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What is the resting position of the hip?
30 flexion, 30 abduction, slight lateral (external) rotation TERM 2
What kind of joint is the hip?
DEFINITION 2 Multi-axial Ball and Socket Joint TERM 3
The acetabulum is formed by the fusion of
what?
DEFINITION 3 Ilium, ischium and pubis (inominate bone)Opens outward, forward and downward (lateral, anterior and inferior) TERM 4
3 ligaments of the hip
DEFINITION 4 iliofemoral -- prevents excessive rotationischiofemoral -- stabilizes in extensionpubofemoral -- prevents excessive abduction of the femur and limits extensionligamentum teres -- attachment of head of femur to acetabulum TERM 5
Forces on the hip in
standing
DEFINITION 5 .3x
forces on the hip standing on one
limb
2.4-2.6x b.w. TERM 7
forces on the hip in walking
DEFINITION 7 1.3-5.8x b.w. TERM 8
forces on the hip walking up stairs
DEFINITION 8 3x b.w. TERM 9
forces on the hip running
DEFINITION 9 4.5+x b.w. TERM 10
Anteversion
DEFINITION 10 measured by the angle made by the femoral neck with the femoral condyles
Why is the patient here?
As far as you are concerned, what do YOU feel is your main concern at this time? TERM 17
Area of
symptoms
DEFINITION 17 Clarify the information the patient provided on the body chart.Do not forget to clear other areas (prove unaffected) TERM 18
What does "prove unaffected" mean for the
hip?
DEFINITION 18 Unlikely for hip to refer symptoms proximally. Typically, buttock symptoms originating from hip will also be associated with groin symptoms.Groin discomfort and limited medial rotation are good indicators of a local hip problem (OA, labral deformation) TERM 19
Joints underlying symptomatic anterior
hip/groin
DEFINITION 19 hip joint TERM 20
Joints which can refer to symptomatic area of
the anterior hip/groin
DEFINITION 20 L1/L
Muscles underlying symptomatic area of the
anterior hip/groin
iliopsoasadductor grouprectus femorisvastus group TERM 22
Other structures with potential to refer to
symptomatic area for anterior hip/groin
DEFINITION 22 inguinal ligamentlabrumhip capsule and ligamentsfemoral nerveobterator nervelateral femoral cutaneous nerveaortaherniafracture TERM 23
Joints which can refer to symptomatic lateral
hip
DEFINITION 23 L3-S TERM 24
muscles underlying symptomatic lateral
hip
DEFINITION 24 TFL TERM 25
Other structures with potential to refer to
symptomatic lateral hip
DEFINITION 25 IT bang
symptom quality
deep vs. superficialdescriptive terms TERM 32
symptom consistency
DEFINITION 32 constant vs. intermittentintermittent symptoms: 24 hr pattern TERM 33
aggravating factors
DEFINITION 33 "what makes your symptoms worse?" TERM 34
walking, stairs, slopes:
DEFINITION 34 limited mobility of hip (flexion/extension) TERM 35
WB directly on hip:
DEFINITION 35 bursitisOA
Sitting:
requires hip flexion (also requires L/S flexion) TERM 37
crossing legs:
DEFINITION 37 Hip F/ER or adduction TERM 38
sit to stand:
DEFINITION 38 stiff/painful after prolonged sitting TERM 39
Easing factors
DEFINITION 39 What makes symptoms better?NWB more comfortable in local hip joint problemsPosition of comfort (POC): F/Abd/ER (Resting Position) TERM 40
Activity limitations/participation restrictions
DEFINITION 40 Provides information regarding whether repetitive activities were a contributing factor to the onset of symptoms.
