DEPARTMENT OF FAMILY MEDICINE

Evaluation of the Adam Lewno, DO PCSM Fellow, University of Michigan Primary Care Sports Update 2017 DEPARTMENT OF FAMILY MEDICINE

Disclosures

• Financial: None • Images: I would like to acknowledge the work of the original owners and artists of the pictures used today DEPARTMENT OF FAMILY MEDICINE

Objectives • Identify the main anatomic components of the hip • Perform basic Hip examination along with associated special tests • Use a group educational model to correlate Hip examination with hip anatomy DEPARTMENT OF FAMILY MEDICINE

Why do we care about the Hip?

• The hip distributes weight between the appendicular and axial skeleton but it is also the joint from which motion is initiated and executed for the lower extremity • Forces through the hip joint can reach 3-5 times the body weight during running and jumping • 10-24% of athletic injuries in children are hip related • 5-6% adult athletic injuries in adults are hip and DEPARTMENT OF FAMILY MEDICINE

Why is the Hip difficult to diagnosis?

The hip is difficult to diagnosis secondary to parallel presenting symptoms of back which can exist concomitantly or independently of hip pathology DEPARTMENT OF FAMILY MEDICINE

Hip Anatomy

• Bone • Ligament • Muscle • • Vessels DEPARTMENT OF FAMILY MEDICINE DEPARTMENT OF FAMILY MEDICINE

Bones DEPARTMENT OF FAMILY MEDICINE

Ligaments DEPARTMENT OF FAMILY MEDICINE

Everything is Connected DEPARTMENT OF FAMILY MEDICINE Muscles DEPARTMENT OF FAMILY MEDICINE

Important Movers DEPARTMENT OF FAMILY MEDICINE

The Forgotten Muscles DEPARTMENT OF FAMILY MEDICINE

Who Does What?

Flexors Extensors ADductors • • • Adductor longus • Sartorius • Adductor Brevis • TFL • Adductor Magnus • Rectus Femoris • • Adductor • Pectineus Magnus • Adductor Longus • Gracilis • Adductor Brevis • Pectineus • Adductor Magnus • Gracilis DEPARTMENT OF FAMILY MEDICINE

Who Does What?

ABductors External Rotators Internal Rotators • • Obturator • Gluteus Medius • Gluteus Minimus Externus • Gluteus Minimus • TFL • Obturator • TFL Internus • Piriformis • Quadratus Femoris • Gluteus Maximus DEPARTMENT OF FAMILY MEDICINE

Neurovascular DEPARTMENT OF FAMILY MEDICINE DEPARTMENT OF FAMILY MEDICINE

Every Patient Has a Story

• Patient age and activity – This includes the mechanism of injury!! • Onset: Acute, chronic, intermittent • Location: anterior, posterior, medial, lateral • Duration • Characterization DEPARTMENT OF FAMILY MEDICINE

Every Patient Has a Story

• Aggravating and Relieving factors • Previous treatments • Prior back or lower extremity injury • Functional deficits and goals of care DEPARTMENT OF FAMILY MEDICINE

What to Consider: Anterior

• Adductor Strains • Osteoarthritis • Osteitis Pubis • Stress fracture • Athletic Pubalgia • Avsucular necrosis of femoral • Mononeuropathy head • Diabetic amotrophy • Acetabular labral tear • Hip flexor • Ligamentum of teres injuries strains/ • Hip Impingement • Iliopsoas • Hip Adductor • Snapping hip (external) strains/tendinopathy • Apophysitis DEPARTMENT OF FAMILY MEDICINE

What to Consider: Posterior

• Lumbar pathology • Ischial tuberosity avulsion • Piriformis syndrome • Hip rotator tears or • SI joint pathology tendinopathy • • Sciatic neuropathy strain/tendinopathy • Snapping Hip (internal) • Ischial bursitis • Hip Impingement • Hip Instability DEPARTMENT OF FAMILY MEDICINE

What to Consider: Lateral

• Greater trochanteric bursitis • Gluteus Medius or minimus tendinopathy • Gluteal muscle tears/strains • IT Band Syndrome • Meralgia paresthetica • TFL strain • Acetabular labral tear DEPARTMENT OF FAMILY MEDICINE

Everyone gather around! DEPARTMENT OF FAMILY MEDICINE

For Your Reference

Remember every test was designed for a reason but your understanding of anatomy that is stressed can lead to more information DEPARTMENT OF FAMILY MEDICINE

Log Roll DEPARTMENT OF FAMILY MEDICINE

FADIR (FADDIR) Flexion, ADduction, Internal Rotation

Positive test is indicated by anterior or anteromedial pain DEPARTMENT OF FAMILY MEDICINE

Hip Scour DEPARTMENT OF FAMILY MEDICINE

Stinchfield Test

At 20 -30 degrees! DEPARTMENT OF FAMILY MEDICINE

FABRE/Patrick • Need to stabilize the contralateral hip and place downward force on the ipsilateral knee • Where the patient has pain is important!! DEPARTMENT OF FAMILY MEDICINE

Ober’s Test DEPARTMENT OF FAMILY MEDICINE Thomas Test & Rectus Femoris test DEPARTMENT OF FAMILY MEDICINE

Ely’s Test DEPARTMENT OF FAMILY MEDICINE

Fulcrum Test

• Possible stress fracture of the femoral shaft • Fulcrum arm is moved from distal to proximal along the as pressure is applied DEPARTMENT OF FAMILY MEDICINE

Thank You

• You! This presentation was dependent on your participation • Dr. Kiningham • Dr. Denay • LT. M.T.