The Essential Hip Exam Layer 1- Osteochondral Layer 2- Inert - - PowerPoint PPT Presentation

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The Essential Hip Exam Layer 1- Osteochondral Layer 2- Inert - - PowerPoint PPT Presentation

Aug 25, 2022 339 likes •442 views

12/13/2018 The Layers of the Hip To treat hip pathology- 1 st task is to understand the source of hip pain Bryan Kelly et al Arthroscopy 2012 The Essential Hip Exam Layer 1- Osteochondral Layer 2- Inert Layer 3-

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SLIDE 1

12/13/2018

The Essential Hip Exam

Alan Zhang MD

Associate Professor Director, Hip Preservation Center Fellowship Director, Sports Medicine UCSF Department of Orthopaedic Surgery

The Layers of the Hip

  • To treat hip pathology-
  • 1st task is to understand the source of hip pain
  • Bryan Kelly et al Arthroscopy 2012
  • Layer 1- Osteochondral
  • Layer 2- Inert
  • Layer 3- Contractile
  • Layer 4- Neuromechanical

2

Layer 1- Osteochondral

  • Structures
  • Femur
  • Acetabulum
  • Articular cartilage
  • Pathology
  • Cam impingement
  • Pincer impingement
  • Subspine impingement
  • Articular cartilage delamination

3

Layer 2- Inert

  • Structures
  • Capsule
  • Labrum
  • Ligamentum teres
  • Pathology
  • Labral tear
  • Capsular instability
  • Adhesive capsulitis

4

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SLIDE 2

12/13/2018

Layer 3- Contractile

  • Structures
  • Muscles crossing hip
  • Pelvic floor
  • Lumbosacral muscles
  • Pathology
  • Gluteus medius tear
  • Hip flexor strain
  • Proximal hamstring strain
  • Adductor tendinopathy

5

Layer 4- Neuromechanical

  • Structures
  • Neuro-vascular structures in

hip region

  • Regional mechanoreceptors
  • Pathology
  • Pain syndromes
  • Neuromuscular dysfunction

6

Location, Location, Location

  • Anterior/groin
  • FAI
  • Arthritis
  • Flexor strain
  • Lateral/thigh
  • Trochanteric pathology
  • Snapping hip
  • Buttock/posterior
  • Low back/sciatic nerve
  • Hamstring injury
  • Referred pain

7

Physical Exam

  • Ambulation
  • Supine exam
  • ROM
  • Strength
  • Provocative/special maneuvers
  • Lateral Exam
  • Prone Exam
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SLIDE 3

12/13/2018

Ambulation

  • Asses gait pattern
  • Antalgic gait

‒ Arthritis/acute injury

  • Trendelenberg gait/Single leg stance

‒ Trochanteric pathology ‒ Gluteus tear

  • FAI gait

‒ Loss of peak hip extension

Trendelenberg Gait FAI gait

  • FAI gait
  • Loss of peak hip extension
  • Zhang et al AJSM 2016
  • Increased hip joint loading in

FAI patients

Supine Exam

  • ROM
  • Strength testing
  • Provocative exams

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SLIDE 4

12/13/2018

Range of Motion

  • Flexion (0-130)
  • IR @ 90 degrees of

flexion (0-30)

  • ER @ 90 (0-60)
  • Abduction (0-60)
  • Extension (0-20)
  • Arthritis- decreased

globally

  • FAI- decreased IR and

flexion

Strength/Muscle Exam

  • Rectus—hip flexion against

resistance

  • Abductors—push out legs
  • Adductors—pull in legs

Provocative Exams

  • Log roll
  • FADIR
  • FABER
  • Labral stress test/ Scour test
  • Straight leg raise
  • Sports hernia exam
  • SI Joint exam

15

Log Roll

  • Assess for

intra-articular hip pathology

16

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SLIDE 5

12/13/2018

Flexion ADduction Internal Rotation

FADIR for FAI FABER Test

  • SI pathology
  • Sometimes anterior labral pathology

Flexion ABduction External Rotation

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SLIDE 6

12/13/2018

Labral Testing/Scour Test Straight Leg Raise

  • Hamstring

tightness

  • Radiating pain

(lumbar radiculopathy)

Sports Hernia (Athletic Pubalgia)

  • Strain or tear of soft

tissue in lower abdomen

  • r groin area
  • Inguinal disruption
  • Adductor injury
  • Abdominal wall injury

23

Sports Hernia Exam

  • Palpation
  • Pubic symphysis/Pubic tubercle
  • Insertion of rectus (confluence of structures)
  • Adductor origin (AL, AB, pectineus)
  • Superficial inguinal ring

‒ Rule out true hernia ‒ Size of ring (dilation indicates weakened area) ‒ Check tenderness of posterior wall

24

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SLIDE 7

12/13/2018

Sports Hernia Exam

  • Special maneuvers
  • Resisted sit up (legs

straight, 10-30 deg trunk flexion)

  • Adductor Squeeze test (0

deg and 90 deg of hip flexion) – pain/strength

  • Valsalva

25

SI Joint Examinations

  • FABER Test
  • Distraction Test
  • Thigh Thrust Test
  • Gaenslen Test
  • Compression Test
  • Sacral Thrust Test
  • 3 or more positive tests indicate SI joint dysfunction

26

Distraction Test

  • Examiner pushed outward and down on both iliac wings

27

Thigh Thrust Test

  • Examiner will flex the hip and knee on injured side to “thrust”

while patient pelvis is flat on table

28

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SLIDE 8

12/13/2018

Gaenslen Test

  • Injured side in extension and off the table while uninjured side is

flexed

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Compression Test

  • Lay on side opposite of pain while examiner pushes down

30

Sacral Thrust Test

  • Examiner Pushes down on Sacrum

31

Lateral Exam

  • OBER test
  • IT band tightness
  • Palpate Greater Trochanter
  • Trochanteric bursitis
  • Gluteus Medius strength testing
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SLIDE 9

12/13/2018

Ober Test

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Gluteus Medius Strength Test

34

Prone exam

  • Hamstring exam
  • Palpate for defects
  • Evaluate for weakness

Thank You

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