hip assessment

• Femoroacetabular impingement

  • abnormal contact between femoral head and acetabular labrum

  factor

  • hip dysplasia:發育不良
  • SCFE: femur head slip from socket
  • Legg Calve Perthes disease: poor blood supply to hip joint lead to bone death
  • high intensity sports: involve repetitive hip movement and high impact

  type of FAI

  cam: young men, abnormal femoral neck

  pincer: middle aged women, abnormal socket
• clinical presentation of FAI

  • intermittent sharp pain
  • c shape pain
  • limited hip flexion and external rotation
  • worsen by prolonged sitting, end range flexion, high intensity sports
• acetabular labral tear

  • common in middle aged women
  • usually anterior(direction) tear

  
• hip osteoarthritis

  • pain and stiffness
  • pain in groin, anterior and lateral hip
  • stiffness when inactivity
  • antalgic gait
  • trendelenburg gait
  • worsen by end range hip flexion
• common hip issue

  groin pain:

  • adductor tendinopathy
  • psteotos pubis: inflammation of pubic bone

  anterior hip pain:

  • FAI
  • acetabular labral tear
  • iliopsoasa tendinopathy

  lateral hip pain:

  • gluteal tendinopathy
  • trochanteric bursitis

  posterior hip pain:

  • hamstring tendinopathy
  • ischiogluteal tendinopathy
  • piriformis syndrome: piriformis compress on sciatic nerve
• special observation:

  • deformity
  • pelvic tilt: lordosis
  • swelling
  • muscle loss
  • iliac crest level
• trendelenburg sign

  • test hip abductor gluteus medius
  • safety*除襪除鞋

  
• leg length discrepancies

  check bony point symmetric:

  front: iliac crest/greater trochanter/ASIS

  back: iliac crest/ greater trochanter/PSIS/ gluteal fold/ischial tuberosity

  measure:

  • supine pull ankle
  • from ASIS to medial malleolus
  • knee ben 90 degree (tibia/femur length discrepancy)

  management: shoes lift/shortening osteotomy/epiphysiodesis
• Hip quadrant test (compression)

  • flexion+adduction+internal rotation
  • possible pathology: OA/ osteochondral defect(uneven surface)/avascular necrosis(no blood)/joint capsule restriction/ acetabular labral defect
• FADIR: FAI/ acetabular labral tear

  FABER (hold ASIS): OA/ acetabular labral tear/ osteochondral defect/ iliopsoas bursitis

  
• FAIR test

  • test pisiformis

  
• ober test

  • test TFL and ITB

  
• Thomas test

  • evaluate flexibility and length of hip flexor
  • associated with patellofemoral pain/ lower back pain/ osteoarthrtis/rheumatoid arthrtis

  hip flex knee extend: 1-2 hip flexor shortened

  hip flex knee flex: 1 hip flexor shortened

  only knee extend: 2 hip flexor shortened

  hip abduction: shortened TFL

  
• accessory movement

  Grade 1: small amplitude movement near start joint range without resistance

  Grade 2: large amplitude movement further range without resistance

  Grade 3: large amplitude to limit joint range with resistance

  Grade 4: small amplitude movement to limit joint range with resistance

  Grade 5: high velocity thrust to joint to mobilise it