Structure
What type of joint is the hip joint?
Ball and socket- synovial joint
What are the functions of the labrum?
provide stability by deepening the socket and acting like a seal to maintain negative intra articular pressure
Decreases force transmitted into the articular cartilage and provides proprioceptive feedback
Seals in the synovial fluid within the space → protects the articular cartilage by helping to distribute and decrease peak loads
You are doing an MMT for hip flexion and the patient was able to go more than 50% but not 100% of their available ROM against gravity. How would you score this?
3-
What are 3 manual ways to get muscle facilitation?
1. quick stretch
2. muscle tapping
3. vibrating
What is the labrum made up of?
fibrocartilage
What is the name of the articular portion and non articular portion of the acetabulum?
Articular- lunate surface (hyaline cartilage)
Non articular- Acetabular fossa
What type of sitting posture may lead to femoral anteversion?
W sitting
When performing the Thomas test, the patient presented with a R sided J sign and L sided femur above horizontal with no abduction. What would you expect to find if you followed up with a R and L Ober test?
R- femur above horizontal due to tight TFL and ITB
L- femur below horizontal
How would you position and instruct the patient if you wanted to perform Post Facilitatory Stretch for iliopsoas?
thomas test position, pin leg onto trunk
stabilize other pelvis on ASIS to prevent lordosis
bring up out of stretch and give 50% - max contraction for 5 seconds and the let the leg drop down and repeat 3-5-7 times and retest thomas test or hip flexion ROM
A patient presents with lateral hip pain. It is aggravated by laying on that side, walking and palpation. What is a potential hypothesis?
Trochanteric bursitis
What bony pathology would present with an excessive Center Edge Angle and what is considered a normal value?
Pincer lesion- acetabular overhang
35 degrees - normal
(Dysplasia <25’
Over coverage >39 / pincer >40)
What motions does the iliofemoral ligament help to restrict?
Extension
Medial branch- abduction
Adduction
External rotation
A 20 year old patient comes to you through Direct Access after falling and was unable to bear weight on her L. She has had severe asthma since she was 4 years old. What test would you do first and what might the findings be?
Patellar-Pubic Percussion!
(+) sound absent or reduced on L indicating there is likely a fracture
You are seeing your patient for aquatic therapy 2 months post op for arthroscopic labral repair. What are 3 things you wouldn't do without MD approval?
1. straight leg hip flexion
2. treading water
3. frog/ whip/ rotational kick
(from Manny's IMPORTANT BOX on slide 36)
What is the antigravity muscle in swayback posture? Why is is different than an individual without swayback posture?
Rectus abdominis because line of gravity is behind axis of rotation at hip joint→ doesn't need to use glute max to extend hip because gravity is doing it
Describe the orientation of the acetabulum.
opening of the acetabulum is laterally inclined 50 degrees, anteriorly rotated 20 degrees, and anteriorly tilted 20 degrees in the frontal, transverse, and sagittal planes respectively
Separately describe the arthrokinematics of the femur on acetabulum for hip flexion, adduction, and IR.
Flexion: anterior roll, posterior slide of femur
Adduction: medial roll, superior slide of femur
IR: medial roll, posterior slide of femur
How would you conduct the Fitzgerald test? What structure is this testing? Can it be used to rule in or out?
Start in Flex-ER-ABD; move into hip Ext, IR, ADD--> sweeping through joint (ending pos is straight leg)
Testing anterior labrum
Rule out- Sn=1.00
Your patient presents with pain in the R buttock and (+) FAIR test on that side. What are 2 possible interventions you may consider?
1. Piriformis Inhibition relaxation (PIR) and contract relax
2. Piriformis STM
Your patient complains of a clicking in their hip when moving into flexion from an extended position. They have a (-) log roll. What is likely the cause of their description of "click"
ITB snaps with movement into flex from extended position--> Pt reports "clicking" but we can distinguish clicking from this snapping.
When a patient has femoral anteversion, what is happening with the alignment of the femoral head and neck in relation to the femoral condyles? What might some of your exam findings be with this patient?
anteversion: femoral head and neck are rotated anteriorly compared to the femoral condyles AKA angle of anterior torsion is greater than 15-20.
exam findings: excessive internal rotation, decreased external rotation of the hip (present in prone and sitting); may present with toe in; greater than 15 degrees of IR in Craigs test
Explain the impact Coxa Valga has on the bones and muscles of the hip joint.
Bones: Brings weight bearing line closer to the shaft of the femur = less shear of bending force across the femoral neck → reduction in density of the lateral trabecular system; Decreases the amount of femoral articular surface in contact with the dome of the acetabulum → more stress on the superior portion of the acetabulum
Muscles: Decreases the moment arm of the hip abductors → Additional muscular force needed to stabilize will increase joint reaction forces on the hip joint
A 52 year old patient presents with hip pain and:
R hip IR: 15 degrees with pain
R hip ER: 37 degrees
R hip flexion: 116 degrees
R hip extension: 19 degrees
What other information would you want to know to be able to diagnose hip OA using Altman's Criteria?
do they have morning stiffness for < or = to 60 minutes
Altman's Criteria: Hip IR > or = 15°, Painful Hip IR, Hip morning stiffness for ≤ 60 minutes, Age > 50 years
1. single leg bridge
2. SL hip abduction with IR
3. Prone heel squeeze
(from Manny's VERY IMPORTANT SLIDE)
What are the hip pathologies that fall under the category "nonarthritic hip pain"?
Refers to a collection of hip pain conditions proposed to involve intra-articular structures of the hip, including:
femoroacetabular impingement, structural instability, labral tears, chondral lesions, and ligamentous teres tears.