The Hip Flashcards
(38 cards)
1
Q
What does C sign mean?
A
sign of intraarticular hip pain
2
Q
Gait
A
- Trendelenberg: sign of glut med weakness, hip goes “towards” the weak or painful hip
- Lurch: body lean over painful hip
*These reduce torque/force over hip by moving COG closer to the painful hip joint
3
Q
Normal ROM
A
- flexion: 120-135
- extension: 30
- IR: 35
- ER: 45
- Abduction: 45-50
- Adduction: 20-30
*Loss of passive internal rotation= hip OA
4
Q
Neuro Exam- MMT
A
- hip flexors (L2)
- KE (L3)
- DF (L4)
- EHL (L5)
- PF (S1)
5
Q
Neuro Exam- Sensation
A
- check lateral thigh if meralgia parenthetic suspected
- inguinal ligament (L1)
- anterior/medial thigh (L2)
- medial knee (L3)
- medial malleolus (L4)
- 1st dorsal webspace (L5)
- lateral foot (S1)
6
Q
Neuro Exam- Reflexes
A
- Patellar (L4)
- Medial hamstring (L5)
- Achilles (S1)
7
Q
What 2 tests can you do if you suspect a radiculopathy?
A
- SLR
- Femoral stretch test
*90% of radiculopathies go below the knee
8
Q
What does the Thomas Test evaluate?
A
evaluates for hip flexion contracture/tightness
9
Q
How to perform the Thomas Test?
A
- patient supine, brings both knees to chest
- then lower one leg to table
- positive test if patient unable to lower leg to table and/or arches thoracic spine when lowering leg
*this may be a cause of internal hip snapping
10
Q
Trendelenberg Sign
A
- stand behind patient and ask them to raise one leg
- positve test is when pelvis drops on the side of the elevated leg–> indicated weak glut med on the contralateral side
11
Q
What does the Ober Test evaluate?
A
-evaluates for IT band tightness
12
Q
How to perform the Ober test?
A
- have patient lay on side, passively flex knee to 90 and abduct the hip, keep hip joint at neutral, then release leg
- positive test is when leg stays abducted or does not fall as far as the other leg
13
Q
What are the tests for intra-articular hip pathology?
A
- FABER test: make a “4”; positive test is groin pain in ipsilateral hip or pain in contralateral SI joint
- Resisted straight leg raise: positive test is groin pain
- Log Roll test: positive test is groin pain
14
Q
Apparent vs. true leg length discrepancy?
A
- apparent: measured from umbilicus to medial malleolus; caused by pelvic obiquity
- true: measure from ASIS to medial malleolus
15
Q
What’s a significant leg length difference?
A
at least 2-3cm
16
Q
How to tell if the leg length difference comes from the femur or tibia?
A
- patient lays supine on table with knee flexed 90 degrees
- If one knee is HIGHER= tibia
- If one knee is more ANTERIOR= femur
17
Q
What is the first physical exam finding in hip OA?
A
-decreased passive internal rotation
18
Q
Bursitis exam finding?
A
Reproduction of pain with palpation over bursa
19
Q
Trochanter bursitis causes?
A
- glut med weakness
- L5 radio–> leads to abductor weakness
- tight IT band
- leg length discrepancies
20
Q
Lateral hip pain
A
Think trochanteric bursitis
21
Q
What is Femoroacetabular Impingement (FAI)?
A
- Abutment of femoral head against acetabulum due to osseous abnormality
- A/w early hip arthritis and labral tears
22
Q
What is the symptoms of FAI?
A
- Insiduous onset of groin pain usually worse with hip flexion, mechanical symptoms (clicking, locking)
- Groin pain with hip flexion (i.e. sitting), but walking is fine
23
Q
What are the three types of FAI?
A
- CAM- think young athletic men; extra bone of the femoral head
- Pincer- think middle aged women; extra bone of the acetabulum
- Mixed- most common
24
Q
Exam of FAI?
A
- Inpingement test: patient supine, passively IR hip, flex to 90, and adduct; basically flex hip and knee towards opposite shoulder
- positive test is groin pain
25
Imaging for FAI?
- X-ray: "bump on femoral head"
| - MR arthrogram: good to evaluate for associated labral tears
26
What are symptoms of hip labral tears?
Similar to FAI; groin pain with certain motions and mechanical symptoms
27
What are the special tests for hip labral tears?
- impingement test
- scour test: maximally flex hip and provide axial load while internally and externally rotating the femur
- Fitzgerald test (anterior labrum): flexion/abduction/ER to extension/adduction/IR
- -Fitzgerald test (posterior labrum): flexion/adduction/IR to extension/abduction/ER
*Need MR arthrogram to assess hip labrum
28
Muscle strain during which type of muscle contraction?
-fast eccentric (lengthening)--> greatest force
29
Hamstring strain
exam reveal pain over muscle belly or origin; palpable defect in muscle; pain with resisted knee flexion
*Need to rule out an avulsion fracture--> tendon pulls off a piece of bone
30
Adductor strain
exam reveals tenderness over adductor muscle group and pain with resisted adduction
31
Avulsion fracture
- Many common sites around the hip/pelvis
- treatment: conservative (rest, ice, ROM, strengthening after full ROM) vs. surgical (high level athletes, displaced apophysis)
32
What is snapping hip syndrome?
-inflammation of muscle from overuse leads to tightness and "snapping" of muscle tendon over bony prominence
33
How to distinguish internal vs. external snapping hip?
- Internal: snapping from subluxation of iliopsoas tendon; exam reveals pain with resisted hip flexion, +Thomas test (evaluated hip flexor tightness)
- External: snapping from IT band subluxation over greater trochanter; exam reveals +Ober test, +tenderness over greater trochanter if bursitis present
34
What is Osteitis pubis?
- Inflammation of pubic symphysis caused by overuse of adductors in athletes, complication of invasive pelvic surgery, childbirth, trauma, etc.
- Exam reveals pain with resisted adduction, + hop test, tenderness to palpation over pubic symphysis
- X-rays show peri-articular sclerosis, widening of pubic symphysis
35
What are the 2 types of femoral neck stress fracture?
- Compression type: inferior aspect of femoral neck (conservative)
- Tension type: "S"uperior aspect of femoral neck ("S"urgery)
36
What are the symptoms of femoral neck stress fracture?
- groin pain progressively worse with activity of ADLs
| - Can't run though a stress fracture! Gets worse.
37
What are the 2 physical exam tests for a femoral neck stress test?
- Fulcrum test: patient seated, place one hand under thigh and apply a downward force on knee; + test is groin pain
- Patellar Pubic percussion test: place stethoscope over pubic symphysis and tap each patella; + test is sound of tapping decreased on affected side
38
Athletic pubalgia/Sports hernia
- tearing of muscle or tendons just superior to attachment to the superior aspect of the pubis ramus
- Usually due to imbalance in strength/flexibility of the adductors and ab muscles as they both attach there
- Exam reveals tenderness around pubic rami, pain with non-resisted and resisted oblique sit-ups, pain with resisted adduction
