Orthopedics > OSCE_HIP > Flashcards

OSCE_HIP Flashcards

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1
Q

What is the Weber Barstow maneuver used for?

A

Leg length assessment.

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2
Q

How do you assess ROM in hip flexion?

A

Pt supine

Therapist palpites PSIS

Pt flexes the hip (AROM). Is this as far as you can go? Pain?

Hip flexion stops when mvt of PSIS. Repositionner la hanche passivement si la personne est allée trop loin. Prendre la mesure.

No pain = OP on the knee (or the posterior femur if knee pain) until PSIS moves.

AROM and PROM can have the same measures

Pain? = PROM

Gonio:
Center on GT

Stabilizing arm = parallel to the bed

Moveable towards lateral epicondyle

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3
Q

How do you asses hip extension ROM?

A

Pt prone

Stabilization: PSIS

Arom: Extension of the hip. Pain? As far as you can go?

No pain = measure AROM. OP at EOR.

Pain = PROM

Center = GT
Stabilizing arm = parallel to the bed
Moveable = femur (lateral epicondyle)
à faire en dernier vu que le pt est prone

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4
Q

For ROM abduction and adduction, where do you stabilize?

A

Abduction = contralateral

Adduction = ipsilateral

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5
Q

How do you assess hip ROM in abduction and adduction?

A

pt is supine

Stabilization:
- Contralateral ASIS (abd)
- ipsilateral ASIS (adduction)
watch for compensation

No pain = OP

Pain = Move to EOR

Gonio STARTS at 90 = 0:
Center = Ipsilateral ASIS
Stabilizing arm = on the other ASIS
Moveable arm = along the femur towards the patella

*Si la jambe sort du plinth, on peut juste la soutenir (no gravity)

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6
Q

How do you measure ROM in hip IR and ER?

A

pt is high sitting

Pt brings the foot inward = ER
Pt brings the foot outward = IR
Measure

No pain = OP
Pain = PROM (support the femur)
Measure

Gonio
- Center = mid patella
- Stabilizing = parallel to the ground
- moveable = parallel to the tibia

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7
Q

How do you measure ROM hip IR and ER in patients that can’t sit?

A

pt supine

Position 90/90

Bring the foot inward = ER
Bring the foot outward = IR
* as far as you can go? any pain?*
No pain = OP

Pain = Passively move the structure to EOR (support the femur)

NO GONIO MEASUREMENT = subjective impression

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8
Q

How do you assess hip IR and ER if you want to screen if Craig’s test is indicated?

A

Pt prone nad therapist is at the feet of the bed

PROM until 90 degrees

IR: Passively bring the feet to fall out together at the same time. Correct compensation (e.g., hip)

ER: One leg at the time. Passively Rotate inwards. Correct any compensation.

Pain?

NO GONIO = subjective impression

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9
Q

What is anteversion and retroversion of the hip?

A

Anteversion = internal rotation of the feet
Retroversion = external rotation of the feet

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10
Q

What is RISOM?

A

RISOM stands for strength screening.

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11
Q

What is MMT?

A

MMT stands for strength grading.

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12
Q

When is RISOM performed?

A

RISOM is done at midrange.

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13
Q

When is MMT performed?

A

MMT is done near end range.

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14
Q

Do you need to eliminate gravity in RISOM?

A

No, you do not need to eliminate gravity in RISOM.

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15
Q

What are the instructions for RISOM?

A

1) Explain procedure, demo movement. 2) Positioning: stabilize proximally, joint angle between mid and end range, use bodyweight to apply pressure when possible. 3) Instruction: let me know if you feel pain or discomfort, don’t let me move you. 4) Apply resistance gradually until patient gives way.

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16
Q

How to position for hip flexion RISOM?

A

Pt is supine

Hip at 45 degrees, knee slightly flexed,

Stabilize ASIS from rotation

Apply pressure anteriorly at distal femur.

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17
Q

How to position for hip extension RISOM?

A

Pt is supine

Hip at 45 degrees, knee slightly flexed,

Stabilize ASIS from rotation

Apply pressure posteriorly at distal femur.

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18
Q

How to position for hip abduction RISOM?

A

Pt supine

Hip is at 0 degrees

Stabilize ASIS on the same side

Apply pressure at lateral distal femur.

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19
Q

How to position for hip adduction RISOM?

A

Pt supine

Hip is at 0 degrees

Stabilize ASIS on the opposite side

Apply pressure at medial distal femur.

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20
Q

How to position for hip internal and external rotation RISOM?

A

Pt is supine

Hip and knee at 90 degrees flexion

Hip at 0 degrees rotation

Apply isometric resistance into IR or ER

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21
Q

What is the positioning for hip flexion MMT without gravity?

A

Side lying

hand wrapped under distal thigh/knee

Stabilize pelvis

Ask pt to bend the hip as much as possible.

OP to see if they have gone full range.

if no mvt = palpation of psoas and iliacus

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22
Q

What is the positioning for hip flexion MMT with gravity?

