Hip & Spine Exam PearlsKenneth Mynatt, PT, DPT, ATC, LATEmory Sports Medicine Complex

kenneth.mynatt@emoryhealthcare.org

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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