Hip Viva Questions

Question 1

1. What are some potential hypothesis for this patient?

Answer 1

Elstein = 4/5 hypothesis

Anterior Hip
Femoroacetabular impingement (FAI)
Labral tear
OA
Iliopsoas/Rec fem strain/tendinopathy 
Femoral nerve injury
Gilmores groin (sports hernia)
Ligament of head of femur tear
Fractured NOF

Lateral Hip
Greater trochanter pain syndrome (GTPS)

Groin Pain
Doha agreement
Adductor-related
Hip-related
Inguinal-related
Pubis-related
Iliopsoas-related

Osteitis pubis
Obturator nerve injury
Avulsion fracture of pubic bone

Buttock pain
Referred from SIJ or Lx
Proximal hamstring tendinopathy
Sciatic nerve injury
Piriformis injury

Question 2

5. You are examining the hip. Can you tell me about its basic anatomical features?

Answer 2

Synovial ball and socket joint

Acetabulum and femoral head

Acetabular labrum and transverse ligament

Iliofemoral lig
Ischiofemoral lig
Pubofemoral lig
Inguinal lig
Transverse lig
Lig of Femoral head

Glute med, min and max
Sartorius
Gracilis
Adductor magnus, brevis and longus
Rec Fem
Pectinius
Piriformis
TFL
Obturator externus and internus
Quadratus femoris

Femoral nerve
Sciatic nerve
Gluteal nerve
Obturator nerve

Femoral and obturator artery supply the femur

Question 3

6. Red Flags specific to the hip?

Answer 3

Testicular Cancer
Groin pain
Father with Hx of cancer or enlarged prostate
Smoker
Constant progressive unremitting night pain
Unexpected weightloss

Avascular necrosis of the femoral head

Swelling within the joint

Unable to weightbare

Hx of trauma

Question 4

7. What are the most important parts of the physical examination and why?

Answer 4

Neurodynamic testing for anterior hip pain (femoral nerve test) and posterior thigh (Slump & SLR)

Muscle length tests
Thomas - anterior hip pain related to the iliopsoas or rec fem
Hamstring 90/90 Obers - Lateral hip pain related to ITB and/or TFL (GTPS?)

Articular Injury
FAI - FADIR, FABER, AIMT, FPAW, max squat test, passive IR

Direct trauma to femur
Femoral stress fracture - Fulcrum test

Lateral hip pain
GTPS - Grimaldi et al 2017 test battery
Palpation, FADIR-R, ADD-R, 30s Single leg stand test

Groin pain
Adductor squeeze test
Double adductor test
Doha statement - Contraction/stretch of muscle with palpation

Question 5

11. Outcome measures?

Answer 5

International Hip Outcome Tool (iHOT-33)

Copenhagen Hip and Groin Outcome Score (HAGOS)

SF-36

Hospital Anxiety and Depression Score (HADS)

Question 6

12. Advice regarding treatment, education about condition, referral and anticipated effect of treatment?

Answer 6

Hip OA Treatment
NICE Guidelines
Patient Education
Strength and aerobic exercise
Pain relief
Mobilisation
Gait retraining
Severe OA = Hip replacement

FAI Treatment
Warwick agreement
Patient Education
Lifestyle and activity modification
Improve strength, stability, neuromuscular control
Improve ROM
Surgery

GTPS Treatment
Grimaldi & Fearon 2015
Education of load management
Abd strengthening
Glute strengthening
Core strengthening
Dont increase compressive load during rehab

Adductor-Related Groin Pain Treatment
Strengthening of the add, glutes, core and other hip musculature

Question 7

13. Nocicieptive pain? Peripheral neuropathic pain? Or Central sensitisation?

Answer 7

GTPS, FAI, Hamstring injury, Groin injury and OA are all nociceptive pain

OA linked to central sensitisation (WIllet et al., 2020)

Injury to the femoral, obturator, sciatic, gluteal nerve = nerve trunk pain

Intervertebral disk prolapse that causes groin or hip pain = nerve root pain

Question 8

How can you differentiate between a hip articular problem and a muscular problem?

Answer 8

Articular
Sharp, close to groin

Muscle
Spread out
More sore when muscle put on stretch e.g. iliopsoas in hip ext

Question 9

What type of injury does an impact trauma more likely indicate?

Answer 9

Extra-articular

Question 10

What is osteitis pubis

Answer 10

Inflammation of pubis synthesis

Question 11

What is Gilmore’s groin

Answer 11

Sport hernia

Seen in sports with repeated kicking - football

Question 12

What is the structure of the objective assessment?

Answer 12

Observation
Palpation
AROM
PROM
MMT
Special Testing
Neurodynamic testing
Functional testing

Question 13

What is the structure of the objective assessment?

Answer 13

Observation
Palpation
Other joints
AROM
PROM
MMT
Special Testing
Neurodynamic testing
Functional testing

Question 14

What are some specific special questions for the hip?

Answer 14

Locking, catching
Giving way
Bladder and bowel problems = deep abdominal muscle control

Question 15

What subjective indicator may a patient say with groin pain?

Answer 15

Pain with change of direction

Question 16

With hip trauma what should you look for

Answer 16

Vascular symptoms due to potential blood clot

Lack of sensation
Unremitting ache pain all the time
Lack of distal pulse
Deadness

Question 17

What should you assess for if they have a Hx of hernia?

Answer 17

Cough

Have they palpated any mass?

Question 18

6. General red flags?

Answer 18

Hx of cancer

Constant progressive night pain

Unexplained weightloss

Radiotherapy / Chemotherapy

Anticoagulants

IV drugs abuse

Longterm steroid abuse

Drug and alcohol abuse

Osteoporosis

Rheumatoid arthritis

Diabetes

Epliepsy

Asthma

Cardia and circulatory problems

Cauda equina

Pregnancy

Hx of trauma

Poor general health

5Ds & 3Ns - Diplopia, dysarthria, dysphagia, nystagmus, numbness, nausea