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Hip Exam, Diagnosing Hip Osteoarthritis, C - Sign: Making a C with had to…

- - - - Musculotendon: Iliopsoas
        
        Acute/traumatic at musculotendinous junction (changing direction)
        
        Overuse strains (near insertions)
        
        Pain at anterior part of the proximal thigh, more lateral than adductor
        
        Pain with passive stretching and manual resistance
        
        Palpation tenderness
      - Musculotendon: Rectus Femoris
        
        Acute/traumatic at musculotendinous junction (kicking, springing)
        
        Overuse strain
        
        Beware of rupture and avulsions
        
        Palpation Tenderness
        
        Provocation with passive stretching and manual resistance
      - Musculotendon: Adductor
        
        Acute at musculotendinous junction (kicking, change of direction)
        
        Overuse strain - proximal tendon/bone
        
        Pain around insertion of adductor longus tendon - may radiate distally along medial thigh
        
        Adductor Squeeze Test
    - - Clinical Presentation:
        
        pain with activities that cause compression
        
        pain at anteromedial aspect of the thigh
        
        Limited end range PROM of flexion, IR and extension
        
        Pain with resisted hip flexion
        
        Pain with Thomas Test
        
        (+/-) snapping hip
    - - Osteitis Pubis (Pubic Stress Syndrome)
        
        Overuse or sheer injury, pubic bone stress
        
        Tenderness to palpation
        
        4 Types:
        
        Noninfectious, pregnancy of invasive urologic and gynecologic procedures
        
        Osteomyelitis (systemic infection)
        
        Sports Related
        
        Rheumatologic
        
        Pain with resisted abdominal and adduction
    - - Athletic Pubalgia (Sports Hernia)
        
        Participating in running, kicking, cutting, changes in direction, acceleration/deceleration
        
        Deep lower abdominal or inguinal pain with exertion (sit up, sneeze, cough)
        
        Test and Measures
        
        Complain of deep groin/lower abdominal pain
        
        Exacerbated with exertion (sprint, cut, sit up); relieved with rest
        
        Palpable tenderness over pubic ramus at insertion of rectus abdominis and/or conjoined tendon (pubic tubercle, abdominal insertions
        
        Pain with resisted hip adduction at 0°, 45°, 90° of hip flexion
        
        Pain with resisted abdominal curl up
        
        May have adductor and hip flexor weakness with dynamic movement
    - - Reproducible with flexion + IR moving into extension + IR
        (if not painful - no need to address)
  - - - Provocation screens via FADIR and FABER
      - Limited ROM in Flexion, IR, and Adduction (with boney end feel)
        
        Hip IR < 20° with hip at 90°
      - Abnormal movement pattern with gait and single leg stance
      - Weakness in hip strength and muscle tenderness
    - - Dull or sharp groin pain +/- clicking
      - FADIR
      - FABER
      - Fitzgerald (Anterior Labral vs Posterior Labral)
      - Log Roll Test
      - Hip Scour
- - - - Direct Trauma (fall/hit)
      - Overload/Overuse
      - Aggravated with side lying, stairs, walking
      - Palpation Tenderness over Greater Trochanter
      - Pain with Ober's Test (Passive elongation of hip abductors)
      - Pain with resisted hip abduction
    - - Pain over Greater Trochanter with extension (may go down lateral thigh)
      - Pain with Ober's
      - Pain with FABER
      - Pain with resisted hip rotation and abduction
      - Poor movement patterns
        
        Hip adduction and IR
        
        Lateral Pelvic Tilt
        
        Increased use of TFL vs. Gluteals
- - - - Sciatic Nerve Distribution Symptoms
      - Pain Increasing with Sitting
      - (+) FAIR testing provocation
      - Tender to palpation over piriformis
      - +/- neurodynamic testing via SLR or Slump
      - +/- strength impairments
    - - Deep localized pain over gluteal or ischial region
      - Pain with passive stretching and loading
      - Tenderness to palpation
      - Decreased flexibility and gluteal muscle performance
      - Single Leg Squat: excessive anterior pelvic tilt, femoral IR + ADD