Examination of the Hip

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Questions and Answers

Which muscle is considered the primary internal rotator at 90 degrees of hip flexion?

Tensor fasciae latae (correct)

Adductor longus

Glute med

Piriformis

Which condition is most likely to result from weakness or impaired coordination of the hip muscles?

Patellar tendonitis

Iliotibial band syndrome

Anterior knee pain (correct)

Achilles tendinopathy

Which statement is true regarding the hip's external rotators?

The sartorius is the primary external rotator.

The primary external rotators include Glute max and the Deep 6. (correct)

Glute med posterior fibers are considered primary external rotators.

Obturator externus is the main contributor to external rotation.

What is the biomechanical relationship between hip dysfunction and knee problems?

Hip dysfunction can lead to knee dysfunction due to regional interdependence. Signup and view all the answers

What effect does anterior pelvic tilt have on hip range of motion?

It facilitates greater hip flexion at the expense of hip extension. Signup and view all the answers

Which muscle is primarily responsible for producing an anterior pelvic tilt?

Iliopsoas Signup and view all the answers

What is the typical functional range of motion for stair descent at the hip?

40 degrees of flexion Signup and view all the answers

Which hip muscles are considered primary hip extensors?

Gluteus maximus and hamstrings Signup and view all the answers

What motion occurs at the hip during the initial phase of a squat?

Flexion Signup and view all the answers

In lower crossed syndrome, which of the following muscle groups is typically weak?

Abdominal musculature Signup and view all the answers

What is the purpose of goniometry techniques in assessing hip motion?

To measure the angle of joint motion Signup and view all the answers

Which of the following statements about hip abductors is true?

Glute medius has roles in both internal and external rotation. Signup and view all the answers

During hip flexion, what is the pattern of capsular restriction at the hip?

Extension > Flexion/Abduction > Internal rotation Signup and view all the answers

What movement at the hip joint is primarily associated with anterior pelvic tilt?

Flexion Signup and view all the answers

Which of the following muscles is primarily responsible for hip adduction?

Adductors Signup and view all the answers

In which plane does abduction and adduction of the hip occur?

Frontal plane Signup and view all the answers

Which ligament provides anterior support to the hip joint?

Pubofemoral ligament Signup and view all the answers

What is the axis of rotation for hip flexion and extension?

Frontal axis Signup and view all the answers

Lower Crossed Syndrome typically involves tightness in which of the following muscle groups?

Erector spinae and hip flexors Signup and view all the answers

What type of joint is the hip categorized as?

Ball and socket joint Signup and view all the answers

During goniometry for measuring hip internal and external rotation, which axis is utilized?

Longitudinal axis Signup and view all the answers

The acetabulum is primarily formed by which three bones?

Ilium, ischium, pubis Signup and view all the answers

What is the function of the acetabular notch?

Complete the acetabular circle Signup and view all the answers

Study Notes

Hip Examination

Examiner: Rebecca Pinkus, PT, DPT, NCS, PT8311
Contributors: Jolene Walsh, PT, MPT; Keith Cole, PT, DPT, PhD, MBiomedEd; Joseph Signorino, PT, DPT, OCS, FAAOMPT; Dhinu Jayaseelan, DPT, OCS, FAAOMPT
University: The George Washington University
Reference: https://paindoctor.com/conditions/hip-pain/

Objectives

Discuss relevant subjective questions specific to hip pathology
Discuss relevant anatomy related to physical examination of the hip
Describe typical goniometric and muscle testing technique for the hip region
Present various clinical presentations of hip dysfunction that may be more likely based on appropriate examination techniques

Subjective Intake

Include both family and individual information
Medical History: HTN/CAD, cholesterol, DM
Symptoms: Quality (burning, aching, stabbing, shooting, stiffness), instability, deep/superficial location
Symptoms Including Aggravating/Alleviating Factors: Sitting, sitting durations, squatting, and 24-hour pain pattern (AM/day/night)
Common Complaints: Joint sounds (clicking, crepitus)

Importance of Subjective History

Hip can be the primary source of pain; localized or referred
Hip structures refer pain to other areas
Possible Referred Pain: Lumbar and/or Thoracic Spine, Pubic symphysis, pelvic girdle pain, visceral (appendix, renal), GU (ureter, bladder), hernia

Where is the Pain?

Table 1: Frequency of pain referral to buttock, thigh, groin, leg, knee, and foot
- Anatomic Region: Buttock, thigh (anterior, lateral, posterior, medial), groin, leg (lateral, posterior, anterior, medial), foot, knee
- Percentage of Patients with Pain: Data represented in a table for each anatomical region

Referred Pain Regions

Diagram showing referred pain from various internal organs to the hip/buttock area
Organs include: liver and gallbladder, lung and diaphragm, heart, stomach, pancreas, ovary (female), colon, kidney, ureter, urinary bladder

Primary Functions

Support the weight of head, arms, trunk in static and dynamic postures
Pathway for transmission of forces between the pelvis and lower extremities

The Hip

Very (very) stable joint
Acetabulum: Faces laterally, inferiorly, and anteriorly
Femur: Longest bone in the body; wide diameter

ROM

Ball and socket" joint: Circumduction joint
Range of Motion (ROM): Flexion, extension, abduction, adduction, external rotation, internal rotation, Axis of rotation (frontal, sagittal, longitudinal)
Muscle groups: Gluteal, adductors, iliopsoas, lateral/external rotators

Acetabulum

Combined ilium, ischium, pubis
Not a complete circle
Acetabular notch (inferior) and transverse ligament complete the circle
Labrum ("O" ring)
70% of the femoral head articulates with acetabulum

Ligamentous Support

Posterior: Ischiofemoral
Anterior: Iliofemoral, pubofemoral

Pelvic Tilt and Hip ROM

Diagram showing neutral pelvis, anterior pelvic tilt, and posterior pelvic tilt, along with associated hip range of motion

Posture

Lower Crossed Syndrome: Defined by Vladimir Janda (1928-2002)
Diagram showing tight erector spinae, weak abdominal, weak gluteus maximus, and tight iliopsoas

Proximal Contribution to Distal Pathology

Hip dysfunction may be linked biomechanically to knee and/or foot problems
Treatment approach is regional interdependence
Clinical Example (Anterior knee pain): Weakness/impaired coordination or timing of hip abductors/external rotators, increased dynamic genu valgum (femoral adduction + internal rotation), increased lateral compression, medial tension

Clinical Case: Hip Osteoarthritis

History:
- Patient is generally older ( > 60 years)
- Groin pain, lateral hip pain, knee pain
- High frequency, associated with L-spine DJD
- Morning hip stiffness ( < 60 minutes)
Functional Loss:

Research Report: Development of a Clinical Prediction Rule

5 variables:
- Self-reported squatting as an aggravating factor
- Active hip flexion causing lateral hip pain
- Scour with adduction creates lateral hip or groin pain
- Active hip extension causes pain
- Passive hip internal rotation less than or equal to 25 degrees

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Description

This quiz covers essential aspects of hip examination, including subjective assessments, anatomy, and examination techniques. Participants will explore common clinical presentations related to hip dysfunction and the appropriate goniometric and muscle testing methods. Understanding these concepts is crucial for effective physical therapy practice.