Hip Assessment

Question 1

standing observation

Answer 1

from behind
* · spinal alignment
* · iliac crest levels, PSIS levels
* · gluteal bulk, gluteal folds, knee creases

from side
* · pelvic tilt, knee hyper extension, gluteal bulk
* · flexion deformity of the hip or knee

from front
* · iliac crest levels, ASIS levels, level of base of patella
* · quads bulk
* · alignment of femur and tibia (?rotated)
* foot posture

Question 2

standing functional tests

Answer 2

Assess for pain reproduction and assess the quality and quantity of movement at the hip, lx / pelvis, knee and ankle. Asterisk for comparable signs.

· sit to stand, stand to sit
· flexion of non weight bearing hip ie. dressing
· walking
· limp
· uneven weight bearing
· external or internal rotation of the

hip · squatting (with overpressure if no pain) · rotation of trunk on one leg (for hip internal and external rotation) · stairs / steps · jog, hop if necessary

lumbar spine active movements

Question 2

supine observation

Answer 2

· leg length - measure if appropriate
· resting position of hip/lower limb rotation

Question 3

supine palpation

Answer 3

• temperature change / thickening / tenderness of trochanteric bursa
• hernia (palpate during coughing in area of inguinal ligament)
• hip joint line

greater troch
pubic symphysis
ischial tuberosity
joint line- inguinal ligament/ hernia/ femoral pulse

Question 4

supine active physiological movements

Answer 4

Instruct the patient to stop as soon as they feel pain and record the range that this occurs at. Record which pain is reproduced. Asterisk signs.

• flexion
• internal and external rotation in neutral
• internal and external rotation in 900
• abduction, adduction – with stabilisation of pelvis

Question 5

supine passive physiological movements

Answer 5

· flexion
· internal and external rotation in neutral
· internal and external rotation in 90°
abduction, adduction – with stabilization of pelvis

Question 6

supine passive combined movements

Answer 6

If the patients pain has not been reproduced with any active or passive movement tests then perform:
* hip quadrant - hip flexion / adduction in an arc from full adduction in 900 flexion to the limit of flexion and neutral adduction.
* faber’s test - hip abduction / external rotation in 800 flexion

Question 7

supine static muscle tests

Answer 7

indication of the general strength of the muscle. May need to assess the strength of the muscle through range.
· hip flexors (iliopsoas, quads)
· hip extensors (gluteus maximus, hamstrings)
· abductors (gluteus med / min, TFL)
· adductors (add mag / br / longus, gracilis)
· rotators

Question 8

supine muscle length tests

Answer 8

Patient stands at the end of the plinth, one knee to chest, roll back into supine on end of plinth.
* iliopsoas (normal = thigh approximately horiz)

• rectus femoris (normal = knee approx 90° flexion with thigh horiz)
• iliotibial band (normal = approx to mid line with thigh horiz)
• adductors (normal = approx to mid line with thigh horiz)

**approx + 10° to each of the above tests on over pressure.

Question 9

prone

Answer 9

active movement- extension note the pattern of recruitment between glute max, hamstrings, erector spinae

ideal - ham, glutes, back

Question 10

trendelenburg

Answer 10

• patient to stand holding onto a surface
• therapist palpates PSIS
• patient stands one one leg
• assess if theres a drop in PSIS on the opposite side to leg standing on positive
• detects a weakness in the gluteus medius

Question 11

Quadrant test

Answer 11

Why- nonspecific hip pathology and a change in ROM. Impingement test
How - one hand on patients foot and other on knee. Patient into flexion scoop knee from shoulder to shoulder. Look for pinching and pain.as a positive indication.

Question 12

FADDIR

Answer 12

Why- is used for examine the Femeroacetabular impingement syndrome, anterior labral tear and iliopsoas tendinitis.

How- patient in supine, hip fully flexed, adduct the hip with combined internal rotation. Positive test= pain at groin

Question 13

FADER

Answer 13

Why- impingement test, gluteal tendinopathy- greater trochanteric pain syndrome lateral hip pain

How- patient in supine, knee in 90 degrees flexion, put hip into flexion, adduction and internal rotation

Question 14

FABER

Answer 14

Why- impingement,

How- patients foot placed on opposite knee then let their leg drop down to the side.

Question 15

Obers

Answer 15

Why- tests for tight TFL and IT band

How- patient lies on side with painful side up. Bottom leg bent forwards. Therapist holds under the knee and passively abducts and extends leg. Lower leg towards table until motion is restricted

Question 16

thomas

Answer 16

Why- measure hip flexor flexibility and quads flexibility

How- patient stands at the end of bed, hugs leg into maximal flexion and then therapist aids patient to lie down on the bed. Therapist push’s foot into 90° flexion if this makes the leg lift up and puts the hip into more flexion it means the quads are tight

Question 17

straight leg raise

Answer 17

Why- test for herniated disc and nerve root irritation. Hamstring tightness

How- therapist passivley moves the hip into flexion with the knee in extension.to get more of a nervy feeling lift the patients head up and flex foot

1. This test places tensile stresses at the sciatic nerve and of traction at the lumbosacral nerve roots primarily from L4 ton S2.
2. The pain or tenderness is often localised in the vicinity of the greater sciatic notch

Question 18

leg length measurement

Answer 18

• discrepancy can be bony or functional
• x-ray measurement (bony)
• Direct- measure ASIS to tip of lateral malleouls (take mean of 2-3 measurements)
• indirect- height of iliac crest/ASIS in standing, comparison of skin creases

Question 19

functional tests

Answer 19

• sitting
• standing
• walking - WB/limp, external/internal rotation of hip
• lye to sit - sit to lye (can they abduct the hip to get on and off the plinth
• steps
• single leg stand - palpate PSIS- trendelenburg test (+ive if pelvis drops on non-wb side)
• squat/mini dip/hop/jog- higher level

Question 20

SLR findings

Answer 20

• Pain that does not increase with neck flexion may indicate a lesion in the hamstring area (tight hamstrings) or in the lumbosacral or sacro-iliac joint.
• Pain that increases with neck flexion or foot dorsiflexion or both indicates stretching of the dura mater of the spinal cord or a lesion within the spinal cord (e.g. disc herniation, tumor, or meningitis
• If symptoms are primarily back pain, it is most likely the result of a disc herniation applying pressure on the anterior theca of the spinal cord, or the pathology causing the pressure is more central. “Back pain only” patients who have a disc prolapse have smaller, more central prolapses
• If pain is primarily in the leg, it is more likely that the pathology causing the pressure on neurological tissue(s) is more lateral
• Disc herniations or pathology causing pressure between the two extremes are more likely to cause pain in both areas