Hip joint

Hip joint

1. Anatomy

   • joint
     • ball and socket
     • WB joint
     • Connects axial skeleton to appendicular skeleton
   • muscles
     • Glut max
     • Glut min and med
     • Internal rotators
     • Hip flexors
       • Iliopsoas
       • Rectus femoris
     • Adductors
     • Hamstrings

2. Subjective ax

   • HPC
     • WHIP
       • When
       • How
       • Interventions to date
       • Pattern since onset
   • Red flags
     • Night pain
     • Weight loss
       • Cancer
     • Trauma
       • #
     • Cauda equina symptoms
     • Sudden weakness
       • ? stroke
   • PMH
     • THREADSOCS
       • OSteoporosis
         • Increases the risk of #
       • Steroids

3. Objective ax

   • Strength testing
     • Adduction
     • Abduction
     • Extension
       • prone
     • Flexion
     • Internal rotation
     • External rotation
   • Special tests
     • Hip inpingement
     • Labral tear
       • Hip quadrant
     • Weak abductors
       • trendelenburg sign
     • Greater trochanteric pain syndrome
       • Single leg stand
       • palpation of greater trochanter
         • tenderness
       • Resisted abduction in adducted position
     • hip flexor tightness
       • modified thomas test
     • OA
       • Flexion
       • Abduction
       • Internal rotation
       • FADIRs
       • FABERs
   • ROM
     • AROM
       • Supine
       • flexion
       • medial rotation
       • extension
       • external rotation
       • Abduction
       • Adduction
     • PROM
       • test if limitations in AROM
   • joints above and below
     • Lumbar spine
     • knee

4. Differential diagnosis

   • Arthrogenic
     • hip #
       • ? hip precautions
       • trauma
         • e.g. fall
       • elderly population
     • OA
       • Stiffness
         • capsular pattern
           • 1. flexion
           • 2. Internal rotation
           • 3. Abduction
       • Treatment
         • Surgery
           • THR
         • Physiotherapy
           • Hip strengthening
           • Aerobic exercise
         • Corticosteroid injection
       • Pain
         • groin
     • Impingement
       • surgery
       • physio
         • hip strengthening
     • Labral tear
       • trauma
       • younger population
   • myogenic
     • Greater trochanteric pain syndrome
       • Treatment
         • Physio
           • Avoid side lying
           • hip strengthening
         • surgery
       • Pain lateral hip
         • SLS
         • palpation
         • Resisted abd. in adducted position
     • muscle weakness
       • Strengthening
       • specific to strength testing
     • muscle tightness
       • stretching
     • muscle strain
       • strengthen surrounding muscles
       • isometrics
     • Lumbar referred pain
   • Neurogenic
     • Lumbar radiculopathy
       • Loss of sensation
       • myotomal weakness
       • tingling, p + n, numbness
       • Treatment
         • Exercise
       • Can take up to 2 years
     • Lumbar radicular pain
   • Other
     • Cancer metasteses
       • Constant pain
       • No mechanical pattern
     • Avascular necrosis
     • Polymyalgia rheumatica
       • bilateral pain
       • early morning stiffness lasting over 30 mins
     • RA
       • SCREEND'EM

5. General treatment

   • Goals
   • Pharmacology
   • Stiffness
     • move it
   • Weakness
     • strengthen it
   • further referrals
   • muscle strains
     • acute management
     • isometrics
     • isotonic
     • progress load

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