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Hip Condition and Examination Techniques, Study Guides, Projects, Research of Pathophysiology

A.T. Still University of Health Sciences (ATSU)Pathophysiology

An overview of various hip conditions and examination techniques used to assess them. It covers topics such as hip-specific red flags, assessment tests like the mcburney's point, blumberg sign, psoas test, and tests for femoral torsion, arthralgia, and hip joint mobility. The document also discusses functional tests like the overhead deep squat, trendelenburg/single leg stance, and lateral step down test, as well as specific tests for hip pathology such as patrick's (faber) test, femoral grind/scour test, anterior and posterior labral tear tests, and the sign of the buttock. Additionally, it covers tests for muscle length assessment, including the thomas test, ober's test, and piriformis test. This comprehensive information can be valuable for healthcare professionals, students, and individuals interested in understanding hip conditions and evaluation techniques.

Typology: Study Guides, Projects, Research

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Hip Examination and Pain Assessment Study Guide
1.Patient demographics: Information on gender, age, occupation,
insurance, eth- nicity.
2.Congenital hip dysplasia: Hip condition more common in female infants.
3.Transient synovitis: Joint inflammation in toddlers, males more affected.
4.Legg-Calvé-Perthes disease: Hip disorder in children aged 3-12, males
predom- inant.
5.Slipped capital femoral epiphysis: Hip disorder in children aged 10-16,
males predominant.
6.Avascular necrosis: Bone death due to lack of blood, males 30-50.
7.Osteoarthritis (OA): Degenerative joint disease, more common in
females over 40.
8.Femoral fractures: Common in females over 65 years old.
9.onset, recurrent, aggrevates and eases, improving worsening
unchanges, pain: What do we want to know about current condition of
patient?
10.Visual Analog Scale (VAS): Pain measurement scale from 0 to 100 mm.
11.Numeric Pain Rating Scale (NPRS): Pain assessment using numerical
values for intensity.
12.Pain types: Includes cramping, sharp, burning, deep, throbbing.
13.muscle: When pain is cramping, dull or aching, it is an issue related to
14.nerve: When pain is sharp and shooting, it is a issue
15.sympathetic nerve: When pain is burning, pressure, and stinging, it is a
issue
16.bone: When pain is deep, nagging, and dull it is aissue
17.fracture: When pain is sharp, severe and intolerable it is a
18.vascular: When pain is throbbing and diffuse, it is a issue
19.components of PMH: i. Injuries, illness, disease, surgery
a. CV-P
b.MS
c. NM
d.GI
e.Metabolic-endocrine (DM)
f.Cancer
g.Trauma
h.Infection
i.Women: pregnancies, births, miscarriages, abortions, other reproductive
hx
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Hip Examination and Pain Assessment Study Guide

  1. Patient demographics: Information on gender, age, occupation, insurance, eth- nicity.
  2. Congenital hip dysplasia: Hip condition more common in female infants.
  3. Transient synovitis: Joint inflammation in toddlers, males more affected.
  4. Legg-Calvé-Perthes disease: Hip disorder in children aged 3-12, males predom- inant.
  5. Slipped capital femoral epiphysis: Hip disorder in children aged 10-16, males predominant.
  6. Avascular necrosis: Bone death due to lack of blood, males 30-50.
  7. Osteoarthritis (OA): Degenerative joint disease, more common in females over 40.
  8. Femoral fractures: Common in females over 65 years old.
  9. onset, recurrent, aggrevates and eases, improving worsening unchanges, pain: What do we want to know about current condition of patient?
  10. Visual Analog Scale (VAS): Pain measurement scale from 0 to 100 mm.
  11. Numeric Pain Rating Scale (NPRS): Pain assessment using numerical values for intensity.
  12. Pain types: Includes cramping, sharp, burning, deep, throbbing.
  13. muscle: When pain is cramping, dull or aching, it is an issue related to
  14. nerve: When pain is sharp and shooting, it is a issue
  15. sympathetic nerve: When pain is burning, pressure, and stinging, it is a issue
  16. bone: When pain is deep, nagging, and dull it is aissue
  17. fracture: When pain is sharp, severe and intolerable it is a
  18. vascular: When pain is throbbing and diffuse, it is aissue
  19. components of PMH: i. Injuries, illness, disease, surgery a. CV-P b.MS c. NM d.GI e. Metabolic-endocrine (DM) f.Cancer g.Trauma h.Infection i.Women: pregnancies, births, miscarriages, abortions, other reproductive hx

ii.Current or past treatment and results iii.Family medical hx

v. Visual changes vi.Balance changes vii. GI pain viii. Unexplained recent weight loss or gain ix.Unusual fatigue x.Unusual thirst xi.Recent swelling or lumps

