Hip examination, evaluation and assessment Dr. Wajeeha Mahmood BSPT, PPDPT

Hip Examination History History Physical Examination Physical Examination Radiology and Laboratory Radiology and Laboratory

History Age Age Mechanism of injury Mechanism of injury Gait Gait Posture Posture Balance Balance Limb position Limb position

History Age Age infancy: congenital hip dysplasiainfancy: congenital hip dysplasia 3-12 year old boys: Legg-Calve-Perthes, acute synovitis3-12 year old boys: Legg-Calve-Perthes, acute synovitis – middle age & elderly: osteoarthritis Mechanism of injury Mechanism of injury land on outside hipland on outside hip land on kneeland on knee repetitive loadingrepetitive loading

History Pain details Pain details 1.location 2.snapping 3.progression of symptoms 4.exacerbating factors 5.alleviating factors Weakness Weakness Occupation, Sport Occupation, Sport

Observation Gait Gait Posture Posture Balance Balance Limb position Limb position – shortened, adducted, medially rotated – abducted, laterally rotated – shortened, laterally rotated Leg shortening Leg shortening

Inspection Pelvic unleveling (iliac crest levels) Pelvic unleveling (iliac crest levels) Pelvic rotation (PSIS levels) Pelvic rotation (PSIS levels) If asymmetric, measure leg lengths If asymmetric, measure leg lengths

Leg Length Measurements Eyeball method Measurement method

Sciatic nerve palpation

Range of Motion Abduction: 30 to 50 degrees Abduction: 30 to 50 degrees Adduction: 30 degrees Adduction: 30 degrees

Range of Motion Flexion: 110 to 120 degrees Flexion: 110 to 120 degrees Extension: 10 to 15 degrees Extension: 10 to 15 degrees

Range of Motion External rotation: 40 to 60 degrees External rotation: 40 to 60 degrees Internal rotation: 30 to 40 degrees Internal rotation: 30 to 40 degrees

Examination Strength testing Strength testing – isometric – eccentric – knee extension – knee flexion

Coxa valga and coxa vara. A pathologically large angle of inclination between the femoral neck and shaft of the femur is called coxa valga, and a pathologically smaller angle is called coxa vara.

THE HIPAND GAIT Normal gait cycle  40 degree of flexion and extension at Hip  10 degree of Abduction at hip  Lateral pelvic tilt  15 degree of hip Ext/Int and Pelvic rotation Loss of any of these motions affects the smoothness of the gait pattern

Hip Muscle Function During Gait Hip Flexors control hip extension Initiate swing. With loss of flexor function, a posterior lurch of the trunk to initiate swing is seen. Contractures in the hip flexors Lumber lordosis

Hip Muscle Function During Gait Hip Extensors Control the flexor moment at initial foot contact initiates hip extension With loss of Extension function a posterior lurch of the trunk occurs at foot contact Contracture of Hip Extensor range in the terminal swing

Hip Abductors Control the lateral pelvic tilt during swinging of the opposite leg With the loss of Abduction lateral shifting of the trunk occurs over the weak side during stance

REFERRED PAINAND NERVE INJURY Hip is innervated primarily from the L3 spinal level Hip joint irritation is usually felt along the L3 dermatome from the groin, down the front of the thigh to Knee

Major Nerves Subject to Injury or Entrapment Sciatic nerve Obturator nerve Femoral nerve

Common Sources of Referred Pain in the Hip and Buttock Region Nerve roots or tissues derived from spinal segments L1,L2, L3, S1, and S2 Lumbar intervertebral and sacroiliac joints