A

1) pt in high sitting position
- AROM + OP
- Bring hip out of EOR
- Stabilization: Iliac crest
- Resistance: distal femur
Can do this position if pt is safe in sitting at EOB and no hip joint concerns

2) pt supine
- AROM + PROM
- Bring the hip to 90
- Stabilization: iliac crest
- Resistance: distal femur
Can do this position if pt has hip surgical restrictions, is weak, or can’t sit

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23
Q

What is the positioning for hip extension MMT with gravity?

A

Pt standing, leaning over EOB

Pt brings the leg upwards, keeping knee straight (AROM)

Provide OP or PROM to see if full range

Bring hip out of EOR

Stabilize PSIS

Resistance at posterior distal femur

Watch for compensation

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24
Q

What is the positioning for hip extension MMT without gravity?

A

pt side lying

Support under knee (arm wrapped)

Stabilize pelvis

Start with some 90 degrees hip flexion

Allow patient to do AROM, check with overpressure.

Make sure that therapist does a trunk rotation

Palpate glute max if no movement

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25
What is the positioning for hip abduction MMT with gravity?
Pt is side lying La jambe qui abducte est par-dessus la jambe qui soutient (pliée) Pt abducte la jambe. OP or PROM pour vérifier si c'est full ROM. Ramener hors du EOR. - Stabiliser PSIS. - Pressure = distal femur
26
How could you test independently MMT in TFL and gluteus medius in hip abduction w/ gravity?
1) TFL: Ask for hip IR. Will relaxe the glute med to isolate TFL 2) gluteus medius: ask for hip ER. Will relax the TFL to isolate glute med. *Pt is side lying. Same procedure than for MMT, but rotate the hip.
27
What is the positioning for hip abduction MMT without gravity?
Supine Stabilize contralateral ASIS Pt brings leg outwards Verify if it's full range (OP) MMT: 2 and less
28
What is the positioning for hip adduction MMT without gravity?
Supine Move the other leg Stabilize ipsilateral ASIS Pt brings the leg inwards Verify if it's full ROM
29
How do you measure MMT in ER and IR versus gravity?
Pt sitting ER: - Bring the foot inwards. - Check if full ROM (OP or PROM) - Stabilize: above knee joint - Pressure: distal tibia IR: - Bring the foot outwards - " " - " " _" "
30
How do you measure MMT in ER and IR without gravity?
Pt supine, hip at 90 degrees. Support the knee and distal tibia IR: Ask pt to bring the foot outwards ER: Ask pt to bring the foot inwards
31
how do you test MMT in sartorius?
Pt supine Ask the pt to go in a tailor's position (hip flexion, abduction, ER) Resistance: Adduction, IR and extension "don't let me move you"
32
What is the contraindication for posterior approach THA?
Hip flexion greater than 90 degrees, hip adduction, hip internal rotation.
33
What are the contraindications for lateral approach THA?
No active hip abduction.
34
What is the procedure for getting out of bed after THA?
Get out on the affected side if possible, shimmy to the edge of the bed, turn, and organize everything.
35
What is the method for turning and ambulating with a walker after THA?
Bad leg stays with walker, move walker, step into walker with bad leg, good leg follows.
36
What is the normal ROM for hip flexion?
120 degrees.
37
What is the normal ROM for hip extension?
30 degrees.
38
What is the normal ROM for hip abduction?
45 degrees.
39
What is the normal ROM for hip adduction?
30 degrees.
40
How do you assess leg lenght?
1- Weber Barstow Maneuver: reset position of pelvis 2- Leg Lenght: Measure approximately leg lenght 3- Femur & Tibia Lenght: See if the difference b/ween lenght of 2 legs comes from femur or tibia
41
What is the normal ROM for hip external rotation?
45 degrees.
42
What is the normal ROM for hip internal rotation?
45 degrees.
43
What is the modified Thomas test used for?
To assess iliopsoas, ITB, sartorius and quadriceps tightness.
44
What is the Thomas test used for?
To assess hip flexor tightness. Positive test: Thigh is lifted off the plinth into hip flexion Negative test: the leg is flat on the bed Gonio: Center: GT Stabilizing: Along the body Moveable: Along the femur towards the lateral epicondyle
45
What is the goal of the Weber Barstow Maneuver?
Reset the position of the pelvis before measuring leg length. Pt supine 1) Flexion active des genoux 2) Flexion de la hanche (bridging). Redescendre. 3) PT fait une extension passive des jambes
46
What is the sequence of the Weber Barstow Maneuver?
1️⃣ Patient supine. 2️⃣ Patient actively flexes knees and pelvis (“triplex flexion”). 3️⃣ Patient bridges (pelvic flexion AROM). 4️⃣ Therapist passively extends lower limbs to resting position. Then compare the position of the medial malleoli with thumbs to see if they’re at the same distance.
47
How is leg length measured after the Webster Barstow Maneuver?
