NMS Conditions Hip

What type of synovial joint is the hip?

Ball-and-socket synovial joint.

What is the normal femoral neck-shaft angle in adults?

Approximately 125°.

What is the normal femoral anteversion angle?

Approximately 15°.

An increase in femoral anteversion is called what?

Excessive anteversion.

A decrease in femoral anteversion is called what?

Retroversion.

What movement is usually lost first in hip osteoarthritis?

Internal rotation.

What two movements make up the classic hip capsular restriction pattern?

Internal rotation and extension.

A patient with hip pain who cannot bear weight should raise suspicion for what?

Fracture or other serious pathology requiring imaging.

Anterior groin pain should make you evaluate which muscles?

Hip flexors and adductors.

Pain radiating from the back to the groin may indicate what?

Renal pathology.

Pain radiating from the groin to the hip may indicate what?

Genitourinary pathology or a hernia.

What serious conditions require immediate referral when evaluating hip pain?

Fracture, avascular necrosis, dislocation, tumor, infection, or hernia.

What combination of therapies is recommended for hip osteoarthritis?

Physical therapy or chiropractic care combined with a strengthening program.

What is the most common risk factor for hip fractures?

Osteoporosis.

What is the classic presentation of a hip fracture?

Elderly patient with hip pain, inability to bear weight, and a history of a fall.

Which type of hip fracture is more common: intracapsular or extracapsular?

Intracapsular.

Which type of hip fracture has more complications?

Intracapsular.

What complications are associated with intracapsular hip fractures?

Nonunion, osteomyelitis, and thromboembolic events.

Ludloff Sign

Positive when the patient cannot perform the movement; indicates traumatic separation/fracture of the lesser trochanter (may also be seen with malignancy).

Anvil Test

Positive when pain localizes to the femoral head or neck; indicates femoral head or neck fracture.

Chiene Test

Increase in trochanteric diameter indicates femoral neck fracture or hip dislocation.

What is the classic patient presentation of a femoral stress fracture?

Young endurance athlete with gradual deep anterior hip pain that worsens with weight bearing.

What sports are commonly associated with femoral stress fractures?

Long-distance running, gymnastics, dancing, and marching.

Which hip movements often reproduce pain in stress fractures?

End-range flexion and internal rotation.

What imaging study is highly sensitive for stress fractures?

Bone scan.

Developmental dysplasia of the hip (DDH) was previously called what?

Congenital hip dislocation.

What tests are used to screen for developmental dysplasia of the hip?

Ortolani test and Barlow maneuver.

Hip Telescoping Test

Positive when pistoning of the femur is present; indicates congenital hip dislocation.

What percentage of sports-related hip dislocations are posterior?

Approximately 90%.

What mechanism causes a posterior hip dislocation?

Force applied to a flexed and adducted hip.

What mechanism causes an anterior hip dislocation?

Force applied to an extended and externally rotated leg.

What is the classic patient with slipped capital femoral epiphysis (SCFE)?

Overweight child or rapidly growing adolescent (8-17 years).

How may chronic SCFE present?

Gradual hip pain, limp, or isolated knee pain.

What confirms the diagnosis of SCFE?

Imaging.

What is another name for Legg-Calvé-Perthes disease?

Avascular necrosis of the femoral head in children.

What is the classic patient with Legg-Calvé-Perthes disease?

Male aged 4-9 years with mild hip pain and a limp.

What causes Legg-Calvé-Perthes disease?

Disruption of blood supply to the femoral head.

What does FAI stand for?

Femoroacetabular impingement.

What are the two types of femoroacetabular impingement?

CAM and Pincer.

Which type of FAI is most common in young athletic men?

CAM impingement.

What structural abnormality causes CAM impingement?

Abnormal morphology of the proximal femur.

Which type of FAI is most common in middle-aged women?

Pincer impingement.

What structural abnormality causes Pincer impingement?

Abnormal morphology of the acetabulum.

Does exercise cause FAI?

No; abnormal bone morphology causes FAI.

What are the classic symptoms of FAI?

Anterior groin pain, stiffness, limping, and sharp pain with squatting, twisting, or turning.

What position is used for the FAI impingement test?

Hip flexion, adduction, and internal rotation (FADIR).

What does a positive FAI impingement test indicate?

Femoroacetabular impingement or anterior intra-articular hip pathology.

Patrick (FABER) Test

Positive when it reproduces hip pain; indicates intra-articular hip pathology.

What is the classic presentation of an acetabular labral tear?

Moderate to severe groin pain with clicking, giving way, night pain, and limping.

What conditions predispose someone to acetabular labral tears?

Femoroacetabular impingement, hip dysplasia, and capsular laxity.

What may acetabular labral tears eventually lead to?

Chondral lesions and early degeneration.

