Hip Exam and Interventions LAB

Question 1

Describe normal/excessive ante version and retroversion of the femur

Answer 1

• Normal: 15-25º anteversion
• Excessive: >25º anteversion
• Retroversion: ≤10º anteversion

Question 2

Describe normal, Cora vara, and Cora valga of the femur

Answer 2

• Normal femoral angle: 125º
• Cora Vara: <125º
• Cora Valga: >125º

Question 3

Describe the Fulcrum test

Answer 3

• Applies stress to the femur
• Attempts to aggravate ay fracture sites
• Place forearm under distal femur and place free hand on top of knee
• Apply opposing forces (trying to bend the femur)

Question 4

What are the muscle length tests for the hip

Answer 4

• Thomas test: pt holds one knee in supine while PT pushes down on opposite knee
• Piriformis test: pt supine and PT places leg into a figure 4 position
• Ober’s test: pt sidelying & PT stabilizes hip while pulling the top leg into extension
• Ely’s test: pt prone & PT flexes one leg into max flexion (heel to butt); assess quads and femoral nerve
• Craig’s test: pt prone & PT flexes leg to about 90º and IR the hip (heel goes laterally); palpate for MOST prominence of the greater trochanter then measure the angle of the tibia, test for ante/retro version

Question 5

Describe the FABER test

Answer 5

• Ask pt to cross leg above knee
• Observe pts AROM w/o pelvic rotation
• Measurement methods: lateral patella to table OR inclinometer
• Add overpressure
• Need the PAIN location

Question 6

Describe the femoral grind/Scour test

Answer 6

• Pt supine
• Start ~90º elevation of leg/knee
• Posterior compression with small arc IR/ER
• Move from slight ABD to slight ADD & back
• Attempts to compress the femoral neck on the acetabular rim

Question 7

Describe the resisted SLR (Stinchfield’s test)

Answer 7

• SLR to 30 degrees
• Apply Resistance into extension
• Positive if Pain: KEY is the pain location is thought to differentiate b/w Groin/Thigh = Hip joint and Buttock/LBP = SIJ or LBP

Question 8

Describe the FADIR test

Answer 8

• CAUTION: if suspect labral pathology begin with a low amplitude arc and gradually increase the arc size
• Pt supine, elevate leg and bend knee
• Add more IR + ADD
• Attempts to cause a pinch of the anterior labrum
• MUST locate pain: buttock = piriformis?; anterior/deep hip = labrum

Question 9

Describe McCarthy sign

Answer 9

• Start in FADIR and go to EABER (Extension-Abduction-External Rotation)
• POS: Click or Clunk or anterior pain
• Can stabilize C/L knee to chest

Question 10

Describe the anterior labral test

Answer 10

• Pt supine
• PT slightly elevates leg/knee
• IR hip and compress hip through the knee with free hand

Question 11

Describe the posterior labral test

Answer 11

• Pt supine
• PT elevates leg/knee to ~90º
• IR hip and compress the hip through the knee with free hand

Question 12

Describe the Log Roll and Dial tests

Answer 12

• First Observe the resting position: Compare L/R for amount of ER
• Dial = IR and then let the leg roll back to passive starting position
• Anything > 45 ER = suggests capsular laxity or illiofemoral laxity
• Log Roll = Roll the leg IR/ER
• Clicks or noise is indicative of labral tear

Question 13

Describe the Barlow test

Answer 13

• Assesses for developmental dysplasia/congenital hip dislocation
• Bad test
• Axial compression + ADD bilaterally
• Cause a sublux/dislocation clunk

Question 14

Describe the Ortolani test

Answer 14

• Assesses for developmental dysplasia/congenital hip dislocation
• Good test
• Distraction + ABD bilaterally
• Cause a relocation clunk

Question 15

What is the Altman criteria for hip OA

Answer 15

• If hip IR ≥ 15º AND
• Pain with hip IR
• Morning stiffness 60min
• Age >50

Question 16

Interventions for hip OA

Answer 16

• Manual therapy
• Exercise

Question 17

What are the indications for a posterior hip glide

Answer 17

• Improve flexion and IR

Question 18

Describe how to perform a hip manipulation

Answer 18

• Start in loose packed position: leg elevated 15-30º flexion and 15-30º ABD
• Absorb the weight of the leg
• Quick and short pull
• Tips: have pt put contralateral heel in table hole and/or ask pt to hold on

Question 19

What does CASSS stand for (movement control exam)

Answer 19

• Control refers to the smoothness, coordination, and timing of movement
• Amount refers to the amplitude of movement at each joint
• Symmetry is observed in bilateral tasks or comparing unilateral performance between limbs
• Speed is the length of time
• Symptoms most commonly refer to pain but also can include mechanical symptoms, reports of instability, or fatigue

Question 20

Describe the lateral step-down test

Answer 20

• Poorly controlled “Dynamic Knee Valgus”
• Trunk Pelvis (Hip) Control (1 point each)
• 2 or more points on the lateral step down test
• 7 point scale: 0-1 = good; 2+ = moderate
• 15 cm step: 60º knee flexion, relationship to DF

Question 21

Conservative treatment of FAI

Answer 21

• Phase 1/Symptom Modulation: modalities, mobilizations, TRA’s & Multifidus
• Key is dynamic control

Question 22

Describe the Beighton hyper mobility exam

Answer 22

• 5 items
• Traditional cutoff is 5/9 for hyper mobility but it is now recommended to be 7/9 (better)

Question 23

What are the 5 items on the Beighton hyper mobility exam

Answer 23

• Passive 5th MCP extension (positive = >90º)
• Passive elbow extension with shoulder at 90º (positive = >10º hyperextension)
• Passive extension of knee in supine (positive = >10º hyperextension)
• Thumb to flexor side of forearm (positive = whole thumb touches side of forearm)
• Trunk flexion (positive = Forward Flexion with
  the knees straight so the hands rest easily on the floor)

Question 24

Clinical conditions of hypermobility

Answer 24

• Ehlers-Danlos syndromes (EDS)
• Marfan’s Syndrome
• Osteogeneses Imperfecta