Hip Assessment

Hip Assessment

1. History->chart review

2. Observation: sitting, standing and gait analysis

   •     Gait assessment can be performed before we even meet the pt. Observe their gait while they walk into the examination room.     
   • Standing posture: observe from back, front and side.
     • Truck, lordosis, scoliosis, ASIS and PSIA, Iliac creast, LLD, Fe oral anterversion and retroversion, coxa valga and varus, genu valgus and carus, pes planus and pes cavas
       • Lordosis->Presents with anterior pelvic tilt in which the ASIS is significantly higher than the PSIS. And vice versa for flexed posture in which the pelvis tilts posteriorly. Scoliosis->Adam's forward bend Iliac crest-> palpation. Measure if the crest is aligned. If not, pt may have a anatomical leg length discrepancy. Can also have an upslip in which one side of innominate is superiorly displaced compared to the other side.  Femoral anterver/retro->usually, the patella follows the femur. Ex: squinting patella->patella pointing inward. Frog eyes->patella pointing outward Coxa valgus->more at risk for labral tears Coxa varus->more at risk for femoral neck fx Genu valgus->knees touching Genu varus->knee separated 2 more fingers apart Pes planus->flexible feet Pes cavus->stiff foot                   

3. Scanning Test: Not sure what's going on with the pt. Scanning is used to rule out other areas you believe may be involved. Look at lumbar ROM: flex, ext, lateral flex, rotation. Is it coming from the hip or the lumbar spine? History of numbness and tingling or pain with repetitive motion (predictive pattern of motion causes pain), the back may be involved.

4. Examination:

   • AROM: flexion, extension, adduction, abduction, ER and IR
   • PROM and end-feel
   • Joint play assessment: What is causing the limited ROM? Is it the due to capsular tightness, motor component or muscle forces?
   • Special Tests: Leave special tests and palpations towards the end because they are very provocative
   • MMT/RIMT
   • Muscle Length: If there is lack of mobility after this test, perhaps it's due to a tight muscle (rectus femoris tightness, ITB tightness, etc.). Do special tests to assess muscular tightness.
   • Neurological test if needed: Most likely you won't be looking at neurological test. There are conditions such as Meralgia paresthetica, in which the lateral femoral cutaneous nerve may be affected, that you'd have perform an neurological assessment

5. Functional Activities: Descending and Ascending stairs, sit to stand, Don and Doffing socks

6. Balance Examination: Single Leg Stance Test, Star Excursion Balance Test

7. Dynamic Examination: Squatting (double and single), step downs, depth jumps

8. Functional Tests (performed on older pts, most likely reporting of hip OA: 6 minute walk, TUG, Self-paced walk, Stair mesure

   • 6 Minute Walk: measured in meters TUG: 3m back and forth from chair Self-paced: Walk 40m at own pace Stair measure:ascending and descendin 9 steps

9. History

   • Chief complaints and location of pain
     • *Location of pain: Anterior groin pain->intraarticular pathology (such as OA) Greater trochanter bursitis->pain at lateral side of hip near the greater troch Pain near PSIS ->sacroiliac involvement. Fortin's finger test->have pt point to the pain, they will likely point at the PSIS (inferior medial pain)     
   • Onset: acute or chronic
   • MOI
     •   *MOI: Acute: about 7 days. We are unable to provocative interventions, such as mobilizations. Want to calm system down during the inflammatory phase and avoid further tissue damage. No eccentrics! Subacute: 2-3 weeks and chronic: 4 weeks. We can be more aggressive with treatments.  *Reactivity level must also be considered. Can get an idea of reactivity based on pt’s reaction to PROM and can also postulate the stage of their injuries!Pain before initial resistance during PROM->highPain at initial resistance to PROM->moderate  Pain past the resistance->low.     
   • Timeline between injury and now: did the pain get better or worse? Did u see MD?
   • Previous treatment
   • IS the pain constant or intermittent?
     • Constant: need to treat chemically with NSAIDs
   • Pain description: twinges of pain->labral as flap gets stuck with increase WB and OCD; locking->labral as flap can interrupt the arthrokinematics; audible sounds->OA has graveling and labral has clicking
   • Swelling: hard to see in hip
     • If see bulge/protrusions, may have hernia. *Hernias occur when abdominal contents protrude through certain areas causing hip pain. More hip pain will be felt when pt performs valsalva maneuver and/or lifting Bulging above or at the inguinal canal->have a inguinal hernia. Bulging below->femoral hernia   
   • Apprehension to end ranges? Ligamentous injury
   • Am or PM pain: morning stiffness lasting about 60 min and goes away with movement->OA Morning stiffness that doesn't go away, looking at a more systematic conditions including Lupus or RA
   • Meds: Neurontin (Gabapentin) and Lyrica->neuropathic pain desensitizers (radiculopathy) . NSAIDs: Motrin, Mobic, Advil. Celebrex->COX2 inhibitor. Scelaxin and Flexural are muscle relaxants usually for LB pain
   • Pain worse with activity ore relieved with activity? Chronic phase->activity makes it feel better (look at tendinopathies). Pain relief within 60 min and with activity->OA
   • Snapping hip: Anteriorly->iliopsoas moving back and forth in the pectineal eminence. Iliofemoral lig as well. Laterally->ITB and glute max gives the sound Posteriorly->hamstrings perhaps Clicking sound more related to labral tears. But loud snapping sounds are more due to the above muscles.
   • Numbness and tingling: neuralgia paresthetica (no motor deficits; just sensory! Rediculopathy can refer pain L2-L4 (due to foraminal stenosis or discogenic) and follows dermatome patterns
   • Lumbar pain?
   • Pain sleeping? Pain sleeping->pts with hip pain will complain of pain when sleeping on side. Pts with greater trochanteric bursitis will have pain sleeping on affected side. Educate on proper way to sleep using pillows to prevent rolling onto t he affected side
   • Repetitive activity at work?
   • Functional limitations and Goals
     • Function, social, and recreational activities