Evaluation of the Hip
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1 Evaluation of the Hip Adam Lewno, DO PCSM Fellow, University of Michigan Primary Care Sports Update 2017
2 Disclosures Financial: None Images: I would like to acknowledge the work of the original owners and artists of the pictures used today
3 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
4 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
5 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
6 Hip Anatomy Bone Ligament Muscle Nerve Vessels
7
8 Bones
9 Ligaments
10 Everything is Connected
11 Muscles
12 Important Movers
13 The Forgotten Muscles
14 Who Does What? Flexors Iliopsoas Sartorius TFL Rectus Femoris Pectineus Adductor Longus Adductor Brevis Adductor Magnus Gracilis Extensors Hamstrings Adductor Magnus Gluteus Maximus ADductors Adductor longus Adductor Brevis Adductor Magnus Gracilis Pectineus
15 Who Does What? ABductors Gluteus Medius Gluteus Minimus TFL External Rotators Obturator Externus Obturator Internus Piriformis Quadratus Femoris Gluteus Maximus Internal Rotators Gluteus Medius Gluteus Minimus TFL
16 Neurovascular
17
18 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
19 Every Patient Has a Story Aggravating and Relieving factors Previous treatments Prior back or lower extremity injury Functional deficits and goals of care
20 What to Consider: Anterior Adductor Strains Osteitis Pubis Athletic Pubalgia Mononeuropathy Diabetic amotrophy Hip flexor strains/tendinopathy Iliopsoas bursitis Snapping hip (external) Apophysitis Osteoarthritis Stress fracture Avsucular necrosis of femoral head Acetabular labral tear Ligamentum of teres injuries Hip Impingement Hip Adductor strains/tendinopathy
21 What to Consider: Posterior Lumbar pathology Piriformis syndrome SI joint pathology Hamstring strain/tendinopathy Ischial bursitis Hip Instability Ischial tuberosity avulsion Hip rotator tears or tendinopathy Sciatic neuropathy Snapping Hip (internal) Hip Impingement
22 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
23 Everyone gather around!
24 For Your Reference Remember every test was designed for a reason but your understanding of anatomy that is stressed can lead to more information
25 Log Roll
26 FADIR (FADDIR) Flexion, ADduction, Internal Rotation Positive test is indicated by anterior or anteromedial pain
27 Hip Scour
28 Stinchfield Test At degrees!
29 FABRE/Patrick Need to stabilize the contralateral hip and place downward force on the ipsilateral knee Where the patient has pain is important!!
30 Ober s Test
31 Thomas Test & Rectus Femoris Contracture test
32 Ely s Test
33 Fulcrum Test Possible stress fracture of the femoral shaft Fulcrum arm is moved from distal to proximal along the thigh as pressure is applied
34 Thank You You! This presentation was dependent on your participation Dr. Kiningham Dr. Denay LT. M.T.
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