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Semester 2 PM Exam 7 > Hip Exam and Eval > Flashcards

Hip Exam and Eval Flashcards

1
Q

The big 4

A

Observation, gait, ROM, palpation

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2
Q

Large percentage of hip complaints stem from

A

lumbar spine/pelvis

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3
Q

Hx should include

A

Mechanism, severity, onset, area, type of pain, 24 hour pain, weightbearing, agg and rel positions, numbness/tingling, hx of low back problems, diagnositc imaging, surgery, changes in ADL, red flag questions

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4
Q

Purpose of history

A

Develops a diff dx
Gives us red flags or specific concerns
Assists with determining if pt fits into scope of PT
Determine pt goals

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5
Q

Diff Dx - SI or lumbar spine

A

Previous hx of back pain

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6
Q

Diff Dx - Mm strain

A

Onset of symptoms, area of pain

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7
Q

Diff Dx - Mm tear

A

onset of symptoms, area of pain

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8
Q

Diff Dx - Tendonitis

A

Onset of symptoms, area of pain

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9
Q

Diff Dx - Avulsion

A

Onset of symptoms, area of pain

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10
Q

Diff Dx - Bursitis

A

Ilipsoas, Iliopectineal, ischial tubercle, greater troch, area of pain and onset

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11
Q

Diff Dx - DJD

A

Onset, x-ray, age, groin pain, radiating to knee, morning stiffness, OA in other joints, pain with prolonged ambulation

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12
Q

Diff Dx - Stress fracture

A

onset, xrays, rule out other pathology, osteoporotic, athlete

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13
Q

Diff Dx - synovitis

A

onset, intensity of pain

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14
Q

Diff Dx - Labral Tear

A

Athlete, trauma, clicking

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15
Q

Diff Dx - avascular necrosis

A

previous trauma, congenital hip dislocation, Legg Calve perthes, slipped capital femoral, steroid use, deep aching throb in hip

