Hip Assessment

Question 1

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

Answer 1

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

Question 2

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

Answer 2

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

Question 3

What structures are involved in an external snapping hip?

Answer 3

IT over greater trochanter

Question 4

What structures are involved in an internal snapping hip?

Answer 4

iliopsoas over pelvic rim

Question 5

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

Answer 5

symptom of other pathologies no actual structures rubbing against each other

Question 6

What are some possible intra-articular injuries?

Answer 6

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

Question 7

What can refer pain to the posterior hip/thigh?

Answer 7

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

Question 8

What can refer pain to the lateral hip/thigh?

Answer 8

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

Question 9

What can refer pain to the anterior hip/thigh?

Answer 9

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

Question 10

How is age relevant when dealing with hip pain?

Answer 10

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)

Question 11

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

Answer 11

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

Question 12

What are the common hip pathology pain regions?

Answer 12

Groin
Buttock
Thigh
Knee

Question 13

What is the difference between an active and latent TP?

Answer 13

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

Question 14

What is the differential diagnosis summary of hip joint pathology?

Answer 14

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

Question 15

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

Answer 15

presence of a limp groin pain and decrease in internal rotation

Question 17

What are some functional tests of the hip?

Answer 17

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

Question 18

What helps rule out facet joint pathology almost conclusively?

Answer 18

Seated extension and rotation test

Question 19

What tests should you perform to rule out the SIJ?

Answer 19

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

Question 20

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

Answer 20

Anterior capsule laxity or hip retroversion

Question 21

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

Answer 21

limited anterior capsule mobility or anteversion

Question 22

What ROMs is the piriformis involved in?

Answer 22

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

Question 23

What is the clinical prediction rule for hip OA?

Answer 23

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

Question 24

What is FADDIR?

Answer 24

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)

Question 25

What is FABER's?

Answer 25

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

Question 26

What is the Scouring Maneuver (Quadrant Test)?

Answer 26

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

Question 27

What is the Flexion-Internal Rotation test?

Answer 27

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

Question 28

What is the posterior Labral tear test?

Answer 28

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

Question 29

What is Stinchfield's Test?

Answer 29

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)

Question 30

What is the Log Roll Test?

Answer 30

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

Question 31

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

Answer 31

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

Question 32

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

Answer 32

Thomas test Pt clicking or locking in history

Question 33

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

Answer 33

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

Question 34

What is a positive Trendelenburg sign?

Answer 34

Pelvis on non stance leg drops

Question 35

What is the hip De-rotation test?

Answer 35

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

Question 36

What is the Sign of Buttocks Test?

Answer 36

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)

Question 37

What is Torque's Test?

Answer 37

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)

Question 38

What does Coxa valga result in?

Answer 38

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

Question 39

What does coxa vara result in?

Answer 39

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