increased pain while sitting with affected leg
crossed
trochanteric bursitis TERM 47
pain at sitting, legs not crossed
DEFINITION 47 trochanteric bursitis TERM 48
pain at sitting, legs not crossed
DEFINITION 48 ischiolgluteal bursitis TERM 49
Pain after walking and
standing
DEFINITION 49 hip arthrosis TERM 50
pain on attempted WB
DEFINITION 50 occult fracture, severe arthrosis
unremitting, long duration
paget diseasemetastatic carcinomasevere arthrosis TERM 52
Numeric rating scales
DEFINITION 52 Functional outcome measuresBased primarily on pain, mobility, gaitHarris Hip Functional ScaleUseful before and after surgeryEmphasizes pain and functionFigure 11- 11Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) (ICC=90)Lower Extremity Functional Scale (LEFS) (ICC= .92) TERM 53
What does it mean if the knee bends during
gait
DEFINITION 53 used to absorb shock if hip is affected TERM 54
Shorter steps
DEFINITION 54 to unweight hip quickly TERM 55
Stiff hip
DEFINITION 55 entire trunk and affected leg advance forward together
Willingness to move
sit to standunstable hip will lead to difficulty controlling movement TERM 62
limb positions equal and symmetric
DEFINITION 62 position may indicate pathology TERM 63
Posterior dislocation
DEFINITION 63 limb is shortened, adducted, and medially rotated; Greater Trochanter is prominent TERM 64
anterior dislocation
DEFINITION 64 limb is abducted and laterally rotated TERM 65
intertrochanteric fractures
DEFINITION 65 limb is shortened and laterally rotated
Where may pain refer from to
hip
from SI and L/S and hip symptoms may refer to lower extremity TERM 67
Active movements in examination
DEFINITION 67 Test repetitive movements and/or sustained postures as indicated by historyWatch for force-couples imbalancePelvis should stay stationary during hip movement (Figure 11-7) TERM 68
Force couple imbalance with hip extension
DEFINITION 68 : glut max, followed by C-L Erector SpinaeIf Erector Spinae contracts 1st, pelvis will rotate ant and lumbar hyperextension will occur TERM 69
Examination in
standing
DEFINITION 69 posture anterior, lateral and posterior views correct deviations functional movement analysis Provides a functional sign that you can use for reassessment that is specific to the patient, and their goals TERM 70
Functional quick test for hip flexion
DEFINITION 70 NWB: foot on stool, bend forward at hip (ex. put on shoe)WB: bilateral/unilateral squat
walking tests
Timed Up and Go (TUG)13 meter walk test6 Min Walk TestSelf paced walk test2 min walk test TERM 77
functional testing of the
hip
DEFINITION 77 SquattingStairs (one at a time)Crossing legs (Figure 4)Stairs (two at a time)Running straightRunning and deceleratingRunning and twistingOne Legged Hop (time, distance, cross-over)Jumping TERM 78
Trendelenburg sign
DEFINITION 78 Pt is asked to stand on one legNormal= ipsilateral hip abduction and contralateral hip adduction(+) = pelvis on opposite side drops when the patient stands on the affected legAlways perform on unaffected side 1st(+) positive sign indicates glut med weakness or unstable hip on the stance side TERM 79
Lateral step down maneuver
DEFINITION 79 Pt is asked to put one foot on stool and stand up straightPt then lowers NWB foot to floorArms should be at side, trunk relatively erect, no hip add or med rot(+) positive sign indicates an unstable hip or weak lateral rotators TERM 80
Clearing of lumbar spine
DEFINITION 80 prn based on hypothesisLumbar Flex., Ext, and Lateral Flexion (side bending).If negative, then test Extension Quadrant
Tests done in sitting
Static Resisted Tests (Resisted Isometric Testing) Hip Flexion Hip Abduction/Adduction Knee Extension/Flexion Neurological Exam in Sitting (if indicated) Deep Tendon Reflexes Sensation (Dermatomes) Myotomes TERM 82
Fulcrum test
DEFINITION 82 Stress fracture of femoral shaft TERM 83
Pace test
DEFINITION 83 Discomfort (pain), weakness, and/or faltering is positive result in the involved lower extremity (piriformis syndrome) TERM 84
Tests done in supine
DEFINITION 84 limb lengthphysiological movements at hip (AROM/PROM)accessory movements TERM 85
Physiological movements at hip
DEFINITION 85 Including +/- passive overpressureObserve and document Symptom response, Quantity of movement, Quality of movement, and End feel Flexion, Abduction, Adduction, IR, ER, Hip Quadrant (F/Add)Capsular Pattern of Hip (Flexion, Abduction and Internal Rotation) These movements are most limited, but order may vary.
extension ROM
TERM 92
abduction ROM
DEFINITION 92 40- TERM 93
adduction ROM
DEFINITION 93 10- TERM 94
internal rotation ROM
DEFINITION 94 34- TERM 95
external rotation ROM
DEFINITION 95 45-
Leg length tests
true leg length discrepencyfunctional leg length discrepancy TERM 97
true leg length
discrepancy
DEFINITION 97 Anatomic or structural change in the LESpine and pelvis are often affected Lateral pelvic tilt Scoliosis TERM 98
functional leg length
discrepancy
DEFINITION 98 Result of compensation for a change that occurs due to positioning rather than structureCould be due to : Unilateral pronation Scoliosis TERM 99
Static resisted tests
DEFINITION 99 resisted isometric testing Hip Flexion Hip Abduction Hip Adduction Knee Extension TERM 100
Importance of clearing the knee
DEFINITION 100 if knee symptoms presentTibial-Femoral Flexion with passive OP
- abduction and adduction with passive OP (direction of heel) Tibial-Femoral Extension w/AP at Tibia
- abduction and adduction with passive OP (direction of heel)
