Card Set Information
COnduct a physical examination of a pt with hip pain in standing?
Always compare sides!
- deformities- flex/ ext, lordosis
- weight bearing
- mm spasm
- mm wasting
- leg lenght
Trendelenburg test- standing on one leg- shift weight
- weight bearing leg hip higher- no glutes
- if the knee is rotated the hip is- if femur rot the knee cap points out
- look for lordosis
Conduct a physical examination of a pt with hip problems in walking.
- walk forwards/ backwards/ sideways
- antalgic gait (penguin)- compensation
- swinging- leg around
- trendelenburg (weakness of abductors)- model
Conduct an active movement assessment of a pt with hip problems.
always ask pt if a certain movement hurts
Compare to the other side
Minimise the lumbar spine movements during hip testing
- flexion- can you bring you knees to your chest
- abd/adduction- supine ??? bring across/ away from midline. To OP hand on other side of hip.
- ER/IR- sitting is the easiest position. Can do it supine. OP in sitting stablise the femur on bed. Int rot take foot away fom midline, ext rot take foot across midline.
- leg length
Conduct some functional tests on your pt with hip problems
Clear Lsp- full range flex/ ext,
- anything the pt says is aggravating
- aggravating/ injury movement
- stairs- depstep up/ down
- squat-full hip flex- feet flat
rot in standing- test ext and int rotation-pt standing, test leg off the floor at 90 degrees and int/ ext rotate hip.
Conduting passive movements of a pt withhip problems
I am going to do the movements for you!
compare to the other side
- hip flexion (140 degrees)
- abduction (45 degrees)
- adduction (25 degrees)
- int rotation- neurtal and at 90 degrees flex (45 degrees)
- ext rotation- " " (60 degrees)
What should you palpate on a hip problem pt?
Note specific palapation is to be done at theend of the examination
- temp/ swelling
- anatomy- greater trochanter
- abductor insertion (pubic symphysis)
- symphysis pubis
- sciatic- 1/2 between greater trochanter and ischial tuberosity
- femoral- 1/2 way between ASIS and pubic symphosis
- lateral cutaneous (medial to ASIS, below inguinal lig)
- trochanteric- side lying
- psoas- in hip flexion
- ischial- back
What are the special test you would conduct for a hip problemed pt?
Do no harm!
- Quadrants (flex/ add/ +/- IR)
- fabers test (flex/ abd/ ER) - testing ant hip jt and capsule.
What static muscles test would you conduct on a pt with hip problems?
- this is a way to differentiate - working out when the pain comes on- with/ without contraction
- for groin tear- squeeze legs
What is the obers test?
- pt in sidelying
- test for tightness of ITB
- pull leg back in ext with knee flex
- once at end range straighten leg and let it drop, watch for cheat movements
- comapre to the other side
DONT FORGET ABOUT MOVEMENT DIAGRAMS
What can be conducted in sidelying when testing a hip pt?
- static mm- abduction
* Ap, PA
* caudad glide
* lateral glide
What are the accessories for a pt with hip problems?
- longitudinal caudad (neutral/ 90 degrees flex) knee bent pull down
- longitudinal cephalad (neutral/ 90 degrees flex)- knee bent push up
- A/P, PA
- lateral glide (neutral/ 90 degrees flex)- seat belt
What movements can you conduct when a pt is in prone lying for a hip?
- ER, IR, Ext
Passive physiological movements
- ext 15 degrees
-IR/ER- good in prone- hip in diff position
Static mm tests
How would you trefl;eat int rotation for a hip problem pt?
: grade 1 and 2
: supine grade 3 and 4
: prone grade 3 and 4
: grade 3 and 4
Why would you chose certain positions?
WHat are the grades of mobilisation and how long would you treat a pt for?
grade 1- small movement- treat pain
grade 2- larger movement but no into restriciton- treat pain
garde 3- larger movmtent into restriction- treat stiffness
grade 4- small movement at end of range- treat stiffness
test for 30 sec see how it goes then 3x 30 sec
How would you treat ext rotation for a hip problem pt?
flexion supine (90 degrees hip/ knee flex)- grade 3/4
ext prone (90 degrees knee flex)-grade 3/4
What are some passive physiological mobilisation techniques for flexion/ adduction of the hip?
grade 4- smaller movement at end range
grade 3- bigger movement
grade 2- irritable pt easy to mid range
This technique is not often used at end range
What is a passive accessory mobilisation technique lateral movement?
Grades 1- 4
alt position- sidelying for grade 1.
flex and int rotation
if stiff bring into more flex
Conduct a PAM longitudinal caudad on a pt with hip pain.
Why chose this technique?
pull down/ can flex leg and sit on foot.
: neutral or flexion- grades 1-4
: thumbs for grade 1 and hands around lower thigh for grade 1 and 2
PAM- used for pain relieving when compression is an irritant.
Demonstrate how you would conduct a assive hysiological technique on a pt with hip pain, in abduction. When wouldnt you use this technique?
Abd/ ext for grade 2
for grades 1-4
Not really used with abduction sprain
Passive physiological technique and ext for the hip.
Demonstrate a PA glide on a pt with hip problems? And why would you use this technique?
ant to post
- sidelying, identify greater trochanter
- thumbs grade 1 and 2
- heel of hand grade 3 and 4
Ensure pt comfort
trying to improve flex????
What exercise would you give to a pt with hip problems and why?
stretching- of hip flexors, pulling pelvis into ant pelvic tilt
strenghtening- glute mucles to stabilise the pelvis
What is a passive accessory movement?
A movement that the pt cannot produce volumtarily
Always compare to the other side
roll, spin, glide, compress, distract
low accessory movements = low physiological movements
WHat is a passive physiological movement?
a physiological movement is one a pt can do, but due to it being passive it means the therapist does the movement for the pt!
Muslces are not activated- non contractile, helps differentiate muscle vs inert structures as source of pain
End feel, ROM- normal? COmpare sides
Demonstrate a thomas test for a hip pt.