Evaluation of the HipEvaluation of the Hip

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Bony Hip Anatomy ReviewBony Hip Anatomy Review

Muscular Hip Anatomy ReviewMuscular Hip Anatomy Review

Real Life Scenario:

Your soccer athlete walks into the training room. He is complaining of pain in his left hip. He says he was at shooting practice and felt a pop and had immediate pain.

What do you do?

Hip EvaluationHip Evaluation

Visual Observation: Visual Observation: Obvious deformityObvious deformity Patterns of SwellingPatterns of Swelling GaitGait Pelvic ObliquityPelvic Obliquity

Hip EvlauationHip Evlauation

MOIMOI How did the injury occur?How did the injury occur? Was there a direct blow to the hip?Was there a direct blow to the hip? Did you twist in a funny way?Did you twist in a funny way?

History:History: Have you ever injured it before?Have you ever injured it before? How long ago did you injure it?How long ago did you injure it? Did you hear or feel any ‘pops’ or ‘cracks’?Did you hear or feel any ‘pops’ or ‘cracks’? Have you had any previous evaluations or Have you had any previous evaluations or

treatments?treatments?

Hip Evaluation

Palpation:Palpation: Palpate all bony and soft tissue anatomy for:Palpate all bony and soft tissue anatomy for:

• Point tendernessPoint tenderness• SwellingSwelling• CrepitusCrepitus• TemperatureTemperature• DeformityDeformity

Ensure Ensure neurovascular neurovascular exam is intactexam is intact

Hip EvaluationHip Evaluation

Palpation (cont’d)Palpation (cont’d) Bony palpations:Bony palpations:

• ASISASIS• Iliac crestIliac crest• Greater TrochanterGreater Trochanter• Ischial TuberosityIschial Tuberosity• SI JointSI Joint• Lumbar VertebraeLumbar Vertebrae

• Soft Tissue PalpationsSoft Tissue Palpations• TFLTFL• Trochantric bursaTrochantric bursa• SartoriousSartorious• AdductorsAdductors• Inguinal lymph nodesInguinal lymph nodes• Gluteus Max. & Med.Gluteus Max. & Med.• Sciatic nerveSciatic nerve• QuadricepsQuadriceps• HamstringsHamstrings

ROM & Strength TestingROM & Strength Testing

ROM should be tested:ROM should be tested: PassivelyPassively ActivelyActively ResistivelyResistively

• ConcentricConcentric• EccentricEccentric

Measure with a GoniometerMeasure with a Goniometer Compare BilaterallyCompare Bilaterally Observe Muscle ToneObserve Muscle Tone

Special Tests:Special Tests:Trendelenburg Test:Trendelenburg Test:

Positive Finding:

When the pelvis on the unsupported side drops noticeably lower then the supported side

Indicates Gluteus Medius weakness on the supported side

Special Tests:Special Tests:Ober’s TestOber’s Test

Positive finding:Inability of the leg to adduct and touch the table is indicative of IT Band tightness

Special TestsSpecial Tests Thomas TestThomas Test

Positive finding:Lack of hip extension with knee flexion greater than 45 degrees is indicative of iliopsoas tightnessFull hip extension with knee flexion less than 45 degrees is indicative of rectus femoris tightness

Special Tests:Special Tests:FABER/Patrick Test:

Positive Finding:When involved lower extremity does not abduct below the level of the non-involved side.Indicative of iliopsoas tightness, sacroiliac dysfunction, or hip joint abnormalities.

Note: FABER is an acronym describing :

F=FlexionAB=AbducationER=External Rotation

Special TestsSpecial Tests

Positive Finding:Pain or apprehensionIndicative of hip joint pathology such as: arthritis, osteochondral defects, avascular necrosis, or acetabular labrum defects

Hip Scouring/Quadrant Test

Manual Muscle Tests: Hip Flexors

Manual Muscle Tests

Hip Extensors

Manual Muscle Tests

Hip Abductors

Manual Muscle Tests

Hip Adductors

Practice!!!

Questions?