OSCE: Hip

Question 1

What are important anterior landmarks of the hip?

Answer 1

• Level of L4: Iliac Crest (upper margin of pelvis)
• Iliac Tubercle and Anterior Superior Iliac Spine (ASIS)
• Greater Trochanter of Femur
• Pubic Tubercle

Question 2

What are important posterior landmarks of the hip?

Answer 2

• Posterior Superior Iliac Spine (PSIS)
• Greater Trochanter of Femur
• Ischial Tuberosity

Question 3

What is the normal ROM for hip flexion (knee flexed)/ knee extended?

What muscles are involved?

Answer 3

120-135^o

^{90 if knee is extnded}

Iliopsoas (femoral nerve L2-L4)

Question 4

What is the normal ROM for hip extension?

What muscles are involved?

Answer 4

15-30^o

Gluteus Maximus (inferior gluteal nerve L5-s2)

Question 5

What is the normal ROM for hip abduction?

What muscles are involved?

Answer 5

45-50^o

Gluteus Medius and Minimus (superior gluteal nerve l5-s1)

Question 6

What is the normal ROM for hip adduction?

What muscles are involved?

Answer 6

20-30^o

Medial Compartment Muscles: Adductor Longus, Brevis, and Magnus, Pectineus, Gracilis

Question 7

What is the normal ROM for hip external rotation?

What muscles are involved?

Answer 7

40-60^o

sartorious, glute medius, glut max

Question 8

What is the normal ROM for hip internal rotation?

What muscles are involved?

Answer 8

30-40^o

Iliopsoas

Question 9

Labral Loading

What compartment is this testing?

How do you peform this test?

What does a positive test indicate?

Answer 9

Central Compartment

1. Flex the patient’s knee and hip to 90°
2. Load into the femur towards the innominate (hip bone)
3. Positive Test (pain) indicates Labral or Cartilaginous Pathology

Question 10

Labral Distraction

What compartment is this testing?

How do you peform this test?

What does a positive test indicate?

Answer 10

Central Compartment

1. Flex the patient’s knee and hip to 90°
2. Distract femur away from the innominate

Positive Test (distraction of pain) indicates Labral or Cartilaginous Pathology

Question 11

Scour

What compartment is this testing?

How do you peform this test?

What does a positive test indicate?

Answer 11

Central Compartment

1. Flex and externally rotate patient’s hip.
2. Load into socket and articulate through annular range of motion.

Positive Test (pain) indicates Labral or Articular Cartilage Pathology

Question 12

Apprehension Faber

What compartment is this testing?

How do you peform this test?

What does a positive test indicate?

Answer 12

FABER 1 OF 3

Central Compartment

1. Patient’s hip is flexed, abducted and externally rotated.
2. Physician induces further external rotation by applying a posterior force at the knee.

Positive Test (anterior subluxation of hip or pain) indicates Labral Pathology

Question 13

Jump sign

What compartment is this testing?

How do you peform this test?

What does a positive test indicate?

Answer 13

Lateral Compartment

1. Patient seated.
2. Pressure is applied to greater trochanter.

Positive Test (patient jump) indicates Trochanteric Bursitis

Question 14

Straight Leg Raise Test

What compartment is this testing?

How do you peform this test?

What does a positive test indicate?

Answer 14

Lateral Compartment

1. Patient supine.
2. Passively flex patient’s ipsilateral hip with knee extended.

Positive Test (pain over lateral leg at >15^o) indicates IT Band contracture

• Positive signs usually occur between 30-60˚ if cause is lumbosacral radiculopathy and/or sciatic neuropathy.
• Positive signs at >70˚ is more likely mechanical low back pain due to muscle strain or joint disease.

Question 15

Patrick’s Faber (Lateral Compartment)

How do you peform this test?

What does a positive test indicate?

Answer 15

Lateral Compartment

1. Patient’s hip is flexed, abducted and externally rotated.
2. Physician braces contralateral ASIS.
3. Patient externally rotates/abducts against resistance.

Positive Test (pain) indicates Gluteus Medius Pathology

Question 16

Patrick’s Faber (Anterior Compartment)

How do you peform this test?

What does a positive test indicate?

Answer 16

Anterior Compartment

1. Patient’s hip is flexed, abducted and externally rotated.
2. Physician braces contralateral ASIS.
3. Patient internally rotates/adducts against resistance.

Positive Test (pain) indicates Iliopsoas Insufficiency or Pathology

Question 17

Thomas Test

What compartment is this testing?

How do you peform this test?

What does a positive test indicate?

Answer 17

Anterior Compartment

1. Patient supine and pulls knees to chest.
2. One leg is lowered to the table to test the flexibility of the hip flexors.

Positive Test (extended leg raises off table) indicates Hip Flexor Contraction.