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MSK 1 > 10/14 - Hip Exam Considerations > Flashcards

10/14 - Hip Exam Considerations Flashcards

1
Q

what is the significance of subjective history

A

may determine up to 90% of dx

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2
Q

what are 6 components of hisotry

A

subjective hx
MOI
chronicity
pain intensity
sport demands
activity status

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3
Q

what does pain w static positions indicate

A

intra-articular path

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4
Q

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

A

ischial bursitis
hamstring syndrome
gluteal bursitis
lumbar disk

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5
Q

what does pain w dynamic activity indicate

A

extra-articular / ms

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6
Q

what does pain w walking on level ground indicate

A

dysplasia
hip flexors

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7
Q

what does pain with walking up stairs indicate

A

inc demand on ABDs

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8
Q

what does pain with deep flexion indicate

A

possibly FAI

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9
Q

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

A

labrum or articular loose bodies
- clicking, catching, locking

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10
Q

what does a C-sign indicate

A

intra-articular path

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11
Q

what does burning pain indicate

A

nerve entrapment

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12
Q

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

A

femoral
lateral femoral cutaneous
ilioinguinal
genitofemoral
obturator
sciatic

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13
Q

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

A

lumbar involvement

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14
Q

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

A

r/o systemic dz, tumor

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15
Q

what should be considered when getting imaging for a hip

A

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

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16
Q

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

A

sx
clinical signs

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17
Q

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

A

limp
groin pain
dec IR

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18
Q

how does labral path pain present

A

central groin and peritrochanteric

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19
Q

what does (-) groin pain r/o

A

labrum and FAI involvement

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20
Q

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

A

lax ant capsule
retroversion

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21
Q

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

A

ant capsule restriction

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22
Q

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

A

ADD
ABD
flex
ER
IR

conflicting evidence on ext

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23
Q

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

A

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

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24
Q

what position should ADD be tested and why

A

neutral
- flex may be provocative

25
Q

fulcrum test

A

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

26
Q

tension-sided vs compression-sided femoral neck stress fracture

A

tension sided
- sup lat neck
- high risk

compression sided
- inf med neck
- low risk

27
Q

when will pts with a femoral neck stress fx have sx

A

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

28
Q

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

A

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

29
Q

where can lumbar spine sx refer to

A

hip and gluteal regions

30
Q

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

A

repeated motion
SLR

31
Q

how can you test for lumbar facet related pain

A

extension rotation test

32
Q

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

A

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

33
Q

what is a (+) FADDIR

A

sx of ant hip pain/discomfort reproduced

34
Q

what is FADDIR testing for

A

intra-articular hip path

35
Q

sensitivity and specificity of FADDIR

A

high sensitivity - if neg, confident that not

poor specificity - if pos, doesn’t tell us that it is intra articular hip path for sure

36
Q

what is the most specific test for hip injuries

A

log roll

37
Q

what is a log roll test doing

A

rotates fem head in relation to acetabulum without stressing surrounding structures

38
Q

what is a (+) log roll

A

“click”

39
Q

what is a consideration of the log roll test

A

not sensitive

40
Q

how can sx be interpretted from a FABER test

A

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

41
Q

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

A

ADD related
iliopsoas related
inguinal related
pubic related

42
Q

what are 2 ways to test for ADD related groin pain

A

ADD tenderness w palpation
pain w resisted testing

43
Q

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

A

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

44
Q

what are 3 ways to test for inguinal related groin pain

A

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

45
Q

what is a way to test for pubic related hip pain

A

palpate - pain at pubic symphysis region

46
Q

what can cause irritation at pubic symphysis manifesting in groin pain

A

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

47
Q

what are 3 ways to test for iliopsoas related groin pain

A

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

48
Q

what are functional tasks impacted by hip-related pain

A
  1. dec squat depth
  2. impaired single-leg balance
    - trendelenburg sign
  3. hopping tasks
    - conflicting evidence
49
Q

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

A
  1. timed lateral step-down
  2. star excursion balance test
  3. Y balance test
50
Q

what does a normal timed lateral step down look like

A

stable pelvis with no trunk compensations
stable pace

51
Q

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

A

trunk lean
trunk flexion
pelvic drop
knee valgus

52
Q

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

A

influence of hip position

53
Q

what dynamic assessment has components of FADDIR

A

timed lateral step down

54
Q

what does the star excursion balance test test for

A

strength
flexibility
proprioception

55
Q

what directions does the Y balance test assess in

A

anterior
posteromedial
posterolateral

56
Q

what are ways to assess the Y balance test

A

both quantitatively (distance) and qualitatively (good form)

57
Q

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

A

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

58
Q

what context were the two patient reported outcome tools devleoped in

A

surgical context

59
Q

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

A

fx
hip path
SIJ

MSK 1 (31 decks)

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