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Ax Midterm > Hip Assessment > Flashcards

Hip Assessment Flashcards

1
Q

What do you want to rule out when dealing with hip pain?

A

Serious conditions such as tumors, infections, stress fx and slipped capital femoral epiphysis (12-15 year old). Refer to doctor

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2
Q

What are the most common hip conditions in young and middle aged active adults?

A

Femoral acetabular impingement, acetabular dysplasia and/or hip instability and labral/chondral or ligamentous teres tears

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3
Q

What structures are involved in an external snapping hip?

A

IT over greater trochanter

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4
Q

What structures are involved in an internal snapping hip?

A

iliopsoas over pelvic rim

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5
Q

What structures are involved in an intra-articular snapping hip?

A

symptom of other pathologies no actual structures rubbing against each other

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6
Q

What are some possible intra-articular injuries?

A

Femoral acetabular impingement
Acetabular labral tear
Chondral injuries
Synovitis
Intra-articular pathologies usually radiate to anterior and medial hip due to structures being innervated by femoral and obturator nerve

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7
Q

What can refer pain to the posterior hip/thigh?

A

proximal hamstring tendinopathies, obturator internus/gemelli, sacral stress fracture, piriformis syndrome, ischiofemoral impingement, sacral neuropathies

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8
Q

What can refer pain to the lateral hip/thigh?

A

Tendinosis of glute medius and minimus, thickening of IT band, trochanteric bursitis
Labral tear may refer laterally

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9
Q

What can refer pain to the anterior hip/thigh?

A

C-sign (ant medial thigh)
OA primary consideration with restriction in hip flexion and internal rotation
Labral tears
FAI, iliopsoas impingement, internal snapping hip, stress fractures, capsular laxity
Tendinopathies of rectus abdominus and osteitis pubis are extra articular pathologies

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10
Q

How is age relevant when dealing with hip pain?

A

It can help narrow our diagnosis
Legg-Calves-Perthes Disease (3-11y)
Slipped femoral epiphysis (12-15y)
Labral tear (adolescents-adults)
OA and osteoporotic fractures (older adults)

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11
Q

What are some alarming symptoms that would require additional screening to rule out infection and cancers?

A

Fever, malaise, night sweats, weight loss, history of drug abuse, past or present diagnosis of cancer or being immunocompromised

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12
Q

What are the common hip pathology pain regions?

A

Groin
Buttock
Thigh
Knee

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13
Q

What is the difference between an active and latent TP?

A

active TP: cause referred pain
Latent TP: only cause pain when you push into it

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14
Q

What is the differential diagnosis summary of hip joint pathology?

A

Groin or thigh pain
symptoms radiate into buttocks or knee (never below the knee)
No neuro deficits reported
Increased pain with loading activities or night pain
Complaints of hip stiffness or catching sensations

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15
Q

What observations significantly predicted an injury originating from the hip and not the spine?

A

presence of a limp groin pain and decrease in internal rotation

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16
Q
A
17
Q

What are some functional tests of the hip?

A

squatting
going up and down the stairs (1 at a time or 2+ at a time)
Crossing your ankle over your knee
Running straight ahead
Running and decelerating
Running and twisting
One legged hop
Jumping
90/90

18
Q

What helps rule out facet joint pathology almost conclusively?

A

Seated extension and rotation test

19
Q

What tests should you perform to rule out the SIJ?

A

combo of thigh thrust, distraction, compression, sacral thrust, and Gaeslens tests

20
Q

What does external rotation of the legs with lat foot on table indicate when pt is supine with legs relaxed?

A

Anterior capsule laxity or hip retroversion

21
Q

What does little to no external rotation of the legs indicate when pt is supine with legs relaxed?

A

limited anterior capsule mobility or anteversion

22
Q

What ROMs is the piriformis involved in?

A

in neutral, helps with external rotation and abduction
With hip flexion past 60 degrees, internal rotation and abduction

23
Q

What is the clinical prediction rule for hip OA?

A
  1. Limited active flexion with lateral hip pain
  2. Active hip extension causes pain
  3. Limited passive hip medial rotation (25<)
  4. Squatting limited and painful
  5. Scour test with adduction causes lateral hip or groin pain
  6. Ask their age
    4 out of 5 must be positive
24
Q

What is FADDIR?

A

Pt supine
AT takes hip into full flexion, lateral rotation and full abduction to start
AT extends the hip combined with medial rotation and adduction
Positive: pain, locking, clicking or catching
Anterior impingement, anterior labral tear, intra-articular pathology
(**Good to determine intra-articular pathology NOT existing)

25
Q

What is FABER’s?

A

flexion abduction and external rotation (figure 4)
+ve if maneuver recreates Pt pain
testing for: intraarticular hip joint patho, SIJ, illiopsoas spasm
If Pt has posterior hip pain then SIJ may be problem, if groin pain occurs without loss of motion the problem is most likely native to the hip

26
Q

What is the Scouring Maneuver (Quadrant Test)?

A

Subject supine
hip max flexed and adducted
Then with compressive force applied down axially move femur through top arch
+ve: recreates pain

27
Q

What is the Flexion-Internal Rotation test?

A

supine
affected hip flexed to 90 degrees (can do 0 degrees log roll)
AT passively internally rotates the leg
Other hand used to apply pressure to stabilize opp. ASIS
+ve: recreates pain, locking, clicking, or catching

28
Q

What is the posterior Labral tear test?

A

pt supine
AT passively brings hip into full flexion, adduction and medial rotation to start
Moves hip into extension, abduction and external rotation
+ve: apprehension, reproduce symptoms, click, groin pain

29
Q

What is Stinchfield’s Test?

A

Designed to help distinguish between intra and extra articular hip pathologies
Pt supine, asked to light straight leg 30-45 degrees
If no pain, provide a downward force on raised leg
+ve: pain produced with or without resistance (anterior thigh or groin)

30
Q

What is the Log Roll Test?

A

does not stress extra articular tissue
Pt supine with legs straight
Examiner passively rotates the femur medially and laterally to compare
Looks at hip mobility
+ve: restriction or painful, click can indicate labral tear, and excessive lat rotation may indicate a lax iliofemoral ligament

31
Q

What tests are good to rule out intra-articular hip pathologies?

A

Combo of FABER, Hip scour and Stinchfield (if all 3 negative)

32
Q

What tests are good to rule in intra-articular hip pathology?

A

Thomas test
Pt clicking or locking in history

33
Q

What 4 tests are both valid and reliable for the diagnosis of gluteal tendinopathy?

A

Trendelenburg sign
Resisted hip abduction
Resisted hip internal rotation
Hip external de-rotation tests

34
Q

What is a positive Trendelenburg sign?

A

Pelvis on non stance leg drops

35
Q

What is the hip De-rotation test?

A

hip flexed at 90 and externally rotated, pt brings leg back to neutral against resistance
+ve: spontaneous reproduction of patients pain

36
Q

What is the Sign of Buttocks Test?

A

Supine and do passive SLR. If limitation, the AT flexes the knee to see if hip goes into further flexion

+ve: if no increase==> lesion in butt or hip (not sciatic nerve or hamstring)

37
Q

What is Torque’s Test?

A

Pt supine close to edge of table, extend leg till ASIS moves medially rotate femur to end ROM and then apply a PA of head of femur for 20 sec
+ve: if recreates symptoms (tests for capsular ligament stability)

38
Q

What does Coxa valga result in?

A

bow legged, increased angle between femoral shaft and neck (>135)

39
Q

What does coxa vara result in?

A

knocked knees, decreased angle between femoral shaft and neck (<105)

Ax Midterm (4 decks)

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