DEPARTMENT OF FAMILY MEDICINE Evaluation of the Hip 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 pelvis DEPARTMENT OF FAMILY MEDICINE Why is the Hip difficult to diagnosis? The hip is difficult to diagnosis secondary to parallel presenting symptoms of back pain which can exist concomitantly or independently of hip pathology DEPARTMENT OF FAMILY MEDICINE Hip Anatomy • Bone • Ligament • Muscle • Nerve • 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 • Iliopsoas • Hamstrings • Adductor longus • Sartorius • Adductor Brevis • TFL • Adductor Magnus • Rectus Femoris • Gluteus Maximus • Adductor • Pectineus Magnus • Adductor Longus • Gracilis • Adductor Brevis • Pectineus • Adductor Magnus • Gracilis DEPARTMENT OF FAMILY MEDICINE Who Does What? ABductors External Rotators Internal Rotators • Gluteus Medius • 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/tendinopathy • Hip Impingement • Iliopsoas bursitis • 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 • Hamstring • 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 Contracture 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 thigh 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..