Hip examination

Question 1

What to think with clicking, catching of hip: pain increased by full flexion or extension

Answer 1

Acetabular labral tears

Question 2

What to think with constant low back/buttock pain with same side groin pain

Answer 2

Hip OA

Question 3

What to think with Lateral thigh pain: increasing when moving from sit to stand

Answer 3

Greater trochanteric bursitis, Muscle strain

Question 4

What to think with Age >60, pain and stiffness in hip with possible radiation to groin

Answer 4

Hip OA

Question 5

What to think with deep aching throb to hip or groin: possible history of prolonged steroid use

Answer 5

Avascular necrosis

Question 6

What to think with Sharp pain in groin

Answer 6

Femoroacetabular (anterior) impingement

Question 7

What to think with pain in the gluteal region with occasional radiation into posterior thigh and calf

Answer 7

Piriformis syndrome, hamstring strain, ischial bursitis

Question 8

What is Baer’s line

Answer 8

between ASIS and umbillicus

Question 9

How would you palpate Iliopsoas

Answer 9

Supine, Contralateral leg is help up by pt. Leg you are palpating is extended.
Then using Baer’s line (ASIS and Umbillicus) move 1/3 away from umbillicus and press into abdominal soft tissue

Question 10

Closed Packed Position for hip

Answer 10

Max Ex, IR, slight abduction

Question 11

Open packed position for the hip

Answer 11

30 Flexion, 30 ABduction, Slight ER

Question 12

Capsular pattern for the hip

Answer 12

Flex=ABduction=IR, slight loss of ex, little to no loss ER

Question 13

Trendelenburg Test

Answer 13

For Lateral Hip tendon pathology

Standing pt raises one leg 10cm  and holds 30 sec
Is a (+) test if:
pelvis drops on the raised leg or 
trunk shifts to stance leg >1 inch

Question 14

Trochanteric Bursitis Test

Answer 14

For trochanteric bursa inflamm or irritation

Pt is S/L with affected side up, stabilize pelvis and then
extend hip and flex knee -> moving into adduction and then flexion

(+) is reproduction of symptoms

Question 15

Ober Test

Answer 15

For TFL/ITB tightness

pt is S/L with examined leg up
Stabilize pelvis and flex knee to 90 degrees and aBduct and extend hip until hip is in line with trunk
Allow gravity to adduct hip as much as possible without medial rotation

(+) unable to adduct towards table
minimal tightness= leg past horizontal but not to table
moderate tightness= leg to horizontal
max tightness= not to horizontal

Question 16

Thomas Test

Answer 16

For tightness of Psoas, TFL/ITB, Rectus

pt is supine at end of table. Make sure pt back is flattened. Then bring one leg towards chest- Make sure not to go all the way to chest this will create a posterior pelvic tilt.
Then begin test of examined leg- this is a passive test
Feeling for rotation of the ASIS the entire time

1. bent knee leg drop- the leg should hit the table (neutral) - if not than psoas may be tight
2. more range in ABduction than neutral= tight TFL
3. when lowering leg if the knee kicks out= rectus tightness

Question 17

S/L Abduction

Answer 17

For assessing muscle imbalances
1. Have pt s/l and Abduct hip- observing the movement pattern. If pt goes into hip flexion or IR think- dominance in TFL

or

2. Place leg into abduction, extension and ER. have them then actively hold the position
   If leg IR or flexes- then think dominance in TFL

Question 18

Straight Leg Raise

Answer 18

For assessing muscle imbalances and movement impairments- and pelvic instability

Pt is supine, palpate greater trochanter and have pt actively perform SLR. The axis of motion should not change much under you finger

(+) if axis moves anterior >1/2 inch- think muscle imbalances around the hip or posterior capsular tightness

Question 19

Patrick’s FABER test

Answer 19

For OA

Pt is supine. then leg is flexed, aBducted and ER.
The lateral ankle is positioned just proximal to opp knee.
Then ASIS on contra side is stabilized and involved leg is lowered and overpressure is added

(+)
reproduction of pain
anterior pain- implies soft tissue shortening or articular pathology
posterior pain- implies SIJ pathology

Question 20

FAIR or FADIR

Answer 20

For impingement test

Pt is supine and leg is flexed, adducted and IR
go into end range and can apply overpressure into IR

(+)
pain in groin or buttock region

Question 21

Scour

Answer 21

For OA

pt supine and hip moves from extension, abduction andER and goes into flexion, adduction and IR
Axially load is applied

(+)
reproduction of symptoms

Question 22

Craig’s Test

Answer 22

For ant/retroversion

Pt is prone and knee flexed to 90 degrees
Palpate greater trochanter- finding the most lateral position
Then measure from knee up the shaft of tibia

Normal = 8-15 degrees

Less= retroversion
more= anteversion

Question 23

Normal range for ant/retroversion of Hip

Answer 23

8-15 degrees

Question 24

Patellar- Pubic - Percussion

Answer 24

For detecting hip fractures

Supine. Tapping on one patella at a time while auscultating the pubic symphysis

(+)
diminution of sound on affected side

Question 25

Leg Length

Answer 25

Supine, Pt performs a bridge and legs 4-8 inches apart
Measure from ASIS to Lat malleolus

(+)
greater than 1/4- 1 inch
Can treat with shoe lift

To do segmental measure:

1. iliac crest to greater trochanter= looking at coxa vara or valgus
2. Greater Trochanter to Lat knee joint= looking at femoral shortening
3. Medial knee joint to med malleolus= looking at tibial shortening

Question 26

Iliopectineal bursa

Answer 26

Supine with hip flex to > 90
with knee maximally flex ( femur should be medial to ASIS)
apply axially load and rotate femur into ER

(+)
reproduction of symptoms in anterior hip joint

Question 27

Trochanteric (gluteal) Bursitis test

Answer 27

Supine with hip and knee flexed to 90 with max adduction

leg full ER= Glut med bursa
Leg full IR= Glut Max bursa

(+)
reproduction of symptoms

Question 28

Fulcrum Test

Answer 28

For Stress Fractures

Pt sitting and legs off plinth
Therapist weaves arm behind one femur and on top of other femur
Then apply force to distal thigh of affected leg

(+)
reproduction of symptoms