Patient supine. Place measuring tape from the inferior border of ASIS to the inferior border of the medial malleolus. Keep tape on firm bony surfaces. Repeat 2–3 times, take the mean (cm or in). Compare left and right sides.
48
When should the Femur/Tibia Length test (1c) be done and what is its goal?
Performed if a leg length difference is observed in the previous test. Goal: Determine whether the LLD originates from the femur or tibia.
49
How do you differentiate femur vs tibia contribution to leg length discrepancy?
Femur: Patient supine, hips and knees flexed to 90°. Compare patella heights (higher patella = longer femur). Avoid twisting the patient. Tibia: Patient prone, knees flexed to 90°. Compare calcanei heights (higher calcaneus = longer tibia).
50
Hamstring Flexibility – SLR: What are the key positions and instructions?
Patient: Supine Therapist: Standing or kneeling on plinth Hands: One on distal tib/fib, one over knee to prevent flexion Instruction: Lift leg slowly with full knee extension until symptoms or firm end-feel Measurement: Option 1: Heel-to-plinth distance (cm/in) Option 2: Hip flexion ROM (GT-centered goniometer)
51
Hamstring Flexibility – 90/90 Test: What are the key steps and measurements?
Patient: Supine Therapist: Standing Hands: One on distal femur (stabilize hip/knee at 90°), one on distal tib/fib Instruction: Extend leg slowly until symptoms or firm end-feel Measurement: Center: GT Stabilizing arm: Parallel to body Moveable arm: Toward lateral epicondyle Outcome: Degrees (angle of tibia from 90/90) Degrees: Should be around 0. Negative = missing flexibility to be in full knee extension.
52
Rectus Femoris Flexibility: What are the key positions and measurements?
Patient: Prone Therapist: Standing Hands: One on distal tib/fib, one stabilizing pelvis Instruction: Flex knee slowly until symptoms or firm end-feel Measurement: Center: Lateral epicondyle Stabilizing arm: Toward GT Moveable arm: Toward lateral malleolus Outcome: Degrees Values: As knee flexion (130-135)
53
Thomas Test for Iliopsoas: What defines a positive vs negative result?
Patient: Supine Therapist: Standing Instruction: Flex opposite hip, maintain lumbar lordosis Positive: Tested thigh lifts off plinth Negative: Leg remains flat Measurement: Center: GT Stabilizing arm: Parallel to bed Moveable arm: Toward lateral epicondyle Outcome: Degrees
54
Modified Thomas Test: What muscles are assessed and how?
Patient: Supine, holding untested leg in flexion Therapist: Standing Tested leg hangs off plinth Iliopsoas: Thigh not parallel/lower than plinth = positive ITB: Hip in abduction + tension = positive Sartorius: Flexion + ER + tension = positive Quadriceps: Knee flexion <90° + tension = positive Measurement: Based on muscle (hip flexion, abduction, ER, knee flexion) Outcome: Degrees
55
Ober’s Test for ITB: What are the key steps and interpretation?
Patient: Sidelying Therapist: Standing Instruction: Passively flex, abduct, extend, then adduct leg Positive: Leg remains in abduction with symptoms Negative: Leg returns to adduction Outcome: Positive or negative
56
Piriformis Test: What defines a positive result and how is it measured?
Patient: Sidelying Therapist: Standing Instruction: Flex hip to 45°, knee to 90°, foot rests on bottom leg Stabilize pelvis to avoid false positive Positive: Knee raised off plinth + symptoms Negative: Knee touches plinth or minimal distance + no symptoms Measurement: Medial epicondyle to plinth Outcome: cm or in
57
Modified Thomas Stretch: What are the OP and stabilization techniques for each muscle?
Iliopsoas: Stabilize ASIS, OP distal femur into extension ITB: Stabilize iliac crest, OP lateral distal femur into adduction Sartorius: Stabilize ASIS, OP distal femur into extension/adduction + leg into IR Quadriceps: Stabilize ASIS, OP distal tibia into knee flexion Treatment time: Flexibility parameters
58
Piriformis Stretch: What are the key steps and treatment time?
Patient: Supine Therapist: Standing Position: Hip at 45° flexion, knee at 90° Stabilize ASIS, passively move leg into adduction Treatment time: Flexibility parameters
59
What are the four PNF techniques used for flexibility?
Hold-relax: Resist in fixed position 6 sec, then passive hold at EOR Contract-relax: Resist through small range 6 sec, then passive hold at EOR Hold-relax agonist contract: Resist 6 sec, then patient actively increases range with therapist Contract-relax agonist contract: Resist through small range 6 sec, then patient actively increases range with therapist
60
What positions are used for PNF to increase knee and hip flexibility?
Knee Extension: 90/90 or SLR (Supine) Knee Flexion: PKB (Prone) or Sitting at EOB (post-TKA) Hip Extension: Thomas or Modified Thomas (Supine) Hip Adduction: Modified Thomas (Supine) Combined Add/IR: Piriformis (Supine) ITB: Ober’s Test (Rarely done)
61
Review therapist assisted exercises (PROM, AAROM, strenght)
Orthopedics
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