  1. Hip specific red flags: -appendicitis -visceral pathology -psoas test for pelvic inflammation or infection -testicular cancer -enlarged inguinal lymph nodes -DVT
  2. McBurney's point: Location for appendicitis pain assessment -pain and tenderness -2/3 distance from umbilicus to right ASIS
  3. Blumberg sign: Rebound tenderness test for visceral pathology. -select site away from painful area -PT places fingers perpendicular to abdomen, slowly depresses deeply then quickly releases POSITIVE TEST- pain on release
  4. Psoas test: Assess for pelvic inflammation or infection via hip flexion. -pt. supine, SLR 30 degrees and resist hip flexion -if there is abdominal pain (+) test, hip or back pain is (-) test
  5. testicular cancer: hip or back pain of unknown etiology in males 18-24 y/o should be screened
  6. enlarged inguinal lymph nodes: located in subcutaneous tissue, easy to pal- pate -lymph nodes enlarge when diseased -field of drainage should be examined to determine cause of enlargement -females: possibility of metastasis of cancer from uterus -proper draping and instructions to pt.
  7. Well's Clinical Prediction Rule: Criteria for assessing DVT risk factors.

-leg pain and midline tenderness -swelling so calf circumference increases > 1.2cm -warmth and firmness to palpation -(+) Homan's sign Positive RF for DVT: -immob -fx -trauma -oral contraceptives -cancer -DM -pregnancy -CHF

  1. systems review: -cardiovascular/ pulmonary -integumentary -musculoskeletal (sports hernia, ankylosing spondylitis) -neuromuscular -gastrointestinal, uritogenital (crohn's, inflammatory bowel, pelvic inflammatory dis- ease, testicular cancer) -other (sickle cell disease, hemophilia) -communication, affect, cognition, learning
  2. Sports hernia: Painful lump along inguinal ligament during exertion.
  3. sports hernia screen: -palpation of marble-sized lump along path of inguinal ligament -pain with exertion cough, menstruation -pain radiating to groin, ipsilateral thigh, flank, lower abdomen -pain with cutting, turning, striding out, kicking -due to deficiency posterior wall inguinal canal, nn entrapment, or adductor tendinopathy
  4. Ankylosing spondylitis: chronic, progressive arthritis with stiffening of joints, primarily of the spine
  5. Lower Quarter Screen: Assessment tool for lower extremity function.
  6. selective functional movement assessment (SFMA): -systematic and stan- dardized way to identify impairments of mobility and motor control associated with functional movement patterns complicated by pain -Used with patients who have pain with movement, can only be used
  1. pt inspection components: -willingness and ability to use injured/painful area -gait analysis -attitude body part: protective positioning, contracture -contours, deformity, size, atrophy, hypertrophy, presence skin creases, swelling -circulation, temperature, color, trophic changes, hair growth, nails, sweating, wound/scars (red vs white), adhesions, keloid, hypertophic
  2. hypertrophic scar: Excess production of scar tissue that is localized to the wound
  3. keloid scar: excess of collagen deposited at the site of a healing or healed wound that is noticeably different from normal skin: scar commonly extends beyond the boundaries of the original wound
  4. anterior hip dislocation: -LE abducted and externally rotated -swelling due to occlusion in femoral triangle -cyanosis
  5. posterior hip dislocation: -LE shortened, adducted, and internally rotated -prominence greater trochanter
  6. Gait analysis: Evaluation of walking patterns and abnormalities.
  7. Leg length discrepancy (LLD): Difference in leg lengths affecting posture and gait.
  8. Leg Length Discrepancy: Weight Bearing -scoliosis vs true LLD -iliosacral origin-innominate rotation -other LE chain deviations NWB Tape measure 1.ASIS to medial malleolus or lateral malleolus 2.Greater trochanter to lateral knee jt line 3.Medial knee jt line to distal medial malleolus Hook lying 1.femoral length 2.tibial height Supine

