OSCE 3 - Hip

Question 1

borders of femoral triangle

Answer 1

Borders: Superiorly – Inguinal Ligament
Medially – Medial border of Adductor Longus
Laterally – Medial border of Sartorius

Question 2

external rotators of hip

Answer 2

sartorius

glut. med.
glut. max

Question 3

Hip ROM

Answer 3

Flexion- 90 knee extended, 120
‐135 knee flexed
Extension  15‐30
Abduction  45‐50 knee extended
Adduction  20‐30
Internal rotation  30‐40
External rotation  40‐60

Question 4

HIP flexion muscles and nerves

Answer 4

iliopsoas muscles
femoral nerve L2-4
verntal rami of lumbars L1-2

Question 5

extension muscles and nerves

Answer 5

glut max

inf. gluteal L5, S1, S2

Question 6

abduction

Answer 6

glut. med and min.

sup. gluteal L5, S1

Question 7

adduction

Answer 7

adductor longus m.

obturator n. L2-4

Question 8

Muscle grading on 5/5 scale

Answer 8

0 - no muscular contraciton
1 - barely detectable flicker/ trace of contraciton
2 - active movement w/ gravity eliminated
3 - active movement against gravity
4 - active movement against gravity and some resistance
5 - against full resistance w/o evidence of fatigue

Question 9

hip compartments

Answer 9

central
peripheral
lateral
anterior/ iliopsoas

Question 10

central contents

Answer 10

 Labrum
 Ligamentum Teres
 Articular surfaces

Question 11

peripheral contents

Answer 11

femoral neck

synovial lining

Question 12

lateral contents

Answer 12

 Gluteus medius
 Gluteus minimus
 Iliotibial Band
 Trochanteric bursae
    Deep
    superficial

Question 13

anterior/ iliopsoas contents

Answer 13

Iliopsoas insertion Iliopsoas Bursae

Question 14

Log roll

Answer 14

nonspecific to central and peripheral compartments
roll the patient’s leg into internal and external rotation
+ test = pain
indicates: central or peripheral compartment pathology

Question 15

central compartment tests

Answer 15

c-sign
labral loading
labral distraction
scour
apprehension: FABER (1 of 3)

Question 16

c sign

Answer 16

cups just above trochanter

indicates labral pathology

Question 17

labral loading

Answer 17

patients hip and knee at 90 degrees, loading into femur towards innominate
+ test = pain
indicates: labral or cartilaginous pathology

Question 18

labral distraction

Answer 18

distracting femur away from innominate
+ test = IMPROVEMENT of pain
indicates: labral or cartilaginous pathology

Question 19

scour

Answer 19

flexing and externally rotating patient’s hip
- loading into socket and articualting through annular range of motion
+ test = pain
indicates: labral or articular cartilage pathology

Question 20

apprehension: FABER for CENTRAL compartment

Answer 20

patient’s hip is flexed, aBducted and externally rotated
- doctor induces further external rotaiton by applying POSTERIOR force at knee
+ test = anterior subluxation of hip or apprehension/ pain
indicates: anterior labral pathology
can also be + with impingement

Question 21

peripheral compartment tests

Answer 21

Ely’s test

rectus femoris test

Question 22

ely’s test

Answer 22

patient prone, passively flex patient’s knees
+ test = ipsilateral hip raises off table
indicates: rectus femoris contracture

Question 23

rectus femoris test

Answer 23

patient supine
one hip flexed up to the chest
other leg bent over edge of table
+ test = knee flexion

Question 24

lateral compartment tests

Answer 24

jump sign
straight leg raise test
ober's test
piriformis test
trendelenburg
patrick's FABER

Question 25

jump sign

Answer 25

patient seated, pressure applied to greater trochanter + test = patient withdraws/ jumps with pressure indicates: trochanteric bursitis

Question 26

straight leg raise test

Answer 26

raise leg wtih knee extended, onspecific test + test = pain indicates: pain from 15-30 = lumbar disc etiology pain laterally >15 degrees - lateral compartment pathology (as IT band passes over greater trochanter

Question 27

ober's test

Answer 27

patient lateral recumbent w// doctor standing behind patient doctor abducts top leg and lowers leg to table while stabilizing hip + test = inability to adduct indicates: IT band contracture

Question 28

piriformis test

Answer 28

patient supine with hip and knee flexed, one ankle crossed over contralateral knee. patient abducts against resistance + test = pain over posterior aspect of greater trochanter indicates: piriformis spasm or pathology

Question 29

trendelenburg

Answer 29

patient standing, doctor behind patient lefts one foot off ground + test = weakness/ inability to hold hips level indicates: contralateral glut. med. weakness (superior glut. nerve)

Question 30

Patrick's FABER for lateral compartment

Answer 30

patient's hip flexed, aBducted and externall rotated doctor braces contralateral ASIS, patient externally rotates/ aBducts against resistance + test = pain or weakness indicates: glut. med pathology

Question 31

anterior/ iliopsoas compartment

Answer 31

Patrick's FABER Psoas Test Thomas Test

Question 32

Patrick's FABER for ANTERIOR compt.

Answer 32

patient's hip flexed, abducted externall rotated, doctor braces contralateral ASIS patient internally rotates/ aDducts against resistance + test = anterior or medial groin pain/ weakness indicates: iliopsoas insufficiency or pathology

Question 33

Psoas Test

Answer 33

flex hip to 30 degrees while patient further flexes against resistance + test = pain/ instability or snapping indicates: psoas contracture or pathology

Question 34

thomas test

Answer 34

patient supine, pulls knee to chest one leg lowered to table to test flexibility of hip flexors + test = inability to fully extend/ extended leg raises off table indicates: hip flexor contraction

Question 35

catching, locking a s/s of

Answer 35

central compartment | peripheral

Question 36

``` instability or.. Pain  Lumbar Spine  Groin/ Medial  Pelvic Rim  Anterior to Posterior  (L5-S1) radicular pattern  In the a.m. or after a run ```

Answer 36

central compartment pathology

Question 37

central compartment potential patohlogies

Answer 37

```  Labral tears  Ligamentum Teres Disruption  Osteochondral defects  Chondromalacia/ Osteoarthritis  Loose Bodies ```

Question 38

Pain with hip movement  Deep Hip  Groin  Limited range-of-motion

Answer 38

peripheral compt.

Question 39

peripheral compt. pathologies

Answer 39

```  Loose Bodies  Impingement syndrome  Pincer Type  CAM Type  Synovitis ```

Question 40

``` Weakness  Difficulty with lifting leg to climb stairs  Pain  Lateral hip  Pelvic rim  Radiating down leg to knee  Knee pain  Instability ```

Answer 40

s/s of lateral compartment

Question 41

lateral compartment pathologies

Answer 41

```  IT Band Syndrome  Bursitis  Rotator cuff Tendonopathies  Gluteus Medius  Gluteus Minimus ```

Question 42

 Pain  Anterior hip  Medial Groin  Anterior deep thigh

Answer 42

s/s of anterior compt.

Question 43

iliopsoas compt. pathologies

Answer 43

 Psoas Tendonitis |  Iliopsoas Bursitis

Question 44

Snapping hip

Answer 44

``` Can be internal or external  Internal  Psoas “snaps” over femoral head  External  IT band “snaps” over trochanter ```