True or False

Chronic hip joint symptoms will never lead to compensatory extra-articular findings.

FALSE

Chronic hip joint symptoms WILL lead to extra-articular findings.

Moral of this story:

Always clear joint above and below

Hilton's Law

States: nerves that supply muscles that move joint also supply sensation to joint

Explains why muscle spasms and cutaneous sensations may accompany joint irritation

C-Sign

Hand cupped over greater trochanter with thumb over posterior aspect of trochanter and fingers gripping groin

*Very characteristic of hip pathology

ROM Needed to Tie Shoes

120 degrees flexion

ROM needed for Sitting

112 degrees flexion

ROM needed to Ascend Stairs

67 degrees flexion

ROM needed to Descend Stairs

36 degrees flexion

ROM needed to Put on Pants

90 degrees flexion

Scour Test Abnormal Finding

and

Causes of Abnormal Finding

Resistance found anywhere along the arc

Capsular tightness, adhesion, myofascial restriction, loss of joint congruity

Two types of FAI

CAM

Pincer

What are CAM FAIs common with?

Post-traumatic deformities, SCFE, Coxa Vara, and AVN

In what type of FAI is motion limited due to abnormal bone growth/shape on the femur?

CAM FAI

In what type of FAI is abnormal bone growth/shape on the acetabulum?

Pincer

FAI where acetabulum has too much coverage of the femoral head

Pincer

*typically exists along cartilage being "pinched" between the rim of the socket and anterior femoral head-neck junction

What does a positive FABER inidicate?

Hip joint may be involved

Iliopsoas spasm

SI Joint involvement

What does Trendelenburg Sign test?

Ability of hip ABductors to stabilize the pelvis on the femur

Trendelenburg Sign

If pelvis drops on the non-WB side, test is considered positive due to probably gluteus medius weakness on the stance (affected) leg

Three Components of the

Sign of the Buttock

1. Limited and painful SLR implicating structure that runs posterior to hip or hip itself
2. Limited and painful hip flex w/ knee flexed indicating involved structure does not spasm from hip to knee (ie hamstrings or sciatic nerve)
3. Noncapsular pattern indicating arthritic changes are not pathogenic

Does Sign of the Buttock identify exact pathology?

NO

It's a screening tool for serious pathology

Refer back to physician

What's a positive on Thomas Test?

Thigh lifts up (iliopsoas)

Knee flexion limited (rectus femoris)

Hamstring Flexibility Test

What is Normal?

Within 20 degrees of full knee extension

What is the best way to perform a leg length discrepancy test?

Radiographically

True leg length discrepancy

There's an anatomica or structural change in the lower leg such as coxa vara, congenital hip dysplasia, fracture, short tibia, etc.

function leg length discrepancy

difference is a compensation for something occurring b/c of positioning in another structure, such as a pronated foot