1.Weber-Barstow measure (lift buttocks, extend LE's, visually compare medial malleoli) 2.90:90 position - femoral length

  1. Arthralgia (more than 3 months) in one to three joints or back pain (more than 3 months), spondylosis, spondylolysis/spondylolisthesis 3.Dislocation/subluxation in more than one joint, or in one joint on more than one

occasion

  1. Soft tissue rheumatism (inflammatory conditions) more than three lesions (e.g., epicondylitis, tenosynovitis, bursitis)
  2. Marfanoid habitus (Marfan-like appearance) (tall, slim, span/height ratio more than 1.03, upper: lower segment ratio less than 0.89, arachnodactyly [long, thin, spider-like fingers] [positive Steinberg/ wristsigns]) 6.Abnormal skin: striae, hyperextensibility, thin skin, papyraceous (paper-like) scar- ring 7.Eye signs: drooping eyelids or myopia or antimongoloid slant 8.Varicose veins or hernia or uterine/rectal prolapse
  3. Active ROM: Patient's voluntary movement range of joints.
  4. Passive ROM: Movement range of joints by an external force.
  5. Crepitation: Grating sound or sensation in joints during movement.
  6. Concordant pain: Pain that reproduces symptoms during examination.
  7. Discordant pain: Pain not reproduced during examination.
  8. Ehlers-Danlos Syndromes (EDS): Genetic disorders affecting collagen quan- tity and quality.
  9. Collagen: Protein providing structure and strength to tissues.
  10. Fragile Skin: Skin that easily bruises or tears.
  11. Joint Hypermobility: Excessive range of motion in joints.
  12. Mitral Valve Prolapse: Condition where heart valve doesn't close properly.
  13. Maximum Beighton Score: Highest possible score is 9 points.
  14. Major Criteria for BJHS: Score e 5/9 in adults indicates BJHS.
  15. Arthralgia: Joint pain lasting over three months.
  16. Marfanoid Habitus: Tall, slim appearance with long fingers.
  17. Soft Tissue Rheumatism: Inflammatory conditions affecting soft tissues.
  18. Gluteal Fist Test: Assesses gluteal muscle contraction timing. Assessment of neuromotor functions of timing and isometric contraction. Pt prone. With permission PT places fists lightly in gluteal mass bilaterally. Pt performs gluteal set. Observe.
  19. Traction and compression Test: Identifies ligamentous versus articular le- sions.
  20. compression test: Pt supine, hip joint resting position. PT compresses hip thru long axis of femur
  21. distraction test: same position as the compression test but with long axis distraction
  1. hip rest position: -30 degrees flexion -30 degrees abduction -slight ER
  2. Closed Packed Position (CPP): Position of maximal joint congruence. -maximal extension, IR, and abduction -Be sure to compress the soft tissue, take up the slack (R1) then glide to the stretch barrier (R2)
  3. Hip Joint Distraction: Technique to relieve hip joint hypomobility.
  4. hip joint distraction- lateral glide: Indication: General hypomobility of the hip joint - true distraction of hip Patient Position: Supine Joint Position: Hip flexed to 90º with pt's leg supported on PT's distal forearm PT Position: Standing at pt's side with strap around waist and pt's proximal femur(pad strap with PT's hand or towel roll on pt's thigh) Hand Placement: Support pt's LE at distal femur and under strap Mobility test & Mobilization: A distraction force is imparted by PT leaning to impart a distal lateral force, tightening belt to move the femoral head from the acetabulum. The line of pull should be parallel with the femoral neck. Mob with Movement: While mobilizing, PT and pt move hip into physiologic flexion range or most restricted motions.
  5. Inferior Glide Technique: Mobilization technique for hip flexion improvement. Indication: General hypomobility of the hip joint - **clear the knee (contraindicated in presence TKA, knee jt instability) - distracts the weight-bearing surfaces hip Patient Position: Supine - may use stabilization straps to fix pelvis to table Joint Position: Rest position PT Position: Standing at foot of table facing pt's feet Hand Placement: Both hand grasp distal lower leg Mobilization: A distraction force is imparted by the PT leaning away from the pt while keeping elbows extended. Mob with Movement: While maintaining mobilization force, PT and pt move hip into position of greatest restriction (generally abduction this technique)
  6. Hip Joint Inferior Glide in Hip Flexion: Indication: General hypomobility of hip joint, decreased hip flexion

Patient Position: Supine - may use stabilization straps to fix pelvis to table Joint Position: Hip flexed to 90º with pt's leg supported on PT's shoulder PT Position: Standing at pt's side facing head of table Hand Placement: Both hands grasp around pt's anterior thigh proximally Mobilization: A caudal glide is imparted through the PT's hands.

