8977 Lecture Notes - Lecture 11: Slipped Capital Femoral Epiphysis, Reactive Arthritis, Osteoarthritis
3 Jul 2018
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HIP INJURIES
Common/ Less Likely/ NTBM?
Objective Examination
Observe mm bulk, gluteal folds and knee crease symmetry, degree of pelvic tilt, lumbar lordosis, etc. Gait (foot, knee, hip) and
march on spot). ASIS deformity and leg length variations.
Functional tests – single leg squat for pelvis control, step down off step and hop and hold landing.
AROM – standing then overpressures/PROM side lying. Flex, Ext, Abd, Add, ER + IR at 0o and 90o.
RISOM – supine and secure pelvis. Flex, Ext, Abd, Add, ER + IR at 0o (prone) and 90o (supine).
Neurological tests – nerve entrapments cause pain not numbness. Femoral nerve slump test (knee to chest).
Vascular tests – cough impulse test for femoral pulse between ASIS and pubic symphysis, ask pt to cough. If pulse ‘squelches’
this indicates hernia – ask guys if any lumps or bumps in scrotum.
Palpation – supine: GT, ASIS, pubic symphysis, adductors, hip flexor tendons. Prone: isch tub, gluteal tendon (medial to GT),
posterior joint line (between GT and isch tub), piriformis (lateral edge of posterior sacrum).
Special tests – use site of pain to justify which S/T you choose.
Groin pain
Lumbar spine:
Seated ROM (bend forward)
Femoral slump test (knee to chest)
SIJ – shear test (supine, feel SIJ and push ASIS at 45o down)
Lumbopelvic instability - active SLR with augmentation (SLR up + down. Compress pelvis to ↓ pain if unstable).
Adductor related – palpate, stretch (leg straight and bent) and contract (RISOM).
Psoas related – palpate (roll inside ASIS), contract and stretch:
Thomas test for psoas tightness (lye on edge of bed, one leg down off bed, other knee bent up).
Abdominal wall related:
Cough impulse test
Resisted sit up (cross hands over chest and do a sit up)
Conjoint test (resist opposite arm and leg)
Pubic bone related - palpation
Hip joint related: imaging, AROM/PROM restrictions
FABER – flex, adb, ER, scoop like McMurrays, add compression for intra-articular. Detects labral tears.
FADIR – flex, add, IR, scoop like McMurrays, add compression for intra-articular. Detects FAI + labral tears.
Labral tear = FABER or FADIR +ve (more so when compressed)
FAI = FADIR most +ve (more so when compressed)
Same pain during compression + distraction = extra articular – synovitis/ capsulitis
FABER + FADIR both equally painful and more so with compression = OA.
Quadrant/ scour – go from FABER to FADIR to detect acetabular lesions.
Ligamentum teres – painful add, back off 30o, flex, back off 30o then rotate. Can push anteriorly from behind
for instability.
Femoral stress # - fulcrum test (fist under leg and push down on femur).
Buttock pain
Lumbar spine
SIJ
Piriformis – stretch by flex, add, ER. Contract – straight led ER and flexed to 90o it becomes an IR. Palpate too.
Sacral abcess, #, tumor – sign of buttock (SLR then when knee bends should be able to stretch further. If not pathology).
Gluteals – palpate, stretch, contract
Lateral hip pain
Lumbar spine
SIJ
TFL/ITB – ober’s test for anterior tightness
find more resources at oneclass.com
find more resources at oneclass.com
Document Summary
Observe mm bulk, gluteal folds and knee crease symmetry, degree of pelvic tilt, lumbar lordosis, etc. Gait (foot, knee, hip) and march on spot). Functional tests single leg squat for pelvis control, step down off step and hop and hold landing. Flex, ext, abd, add, er + ir at 0o and 90o. Flex, ext, abd, add, er + ir at 0o (prone) and 90o (supine). Neurological tests nerve entrapments cause pain not numbness. Vascular tests cough impulse test for femoral pulse between asis and pubic symphysis, ask pt to cough. If pulse squelches" this indicates hernia ask guys if any lumps or bumps in scrotum. Palpation supine: gt, asis, pubic symphysis, adductors, hip flexor tendons. Prone: isch tub, gluteal tendon (medial to gt), posterior joint line (between gt and isch tub), piriformis (lateral edge of posterior sacrum). Special tests use site of pain to justify which s/t you choose.
