Hip & Spine Exam Pearls - Emory School of MedicinePearl (1) Hip OA 1 • JOSPT 2017: • >50 y.o....
Transcript of Hip & Spine Exam Pearls - Emory School of MedicinePearl (1) Hip OA 1 • JOSPT 2017: • >50 y.o....
Hip & Spine Exam PearlsKenneth Mynatt, PT, DPT, ATC, LATEmory Sports Medicine Complex
Disclosures
• I have no relevant financial relationships with commercial interests.
Inspection & Leg Length Discrepancy13
• Inspect from feet up• Palpation• Gait• Functional - umbilicus to medial malleoli
• Up slip/Downslip• Anterior/Posterior innominate rotation
• Anterior innominate appears longer• Posterior innominate appears shorter
• Structural – ASIS to medial malleoli
Anterior Hip
Pearl (1) Hip OA1
• JOSPT 2017: • >50 y.o.• Moderate anterior/lateral hip pain with weight bearing• Morning stiffness < 1 hr• Hip IR < 24 degrees or Reduced Hip IR & Hip Flex by 15 degrees• Pain with passive hip IR
• FADIR, FABER, scour• BMI• End feel
Pearl (2) FAI2,3
• Active young/middle age adult (25-50 y.o.)• Insidious onset• Groin pain • Decreased IR and flexion• FADIR, FABER• Pain with prolonged sitting/deep hip flex • Hx: AVN, repetitive trauma
Pearl (3) Labral Tear4,5,6
• Active young adult, 15-41 y.o. • Anterior hip or groin
• 94% anterior tears
• Clicking, clunking, locking, giving way • Pain at night, prolonged sitting, activity • FADIR, posterior impingement test• Hx: FAI
Pearl (4) Hip Flexor Strain7,8
• Acute onset• Gait: antalgic swing phase, reduced heel/toe off• Palpable• Resisted hip flexion: painful and weak • Full PROM• Hx of recent injury – within 15 weeks• Soccer and hockey
Pearl (5) Proximal Rectus Femoris9
Strain/Tear• Acute onset• Visible defect • TTP: distal to AIIS• Sprinting, kicking• Ely test
Pearl (6) Internal (anterior) Snapping Hip Syndrome10
• Iliopsoas tendon over iliopectineal eminence or femoral head
• Transitioning from hip Flex/ER/ABD toExt/IR/ADD
• Palpable and often audible • Thomas test, FABER to EADIR• Glute weakness
Anterior Hip Location ROM Age Hallmark Test
Hip OA Groin Bony PROM Age > 50 Morning stiffness FABER, FADIR, scour
FAI Groin Bony PROM Age: 25-50 Non-descript FABER, FADIR
Labral Tear Groin Bony PROM Age: 15-41 Clicking FABER, FADIR
Hip Flex Strain Groin Full PROM Young adult MMT painful
Rectus Strain Proximal femur Full PROM Young adult Location of s/s Ely
Internal snapping hip
Groin Full PROM Reproduce s/s with ROM
Thomas
Lateral Hip
Pearl (7) External (lateral) Snapping Hip Syndrome10
• ITB• Or anterior fibers of gluteus maximus
• Greater trochanter - palpation• Giving way• Active hip flex/ext or hip IR/ER• Palpable and often audible• Ober’s test
Pearl (8) Greater Trochanteric Bursitis11
• Greater trochanter - palpation• Hip ABD/ER weakness • Painful sleeping on affected side• Leg length discrepancy
• Foot Pronation
• CSI
Pearl (9) Gluteus Medius Tendinopathy11,12
• Trigger point• Dull/achy • Hip ABD/ER weakness• Trendelenburg sign• Tear
• Chronic degeneration• Age
Pearl (10) Meralgia Paresthetica11
• Lateral femoral cutaneous n.• N/T anterolateral thigh• Absence of motor deficits
• Iliac crest bone graft• Obese, tight pants/belts• Prolonged sitting
Lateral Hip Location Hallmark Cause Test
External snapping hip
Greater trochanter Audible/palpable Tightness of TFL Ober
Grt. Troch. bursitis
Greater trochanter Location of s/s Lateral hip weakness
CSI improves s/s
Glute med. tendinop
Gluteus medius Trigger point Lateral hip weakness
MMT, trendelenburg
Meralgia Paresthetica
Anterolateral thigh N/T anterolateral thigh – no motor loss
Tight pants/belt Palpation
Leg Length Supine measure medial malleolus level
Palpation of ASIS/PSIS
Positional, structural, tightness
Muscle energy
Thank You!
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