  1. Patrick's/ FABERTest: Tests for hip joint pathology, iliopsoas spasm, SI dys- function

-Pt supine with test leg in figure 4 position with ankle proximal to contralateral knee -Examiner stabilizes contralateral ASIS and gently applies force to lower knee of test leg toward table Negative: knee test leg at least parallel to opposite leg

  1. knee test leg remains above opposite leg or produces concordant hip pain: What indicates a positive patrick's/FABER test?
  2. Femoral Grind/scour Test: -test for slipped capital femoral epiphysis, intra-ar- ticular derangement, labral pathology -Pt supine with test leg flexed at hip and knee, opposite leg straight. -PT flexes test hip to at least 90p with knee flexed then applies an axial load thru the femur while IR/ER (adducting) the hip
  3. concordant pain, joint clicking: What indicates a positive femoral grind/scour test?
  4. Anterior Labral Tear Test (flex, add, IR test): -test for anterior- superior im- pingement syndrome, anterior labral tear, piriformis syndrome -Pt supine with contralat LE extended -PT stands on test side, grasps pt's knee and ankle of test leg -PT placeship into full flex, ER, and abduction (start position) then moves hip into ext, IR, adduction -May provide long axis compression thru femur in attempt to isolate labral/intra-ar- ticular pathology.
  5. positive anterior labral test: pain or symptom production (anterior pain or clicking ’ anterior labrum and/or impingement; posterior pain in buttock or posterior LE ’ piriformis)
  6. Posterior Labral Tear Test: - test for labral tear, anterior hip instability, poste- rior-inferior impingement -Pt supine with contralat LE straight -PT stands on test side, grasps pt's knee and ankle of test leg -PT places up into full flex, add, IR (start position) then moves hip into extension, abduction, ER -May provide long axis compression thru femur in attempt to isolate labral/intra-ar- ticular pathology.
  1. Sign of the Buttock: -test for hip, ischial bursitis, neoplasm, buttock abscess vs hamstring length or lumbar pathology -Pt supine. -PT performs PSLR on test LE. -If pain of restriction is found, PT flexes knee of test LE then attempts toflex the hip further. -Negative: If hip flexion increases with knee flexion then it is negative for the sign of the buttock. Limitation ofPSLR may indicate lumbar spine dysfunction, HS tightness, or nerve mobility restriction.
  2. Hip flexion does not increase with knee flexion. Additional finding is a non-capsular pattern of the hip with PROM: What indicates a positive sign of the buttock test?
  3. Tests for muscle length: -thomas test -Ely's test -Ober's test -piriformis test -SLR and 90-90 SLR tests
  4. Thomas test: assessment for hip flexion contracture (iliopsoas, rectus femoris)
  5. Ely's Test: -assessment for rectus femoris length -Pt prone. PT passively flexes knee while monitoring posterior aspect pt's pelvis to assess for movement
  6. With passive knee flexion, ipsilateral hip flexes as noted by pelvic move- ment: What indicates a positive Ely's test?
  7. Ober's Test: Tests length of TFL and ITB. -Pt sidelying with test leg uppermost and bottom LE flexed for stability. -PT stands behind patient supporting test LE in abduction and extension in neutral rotation while firmly stabilizing pelvis to avoid lateral tilt or posterior rotation. -PT slowly lowers test limb until resistance is felt and/or pelvis begins to move. Note: Test may be performed with knee flexed however less stretch is placed on ITB and more stress is placed on the femoral nn.

Onset of neurologic pain or paresthesia may indicate pathology of the femoral nn

  1. Test limb remains abducted so that foot does not touch the table. May measure.: What indicates a positive Ober's test?