Hip Examination

Question 1

What are the flexor muscles of the hip? What nerves innervate them?

Answer 1

Iliopsoas
Sartorius
TFL
Rectus Femoris
Adductor Longus
Pectineus

femoral nerve

Question 2

What are the extensor muscles of the hip? What nerves innervate them?

Answer 2

Gluteus Maximus
Adductor Magnus (posterior)
Biceps femoris(long)
Semitendinosis
Semimembranosus

inferior gluteal, obturator, and sciatic nerves

Question 3

What are the external rotators of the hip? What nerves innervate them?

Answer 3

Gluteus Maximus
Piriformis
Obturator Internus
Gemellus Superior
Gemellus Inferior
Quadratus Femoris

Inferior gluteal nerve and nerves to piriformis, obturator, gemellus superior and inferior, and quadratus femoris.

Question 4

What are the adductor muscles of the hip? What nerve innervates them?

Answer 4

Pectineus
Adductor Longus
Adductor Brevis
Adductor Magnus (anterior/posterior)

Obturator nerve

Question 5

What are the abductor muscles of the hip? What nerve innervates them?

Answer 5

gluteus medius (all)
gluteus minimus (all)
TFL

superior gluteal nerve

Question 6

What type of joint is the hip? how many degrees of freedom does it have?

Answer 6

multiaxial ball and socket joint

3 degrees of freedom

Question 7

What are normal ROM for hip:
flexion?
extension?
abduction?
adduction?
ER?
IR?

Answer 7

flexion- 110-120 degrees
extension- 10-15 degrees
abduction- 20-50 degrees
adduction- 20 degrees
external rotation- 40-60 degrees
internal rotation- 20-40 degrees

Question 8

What’s the closed pack postion of the hip?

Answer 8

full extension, slight abduction, slight IR

Question 9

What’s the loose pack postion of the hip?

Answer 9

30 degrees flexion, 30 degrees abduction, slight ER

Question 10

What’s the capsular pattern of the hip?

Answer 10

flexion, abduction, IR

Question 11

What’s a normal angle of inclination?

What forces will be experienced with coxa vara/valga

Answer 11

125 degrees

105 or less = coxa vara
increased downward sheer across femoral neck, decreased compression, and decreased functional length of hip abductor muscles

140 or more = coxa valga
increased limb length, decreased sheer, increased compression over decreased available weight bearing surface, increased functional length of hip abductor muscle

Question 12

What is normal anteversion? How do you test it?

Answer 12

8-15 degrees

craig’s test.
pt prone, feel for where greater trochanter is most lateral and measure bisection of tibia against vertical.

Question 13

What are general observations you need to make for someone with hip complaint?

Answer 13

age, sex, weight, fitness level, independence, assistive device.

Question 14

What should you ask in the subjective examination?

Answer 14

Where is the pain?
What position makes it increase or decrease?
What does it feel like?
Describe how it changes during a 24 hour period.
Motion problems?
Mechanism of Injury?

Question 15

What is the possible source of groin pain?

Answer 15

hip

Question 16

What is the possible source of anterior medial thigh pain?

Answer 16

hip

Question 17

What is the possible source of posterior pain?

Answer 17

Lumbar spine

Question 18

What is the possible source of lateral thigh pain?

Answer 18

Lumbar spine

Question 19

What is the possible sources of lateral hip pain?

Answer 19

trochanteric bursitis
gluteus medius strain
L4 Nerve root pain

Question 20

Classically, what pain is in the anterior groin area and radiates to the medial thigh?

Answer 20

hip

groin

Question 21

what is the “c-sign” characteristic of?

Answer 21

joint pathology
(often misunderstood as a lateral disorder)

Question 22

Stiffness in the AM or after sitting that disappears within half an hour is characteristic of what?

Answer 22

osteoarthritis

Question 23

Stiffness in the AM that usually lasts longer than 1 hour is characteristic of what?

Answer 23

rheumatoid arthritis

Question 24

Hip stiffness in the am and stiffness after sitting and pain with WB can be characteristic of what?

Answer 24

avascular necrosis

Question 25

What do you want to know in the subjective examination of recent trauma?

Answer 25

``` mechanism of injury force direction weight bearing age of the patient pain popping swelling function ```

Question 26

What do you want to know in the subjective examination of chronic pain?

Answer 26

``` pain positions previous history chronic effusion weakness gait clicking, grinding, or popping function ```

Question 27

What are some red flags?

Answer 27

unexplained weight loss, fatigue fever loss of appetite bowel/bladder changes night pain unrelated to movement severe pain hip pain in men 18-24 yoa of unknown etiology-testicular cancer pain at mcBurney's point (1/3-1/2 distance from R ASIS to umbilicus tenderness coupld be appendicitis) blumberg's sign- rebound tenderness for visceral pathology (supine, push down deep and slow perpendicular to an abdomincal region away from painful region, then lift up quickly, positive sign= pain on release)

Question 28

What are the systemic causes of hip pain?

Answer 28

``` RA Crohn's disease Reiter's syndrome SLE psoriasis bone tumors inflammatory bowel or PID sickle cell anemia hemophelia urogenital problems ankylosing spondylitis ```

Question 29

How do you screen for a sports hernia?

Answer 29

Positive signs = palpation of a marble sized lump along the path of the inguinal ligament pain with exertion, cough, menstruation radiating pain into the groin, ipsilateral thigh, flank, or lower abdomen pain with cutting, turning, stride out

Question 30

nontraumatic causes of hip pain? and how should you examine this?

Answer 30

use a pain diagram and have patient elaborate on each area - osteoarthritis - overuse injuries (muscle strain/ stress fracture) - femoral anterior impingement - inflammation (bursitis, tendonitis) - hernia(inguinal, femoral) - gout - referred pain (lumbar spine, SIJoint, knee) - Infectious diseases - vascular diseae (avascular necrosis) - childhood disorders (congenital dysplagia, legg-calve-perthes disease, SCFE) - systemic - myofascial pain - neurological (nerve entrapment)

Question 31

What are examples of traumatic injuries?

Answer 31

``` acetabular labral tears femoral subluxation/dislocation femoral fracture pelvic fracture avulsion fractures soft tissue contusions myositis ossificans ```