or tendons just superior to attachment to the superior aspect of the pubis ramus
  • Usually due to imbalance in strength/flexibility of the adductors and ab muscles as they both attach there
  • Exam reveals tenderness around pubic rami, pain with non-resisted and resisted oblique sit-ups, pain with resisted adduction

Physical Exam (7 decks)

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