What injury can mimic an acetabular labral tear?

Ligamentum teres tear.

Ligamentum Teres Test

Pain during internal or external rotation in the test position indicates a ligamentum teres tear.

What is the classic presentation of greater trochanteric pain syndrome?

Localized lateral hip pain in a 40-60-year-old patient with tenderness over the greater trochanter.

Where may pain from greater trochanteric pain syndrome radiate?

Low back, lateral thigh, and knee.

Which orthopedic tests may reproduce pain in greater trochanteric pain syndrome?

Patrick (FABER) and Ober tests.

How is greater trochanteric pain syndrome managed?

Correct mechanics, stretch hip abductors, avoid side posture acutely, and consider radial shockwave therapy.

Ober Test

Positive when the leg remains abducted; indicates IT band contracture.

What is the largest bursa around the hip?

The iliopsoas (iliopectineal) bursa.

What is the classic presentation of iliopsoas bursitis?

Acute anterior hip pain with antalgic gait and possible anterior thigh referral.

What commonly causes iliopsoas bursitis?

Hip flexor tightness and repetitive activity.

What is the classic presentation of ischial bursitis?

Pain while sitting on hard surfaces or horseback riding.

What condition can ischial bursitis mimic?

Sciatica.

Which orthopedic tests may be positive with ischial bursitis?

Straight Leg Raise and Patrick (FABER).

What is the key feature of snapping hip syndrome?

Snapping around the hip that is often painless.

Anterior snapping hip usually involves what structure?

Iliopsoas tendon snapping over the lesser trochanter or iliopectineal eminence.

Lateral snapping hip usually involves what structure?

IT band snapping over the greater trochanter.

Posterior snapping hip usually involves what structure?

Biceps femoris tendon snapping over the ischial tuberosity.

If snapping hip develops after trauma, what should be suspected?

Acetabular labral tear.

What is generally preferred for treating snapping hip syndrome: strengthening or stretching?

Strengthening.

What is the classic presentation of hip osteoarthritis?

Middle-aged or elderly patient with gradual hip, groin, buttock, or knee pain and stiffness.

What is the first motion typically lost in hip osteoarthritis?

Internal rotation.

How is hip osteoarthritis managed?

Weight loss (if indicated), non-weight-bearing exercise, stretching, and manipulation.

Jansen Test

Positive when the affected leg cannot abduct and externally rotate as well as the opposite side; indicates hip osteoarthritis.

What is the classic presentation of rheumatoid arthritis affecting the hip?

Female aged 25-55 years with bilateral hip pain, stiffness, swelling, and decreased ROM.

Should a rheumatoid arthritis hip be manipulated?

No.

What causes osteitis pubis?

Forced adduction injury or repetitive trauma from kicking or running.

Where is tenderness found in osteitis pubis?

Over the pubic symphysis.

What movement reproduces pain in osteitis pubis?

Resisted hip adduction.

How is osteitis pubis managed?

Activity modification.

What is the classic presentation of an adductor strain?

Athlete with a sudden pulling sensation in the groin.

Which adductor is most commonly injured?

Adductor magnus.

What movement reproduces pain with an adductor strain?

Resisted hip adduction.

How is an adductor strain managed?

Support taping and gentle stretching.

What nerve is compressed in meralgia paresthetica?

Lateral femoral cutaneous nerve.

What is the classic presentation of meralgia paresthetica?

Numbness and tingling over the lateral thigh.

What commonly causes meralgia paresthetica?

Compression at the inguinal ligament from prolonged sitting, obesity, heavy belts, or keys.

Where is the lateral femoral cutaneous nerve most superficial?

About 1 inch inferior to the ASIS.

How is meralgia paresthetica managed?

Avoid prolonged sitting and remove the source of compression.

What muscle is most commonly involved in contusions leading to myositis ossificans?

Quadriceps.

What finding suggests myositis ossificans after a quadriceps contusion?

A painful palpable lump with calcification visible on radiographs.

What is the immediate management of a quadriceps contusion?

Ice, compression, and maintaining the knee in flexion.

True leg length measurement

ASIS to medial malleolus.

Apparent leg length measurement

Umbilicus to medial malleolus.

What leg length discrepancy may be clinically significant?

Approximately 5 mm.

Phelps Test

Positive when knee flexion allows greater hip abduction; indicates gracilis contracture.

Thomas Test

Positive when the affected thigh rises from the table; indicates iliopsoas tightness.

Trendelenburg Test

Positive when the pelvis drops on the elevated leg side; indicates gluteus medius weakness on the stance leg or hip pathology on the elevated leg.

What spinal levels can refer pain to the greater trochanter and mimic trochanteric bursitis?

T12-L1 (Maigne's syndrome).

What joint commonly refers pain to the buttock?

The sacroiliac (SI) joint.