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16
Q

Diff Dx - Pubic symphysis dysfunction

A

Previous history of back pain, trauma

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17
Q

Diff Dx - Lower abdominal strain

A

area of pain

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18
Q

Dff Dx - Entrapment of nerves

A

femoral, obturator, iliohypogastric, numbness/weakness in leg

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19
Q

Diff Dx - Leg Calve Perthes

A

Age, positioning of limb

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20
Q

Diff Dx - Slipped capital femoral epiphysis

A

Age, leg position

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21
Q

Diff Dx Osteoid osteoma

A

Onset of sx, night sweats, loss of weight, rule out musculoskeletal/neuro path

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22
Q

Diff Dx Meralgia paresthetica

A

Abnormal sensation in testing lateral femoral cutaneous

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23
Q

Diff Dx Inguinal/femoral hernia

A

onset of sx, bulging at site

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24
Q

Diff Dx - Muscle calcification

A

previous muscle contusion

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25
Diff Dx - tumor
night sweats, rule out musculoskeletal/neuro
26
Diff Dx - inflammatory synovitis
history of it, systemic issues versus single joint
27
Diff Dx - subluxation
trauma
28
Diff Dx - Dislocation
Trauma
29
Diff Dx - Infection
fever, acute pain
30
Diff Dx - Inflamed lymph nodes
palpation will reveal, need to rule out musculo/neuro
31
Diff Dx - Referred visceral pain
Rule out musculo/neuro
32
Diff Dx - thrombosis of femoral artery, great saphenous vein, gluteal arteries
pulses, are of pain
33
Diff Dx - bladder infection
fever, pain with urination
34
Diff Dx - congenital hip dislocation
age
35
Diff Dx - septic arthritis
Fever, history of infection
36
Lumbar scan
Observation/palpation Gait AROM and overpressure If needed - PA spring, neural, dermatomes, myotomes, reflexes
37
Lumbar scarn observation/palpation
Lumbar spine and hip Anteversion or Retroversion Knee and foot position LE sx can radiate up to hip and vica versa
38
Lumbar Scan - Gait
observe lumbar spine and LE Determin pain level with WB ROM with gait Trendelenburg or any other muscle weakness
39
Lumbar Scan - Neuro
Slump, SLR, derm, myo, reflexes
40
How to clear joint below
Knee | AROM and overpressure
41
Hip tests and measures
``` Observation Gait AROM and overpressure Palpation Muscle contraction Joint mob Flexibility Special tests Functional tests Outcome measures ```
42
Observation - Posture
Anteversion/Retroversion Coxa vara/valga Leg length differences
43
If patient has lordotic posture...
weak RA, tight iliopsoas
44
If patient has sway back
weak iliopsoas, tight ES, tight hams, weak glut max
45
If patient has asymmetrical iliac crests
tight hip abductors, tight quadratus lumborum
46
Balance/Gait - One leg stand
Trendelenburg Balance PF strength
47
Balance/Gait - Gait
Affect of posture on gait Balance Pain with gait
48
AROM
``` Flexion Extension Abduction Adduction IR ER ```
49
Hip Flexion -
Sitting or supine (Usually supine)
50
Hip Extension -
Supine - doesnt asses extensors unless PT adds resistance Prone - only tests a limited range Sidelying - resistance can be applied to imitate gravity, pelvis has to be stabilized
51
Hip Abduction
Supne
52
Hip Adduction
Supine
53
Hip IR
Supine - hip 90 degrees
54
Hip ER
Supine, hip 90 degrees
55
Hip OA cluster
Hip IR less than 15 Hip flexion less than or equal to 115 Age greater than 50
56
Hip OA cluster 2
Hip IR greater than or equal to 15 Pain with hip IR Morning stiffness of hip for up to 60 min Age greater than 50
57
End Feels for hip in normal
should all be tissue resistance (springy/muscular)
58
Muscle testing
Myotomal testing GMT MMT Resisted contraction of muscle
59
GMT
helps you determine general strength
60
MMT
for specific muscles that are weak
61
Resisted Contraction
used to determine if greater muscle contraction will cause pain Isolates to a muscle or tendon problem Resisting muscle in lengthened position is a good way used for subtle lesions that midrange contraction may not pick up
62
Strong and painless Resisted COntraction
Normal or very isolated minor pathology
63
Strong and painful Resisted contraction
Minor/moderate pathology of mm, tendon, bursa
64
Weak and painful resisted contraction
more acute or major pathology of mm, tendon, fracure
65
Weak and painless resisted contraction
serious pathology, nervous system, tumor
66
Joint mobility assessment
Resting (open packed) position Close packed position Capsular pattern
67
Resting (open packed) position
Flexed 30 degrees, abd 30 deg, slight lateral rotation
68
Close packed position
max ext, medial rotation and abduction
69
Capsular pattern
medial rotation, flexion, abduction = extension
70
in treatment when contractile tissues are lengthened...
follow with lengthening non contractile tissue and vice versa
71
Joint Mobility Assessment
Lateral distraction Longitudinal Distraction Anterior Posterior Posterior Anterior
72
Flexibility
``` Thomas Modified Thomas Elys Ober Modified Ober Hamstring Piriformis ```
73
Below 60 degrees of hip flexion, piriformis is
an external rotator
74
Above 60 degrees of hip flexion, piriformis is
a medial rotator and horizontal abductor
75
Special Tests
Scour | FABERE
76
Scour test
nonspecific for medial - anterior lesions and when done in abduction for posterior-lateral lesions
77
FABERE test
non specific for screening hip pathology if pain is in hip
78
Labral Tests
Internal rotation, compression = high Sn, poor Sp | MRA is best
79
Craigs Test
Used to assess anteversion/retroversion | Determine the point where GT is most lateral
80
Leg Length Test
x ray is gold standard
81
Activity limitations and participation restrictions
``` One leg balance Sit to stand Single leg squat Step ups Step downs Isolated sport activity 6 min walk test TUG ```
82
Outcome Measures - Lower Extremity Functional Scale
Intended for clients with musculoskeltal condition of LE Low score = 0, high = 80 Discriminating btw acute and chronic, surgery/ no surgery and clients recieving or not recieving home care
83
For individual patient to evaluate true change with LE functional scale../
minimally important differece = 9 points
84
Outcome Measures - Patient Specific Functional Scale
Clients identify up to 5 activities with which they have difficulty Clients rate 0-10 of current level of difficulty
85
Minimally detectable change for Patient specific functional scale
2.5 points
86
WOMAC - outcome measures
3 scales, pain stiffness and physical function | Mainly for OA
87
Harris Hip Score - outcome measures
Used by physicians for total hip replacement | Surgery deemed successful if score inc 20 points plus radiology looks stable
88
Final Eval
``` Tx dx Prognosis Goals Plan Intervention ```

Semester 2 PM Exam 7 (8 decks)

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