10/14 - Hip Exam Considerations

Question 1

what is the significance of subjective history

Answer 1

may determine up to 90% of dx

Question 2

what are 6 components of hisotry

Answer 2

subjective hx
MOI
chronicity
pain intensity
sport demands
activity status

Question 3

what does pain w static positions indicate

Answer 3

intra-articular path

Question 4

what paths may be associated w sitting buttock pain (4)

Answer 4

ischial bursitis
hamstring syndrome
gluteal bursitis
lumbar disk

Question 5

what does pain w dynamic activity indicate

Answer 5

extra-articular / ms

Question 6

what does pain w walking on level ground indicate

Answer 6

dysplasia
hip flexors

Question 7

what does pain with walking up stairs indicate

Answer 7

inc demand on ABDs

Question 8

what does pain with deep flexion indicate

Answer 8

possibly FAI

Question 9

what does sharp pain indicate and what other sx are typically associated

Answer 9

labrum or articular loose bodies
- clicking, catching, locking

Question 10

what does a C-sign indicate

Answer 10

intra-articular path

Question 11

what does burning pain indicate

Answer 11

nerve entrapment

Question 12

what nerves at the hip are at risk for being entrapped (6)

Answer 12

femoral
lateral femoral cutaneous
ilioinguinal
genitofemoral
obturator
sciatic

Question 13

if in addition to burning pain, the patient is also experiencing paresthesias, numbness, weakness - what should be considered

Answer 13

lumbar involvement

Question 14

what is one of the first things to consider when hearing of night pain

Answer 14

r/o systemic dz, tumor

Question 15

what should be considered when getting imaging for a hip

Answer 15

high prevalence of (+) findings in asymptomatic people
- abnormalities seen might not even have anything to do w sx

Question 16

since imaging shouldn’t be done in isolation, what other things should be considered (2)

Answer 16

sx
clinical signs

Question 17

what sx are more likely to be coming from the hip than the spine

Answer 17

limp
groin pain
dec IR

Question 18

how does labral path pain present

Answer 18

central groin and peritrochanteric

Question 19

what does (-) groin pain r/o

Answer 19

labrum and FAI involvement

Question 20

in a relaxed supine position, why would inc ER be seen

Answer 20

lax ant capsule
retroversion

Question 21

in a relaxed supine position, why would dec ER be seen

Answer 21

ant capsule restriction

Question 22

what primary motions will you see dec strength in if a patient has hip related pain

Answer 22

ADD
ABD
flex
ER
IR

conflicting evidence on ext

Question 23

how does 90deg of hip flex vs <90deg bias hip flexors

Answer 23

90deg - biases psoas
<90 - biases many other flexors

Question 24

what position should ADD be tested and why

Answer 24

neutral
- flex may be provocative

Question 25

fulcrum test

Answer 25

tests for stress fracture (ie femoral neck) - through recreating sx by loading or creating vibration moment

Question 26

tension-sided vs compression-sided femoral neck stress fracture

Answer 26

tension sided - sup lat neck - high risk compression sided - inf med neck - low risk

Question 27

when will pts with a femoral neck stress fx have sx

Answer 27

in WB - esp running or hopping - when loading the joint

Question 28

why are tension sided femoral neck stress fx problematic and who are they often seen in

Answer 28

often non union and develop into AVN - see in younger, female, endurance athletes

Question 29

where can lumbar spine sx refer to

Answer 29

hip and gluteal regions

Question 30

what are ways to test for discogenic/radiculopathy (2)

Answer 30

repeated motion SLR

Question 31

how can you test for lumbar facet related pain

Answer 31

extension rotation test

Question 32

what test is used to test for SIJ originated pain and how does this work

Answer 32

thigh thrust - post force on femur into acetabulum shears the pelvis on the sacrum

Question 33

what is a (+) FADDIR

Answer 33

sx of ant hip pain/discomfort reproduced

Question 34

what is FADDIR testing for

Answer 34

intra-articular hip path

Question 35

sensitivity and specificity of FADDIR

Answer 35

high sensitivity - if neg, confident that not poor specificity - if pos, doesn't tell us that it is intra articular hip path for sure

Question 36

what is the most specific test for hip injuries

Answer 36

log roll

Question 37

what is a log roll test doing

Answer 37

rotates fem head in relation to acetabulum without stressing surrounding structures

Question 38

what is a (+) log roll

Answer 38

"click"

Question 39

what is a consideration of the log roll test

Answer 39

not sensitive

Question 40

how can sx be interpretted from a FABER test

Answer 40

post sx - SIJ ant sx - acetabulum femur joint stretch - ms length

Question 41

what are the 4 defined clinical extra-articular entities for groin pain

Answer 41

ADD related iliopsoas related inguinal related pubic related

Question 42

what are 2 ways to test for ADD related groin pain

Answer 42

ADD tenderness w palpation pain w resisted testing

Question 43

what test do you use the traffic light approach for with ADD related groin pain

Answer 43

testing w pain if squeezing legs together - red light >5/10 pain - want pain <5

Question 44

what are 3 ways to test for inguinal related groin pain

Answer 44

palpation - inguinal canal / lower ab pain pain w resisted ab testing pain w cough/sneeze

Question 45

what is a way to test for pubic related hip pain

Answer 45

palpate - pain at pubic symphysis region

Question 46

what can cause irritation at pubic symphysis manifesting in groin pain

Answer 46

rotation at one side of pelvis while other is stable - shearing is created

Question 47

what are 3 ways to test for iliopsoas related groin pain

Answer 47

palpate - iliopsoas tenderness pain w resisted hip flex pain w hip flex stretching

Question 48

what are functional tasks impacted by hip-related pain

Answer 48

1. dec squat depth 2. impaired single-leg balance - trendelenburg sign 3. hopping tasks - conflicting evidence

Question 49

what are dynamic assessments to assess someone with hip-related pain (3)

Answer 49

1. timed lateral step-down 2. star excursion balance test 3. Y balance test

Question 50

what does a normal timed lateral step down look like

Answer 50

stable pelvis with no trunk compensations stable pace

Question 51

what are compensations seen in a lateral step down (4)

Answer 51

trunk lean trunk flexion pelvic drop knee valgus

Question 52

what plays a large role in the compensations seen in lateral step down

Answer 52

influence of hip position

Question 53

what dynamic assessment has components of FADDIR

Answer 53

timed lateral step down

Question 54

what does the star excursion balance test test for

Answer 54

strength flexibility proprioception

Question 55

what directions does the Y balance test assess in

Answer 55

anterior posteromedial posterolateral

Question 56

what are ways to assess the Y balance test

Answer 56

both quantitatively (distance) and qualitatively (good form)

Question 57

what outcome measures are utilized in young and middle aged adults w hip related pain

Answer 57

hip and groin outcome score (HAGOS) international hip outcome tool (iHOT)

Question 58

what context were the two patient reported outcome tools devleoped in

Answer 58

surgical context

Question 59

tests w high sensitivity should be used early w hip pain to r/o what

Answer 59

fx hip path SIJ