hip & spine exam pearls - emory school of medicinepearl (1) hip oa 1 • jospt 2017: • >50...
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Hip & Spine Exam PearlsKenneth Mynatt, PT, DPT, ATC, LATEmory Sports Medicine Complex
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Disclosures
• I have no relevant financial relationships with commercial interests.
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Inspection & Leg Length Discrepancy13
• Inspect from feet up• Palpation• Gait• Functional - umbilicus to medial malleoli
• Up slip/Downslip• Anterior/Posterior innominate rotation
• Anterior innominate appears longer• Posterior innominate appears shorter
• Structural – ASIS to medial malleoli
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Anterior Hip
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Pearl (1) Hip OA1
• JOSPT 2017: • >50 y.o.• Moderate anterior/lateral hip pain with weight bearing• Morning stiffness < 1 hr• Hip IR < 24 degrees or Reduced Hip IR & Hip Flex by 15 degrees• Pain with passive hip IR
• FADIR, FABER, scour• BMI• End feel
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Pearl (2) FAI2,3
• Active young/middle age adult (25-50 y.o.)• Insidious onset• Groin pain • Decreased IR and flexion• FADIR, FABER• Pain with prolonged sitting/deep hip flex • Hx: AVN, repetitive trauma
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Pearl (3) Labral Tear4,5,6
• Active young adult, 15-41 y.o. • Anterior hip or groin
• 94% anterior tears
• Clicking, clunking, locking, giving way • Pain at night, prolonged sitting, activity • FADIR, posterior impingement test• Hx: FAI
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Pearl (4) Hip Flexor Strain7,8
• Acute onset• Gait: antalgic swing phase, reduced heel/toe off• Palpable• Resisted hip flexion: painful and weak • Full PROM• Hx of recent injury – within 15 weeks• Soccer and hockey
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Pearl (5) Proximal Rectus Femoris9
Strain/Tear• Acute onset• Visible defect • TTP: distal to AIIS• Sprinting, kicking• Ely test
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Pearl (6) Internal (anterior) Snapping Hip Syndrome10
• Iliopsoas tendon over iliopectineal eminence or femoral head
• Transitioning from hip Flex/ER/ABD toExt/IR/ADD
• Palpable and often audible • Thomas test, FABER to EADIR• Glute weakness
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Anterior Hip Location ROM Age Hallmark Test
Hip OA Groin Bony PROM Age > 50 Morning stiffness FABER, FADIR, scour
FAI Groin Bony PROM Age: 25-50 Non-descript FABER, FADIR
Labral Tear Groin Bony PROM Age: 15-41 Clicking FABER, FADIR
Hip Flex Strain Groin Full PROM Young adult MMT painful
Rectus Strain Proximal femur Full PROM Young adult Location of s/s Ely
Internal snapping hip
Groin Full PROM Reproduce s/s with ROM
Thomas
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Lateral Hip
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Pearl (7) External (lateral) Snapping Hip Syndrome10
• ITB• Or anterior fibers of gluteus maximus
• Greater trochanter - palpation• Giving way• Active hip flex/ext or hip IR/ER• Palpable and often audible• Ober’s test
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Pearl (8) Greater Trochanteric Bursitis11
• Greater trochanter - palpation• Hip ABD/ER weakness • Painful sleeping on affected side• Leg length discrepancy
• Foot Pronation
• CSI
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Pearl (9) Gluteus Medius Tendinopathy11,12
• Trigger point• Dull/achy • Hip ABD/ER weakness• Trendelenburg sign• Tear
• Chronic degeneration• Age
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Pearl (10) Meralgia Paresthetica11
• Lateral femoral cutaneous n.• N/T anterolateral thigh• Absence of motor deficits
• Iliac crest bone graft• Obese, tight pants/belts• Prolonged sitting
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Lateral Hip Location Hallmark Cause Test
External snapping hip
Greater trochanter Audible/palpable Tightness of TFL Ober
Grt. Troch. bursitis
Greater trochanter Location of s/s Lateral hip weakness
CSI improves s/s
Glute med. tendinop
Gluteus medius Trigger point Lateral hip weakness
MMT, trendelenburg
Meralgia Paresthetica
Anterolateral thigh N/T anterolateral thigh – no motor loss
Tight pants/belt Palpation
Leg Length Supine measure medial malleolus level
Palpation of ASIS/PSIS
Positional, structural, tightness
Muscle energy
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Thank You!
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References• 1: Cibulka MT, Bloom NJ, Enseki KR, Macdonald CW, Woehrle J, Mcdonough CM. Hip Pain and Mobility Deficits-Hip Osteoarthritis: Revision 2017. J
Orthop Sports Phys Ther. 2017;47(6):A1-A37.
• 2: Banerjee P, Mclean CR. Femoroacetabular impingement: a review of diagnosis and management. Curr Rev Musculoskelet Med. 2011;4(1):23-32.
• 3: Thomas GE, Palmer AJ, Andrade AJ, et al. Diagnosis and management of femoroacetabular impingement. Br J Gen Pract. 2013;63(612):e513-5.
• 4: Groh MM, Herrera J. A comprehensive review of hip labral tears. Curr Rev Musculoskelet Med. 2009;2(2):105-17.
• 5: Su T, Chen GX, Yang L. Diagnosis and treatment of labral tear. Chin Med J. 2019;132(2):211-219.
• 6: Springer BA, Gill NW, Freedman BA, Ross AE, Javernick MA, Murphy KP.. N Am J Sports Phys Ther. 2009;4(1):38-45.
• 7: Eckard TG, Padua Acetabular labral tears: diagnostic accuracy of clinical examination by a physical therapist, orthopaedic surgeon, and orthopaedic residentsDA, Dompier TP, Dalton SL, Thorborg K, Kerr ZY. Epidemiology of Hip Flexor and Hip Adductor Strains in National Collegiate Athletic Association Athletes, 2009/2010-2014/2015. Am J Sports Med. 2017;45(12):2713-2722.
• 8: Orchard JW, Chaker jomaa M, Orchard JJ, et al. Fifteen-week window for recurrent muscle strains in football: a prospective cohort of 3600 muscle strains over 23 years in professional Australian rules football. Br J Sports Med. 2020;
• 9: Esser S, Jantz D, Hurdle MF, Taylor W. Proximal Rectus Femoris Avulsion: Ultrasonic Diagnosis and Nonoperative Management. J Athl Train. 2015;50(7):778-80.
• 10: Yen YM, Lewis CL, Kim YJ. Understanding and Treating the Snapping Hip. Sports Med Arthrosc Rev. 2015;23(4):194-9.
• 11: Grumet RC, Frank RM, Slabaugh MA, Virkus WW, Bush-joseph CA, Nho SJ. Lateral hip pain in an athletic population: differential diagnosis and treatment options. Sports Health. 2010;2(3):191-6.
• 12: Ortiz-declet V, Chen AW, Maldonado DR, Yuen LC, Mu B, Domb BG. Diagnostic accuracy of a new clinical test (resisted internal rotation) for detection of gluteus medius tears. J Hip Preserv Surg. 2019;6(4):398-405.
• 13: Menz HB, Dufour AB, Riskowski JL, Hillstrom HJ, Hannan MT. Foot posture, foot function and low back pain: the Framingham Foot Study. Rheumatology (Oxford). 2013;52(12):2275-82.