Common Causes of Hip Pain • Osteoarthritis • Osteonecrosis Physical Examination of the Hip • Sciatica • Stress Fracture • Infection • Impingement / labral tear • Trochanteric Bursitis • IT Band Pathology Physical Exam 1. Gait analysis 2. Examination Standing • Hip / spinal alignment • Crouch may be hip contracture Gait Analysis 3. Examination Supine • Palpation • Range-of-motion • Strength testing • Distal pulses 4. Provocative maneuvers Pathologic Gait Antalgic: Shortened stance on painful side Steppage: Leg lifts higher to clear ground Waddling: Broad-based, pelvis drops towards raised leg during swing . proximal myopathy Trandelenburg: Trunk towards weak side during stance . abductor weakness Look at posture…leaning forward might be spine Steppage gait . Antalgic gait . - Compensatory for foot drop - “Limping” - Exaggerated hip flexion - Shortened stance allows foot on weak side to clear ground phase on painful / - Tibialis anterior weakness affected limb -RX: • AFO brace, • Refer, especially if acute Trandelenburg gait . - Weak abductors - Superior gluteal nerve - Prior hip surgery Exam Standing . - Walk around the patient - Overall posture - Pelvic tilt Exam Standing • Scoliosis • Leg length discrepancy - Crouch • Hip contracture • Spinal hyperlordosis - Adductor contracture Exam Supine . - Palpation… • know your anatomy / landmarks - Range of motion . Exam Supine • Flexion: 110 - 120° • Extension: 10 - 15° • IR/ER: 30 - 40° / 40 – 60° - Strength and sensation testing - Don’t forget distal pulses Exam Supine . Exam Supine . - Inspection - Strength Testing - Swelling, ecchymosis - Hip flexors, ABductors, ADductors - Palpation - Distal muscles for spine helath - Abdomen / inguinal region - Provocative testing - Lateral vs medial - Log Roll (fracture, infection, RA, AVN, etc) - Low back and posterior hip/pelvis - Straight leg raise (radiculopathy) - Range of motion - Ober’s test (IT band, trochanteric bursitis) - Flexion/extension - FABER (Flexion ABduction External Rotation) - Internal/external rotation • Impingement / Labral Tear - Obligate external rotation with hip - FADIR (Flexion ADduction Internal Rotation flexion . .. CAM lesion • Impingement Log roll Insert Chiodo Log roll image Special Tests . - Fracture - Infection - Advanced chronic pathology - Image and/or refer ! Straight-leg raise Faber / Patrick Test - Lumbar nerve root irritation - Positive: . radicular sx’s reproduced - SI joint - Intra-articular pathology Treatment: - Inflammatory disease - PT, injections, time - Iliopsoas strain - Refer if neurologic deficits - SI joint - Intra-articular pathology - Inflammatory disease - Iliopsoas strain FadIR Test - Femoroacetabular Impingement (FAI) Ober’s test - Iliotibial band - Contracted, inflamed, or painful - Positive: Affected leg remains . .orthoinfo.com AAOS elevated / abducted after released - Rx: PT, NSAIDs, rarely surgery FAI RX: NSAIDs, injection, PT, arthroscopy Gaenslen’s test Thomas test - Leg lifts off table with contralateral hip flexion - Test for hip flexion contracture Big picture . - Always consider joints above and join below - Lateral pain and tenderness . • IT band, greater trochanter, radicular - Anterior / medial pain . Thank you! • Hip joint proper (arthritis, fx, infection, AVN, impingement) • Inguinal and abdominal pathology (e.g. hernia) - Posterior pain and tenderness . • SI joint, radicular pain, hamstrings, ischium Anterior Hip Pain • DDX: • Perform this exam • Order these tests • Treat with NSAIDs, Injection, referral Lateral Hip Pain Posterior Hip Pain • DDX: • DDX: • Perform this exam • Perform this exam • Order these tests • Order these tests • Treat with NSAID’s, Injection, referral • Treat with NSAID’s, Injection, referral.