What type of joint is the hip joint?
ball and socket
The hip joint is essential to stability and mobility of the entire human mechanism during what activities?
Postural support, transitions, gait
What does hip pain lead to?
Mechanical alterations in the kinetic chain
-can affect LBP, the knee and ankle
What is the anterior hip innervated by?
The femoral and obturator nerves
-causes groin pain if injured
What is the posterior hip innervated by?
Sciatic nerve
-causes buttock and trochanteric pain
What are the age and gender influences on hip problems?
4-10 years: legg calve perthes (Avascular necrosis of femoral head)
12-19 years: slipped capital femoral epiphysis
15-25 years: articular osteochondritis (irritation of hip joint)
What are the two approaches for a total hip arthoplasty? (Replacement)
Posteriorlateral approach (most common) Direct anterior approach
What are common indicators of OA?
Decreased hip internal rotation and external rotation
Groin pain
The successfully treated hip pain and joint dysfunction relies upon through exam of what?
- entire lower limb lumbar spine
- pelvis and SI function and alignment
- hip muscle control and activation patterns
- deep abdominal, core and pelvic floor muscle control
- thigh muscle length and strength
- neural tissue extensibility (example, sciatic and femoral nerve)
- hip joint biomechanics as a whole and in isolation (with walking, functional tasks and isolation)
Red flags for hip joint injury
- unrelenting pain
- unable to bear weight through LE
- history of cancer
- age >55
- unexplained weight loss
- bowel/bladder disturbances
- history of a fall
- long term corticosteroid use
- history of Avascular necrosis of the opposite hip
- pain unchanged by position
- trauma
- recent growth spurt (adolescents)
- RLQ pain and nausea or vomiting (appendicitis)
Differential diagnosis of the hip
- Legg calve perthes
- Juvenile RA
- Epiphysiolysis
- Articular osteochondritis sessions
- Ischemia femoral necrosis
- Osteoporosis
- OA
- Hernia
- Hip fracture
- Bursitis
- Tendinopathy
- Labrador tear
- Nerve entrapment
- Piriformis syndrome
- Groin strain
- SI dysfunction
- Lumbar spine dysfunction
- Hip dysplasia
What Interview questions do you ask?
- Pain–> location, type, cause and severity
- catching or clicking
- numbness or tingling
- PMHx
- diagnostic imaging
- what makes it better or worse
- orthotics
- work duties
- what do you avoid doing? (Stairs or squatting)
- exercises
- past treatment
- medications
- history of LBP or SI pain, knee pain
What things should you observe when you first meet you patient?
- Posture: pelvis, hips (Q-angle), knees, feet
- Leg length
- Gait: pes planus/cavus, anteversion, retroversion
Rectus femoris muscle length: Thomas test
Landmarks: -SA: greater trochanter of femur -A: lateral epicondyle of femur -MA: lateral malleolus Patient action: supine with hip of LE extended, flex the opposite hip toward chest (enough to flatten back)
- If rectus femoris has decreased length, patients knee will extend slightly
- if muscle length is normal, knee will remain at 90 degrees of flex
Iliotibial band and TFL muscle length: ober test and modified ober test
- Patient action: side lying with hip and knee of lowermost extremity flexed to 45 degrees
- Examiner action: stabilize pelvis, passively abduct hip then extend hip, allow lower extremity to drop into adduction toward the table
- Ober test: patients knee in 90 degrees of flexion
- Modified ober test: knee in full extension positive test occurs if relaxed hip does not fall below horizontal
Iliotibial band and TFL muscle length: ober test and modified ober test- inclinometer
Assistant needed to perform correctly
During test:
-maintain knee flexion at 90 degrees (ober)
-maintain knee in full extension (modified ober test)
Place inclinometer on the lateral epicondyle of the femur
Read inclinometer:
-if LE remains horizontal = 0 degrees
-if LE falls into adduction a + number is recorded
-if LE remains in abduction a - number is recorded
What does FABER stand for?
Flexion, ABduction, External Rotation
What is the FABER test?
Patient: supine with painful leg ankle placed on contralateral thigh above knee
Examiner: place patients foot (of test leg) on top of contralateral knee, stabilize opposite pelvis, slowly over the knee (of test leg) toward the exam table
Results:
-negative test= test knee falls to the table, no pain
-positive test = test knee remains above the opposite straight leg
Positive test indicates a hip joint pathology, iliopsoas spasm or SI joint pain
