[Script Info]
Title: 
[Events]
Format: Layer, Start, End, Style, Name, MarginL, MarginR, MarginV, Effect, Text
Dialogue: 0,0:00:00.00,0:00:02.11,Default,,0000,0000,0000,,(English captions by Andrea Matsumoto from the University of Michigan)
Dialogue: 0,0:00:03.11,0:00:07.51,Default,,0000,0000,0000,,To ensure a thorough assessment it is best\Nto perform the musculoskeletal exam of the
Dialogue: 0,0:00:07.51,0:00:09.65,Default,,0000,0000,0000,,hip in a systematic way.
Dialogue: 0,0:00:09.65,0:00:13.60,Default,,0000,0000,0000,,The following is a suggested order of exam\Nthat incorporates the common techniques for
Dialogue: 0,0:00:13.60,0:00:17.88,Default,,0000,0000,0000,,diagnosing hip injuries.
Dialogue: 0,0:00:17.88,0:00:19.77,Default,,0000,0000,0000,,Begin the hip exam with inspection.
Dialogue: 0,0:00:19.77,0:00:24.47,Default,,0000,0000,0000,,Observe the gait as the patient walks away\Nand towards the examiner looking for an antalgic
Dialogue: 0,0:00:24.47,0:00:30.93,Default,,0000,0000,0000,,gait, Trendelenburg, or pelvic wink gait types.
Dialogue: 0,0:00:30.93,0:00:35.89,Default,,0000,0000,0000,,From an anterior view assess for alignment\Nof shoulders, iliac crests, and knees.
Dialogue: 0,0:00:35.89,0:00:41.78,Default,,0000,0000,0000,,Observe body habitus and look for lower extremity\Natrophy or skin changes.
Dialogue: 0,0:00:41.78,0:00:48.06,Default,,0000,0000,0000,,From a posterior view again assess for asymmetry,\Natrophy, or skin changes.
Dialogue: 0,0:00:48.06,0:00:55.06,Default,,0000,0000,0000,,Look closely for spinal lordosis, scoliosis,\Nor paravertebral muscle spasm.
Dialogue: 0,0:00:55.16,0:01:01.55,Default,,0000,0000,0000,,To evaluate for lumbar causes of referred\Nhip pain check back range of motion.
Dialogue: 0,0:01:01.55,0:01:15.55,Default,,0000,0000,0000,,Flexion, extension, lateral flexion to the\Nleft and right, and rotation.
Dialogue: 0,0:01:16.27,0:01:19.35,Default,,0000,0000,0000,,The Trendelenburg test assesses for hip stability.
Dialogue: 0,0:01:19.35,0:01:24.46,Default,,0000,0000,0000,,The examiner sits behind the patient and places\Nthumbs in the posterior superior iliac spines
Dialogue: 0,0:01:24.46,0:01:28.33,Default,,0000,0000,0000,,and hands on the iliac crests to check for\Nlevel height.
Dialogue: 0,0:01:28.33,0:01:32.37,Default,,0000,0000,0000,,The patient then stands on one leg with the\Nraised unsupported leg flexed at the knee
Dialogue: 0,0:01:32.37,0:01:34.45,Default,,0000,0000,0000,,and hip.
Dialogue: 0,0:01:34.45,0:01:39.42,Default,,0000,0000,0000,,In normal function, the unsupported pelvis\Nelevates slightly, indicating the gluteus
Dialogue: 0,0:01:39.42,0:01:43.40,Default,,0000,0000,0000,,medius muscle appropriately abducts the supported\Nhip.
Dialogue: 0,0:01:43.40,0:01:47.96,Default,,0000,0000,0000,,If the pelvis drops on the unsupported side\Nor remains level, it's considered a positive
Dialogue: 0,0:01:47.96,0:01:52.70,Default,,0000,0000,0000,,Trendelenberg, indicating a weak gluteus\Nmedius or intra-articular pathology in the
Dialogue: 0,0:01:52.70,0:01:55.04,Default,,0000,0000,0000,,supported hip.
Dialogue: 0,0:01:55.04,0:02:00.09,Default,,0000,0000,0000,,The standing flexion test assesses for lumbosacral,\Nsacroiliac, or pelvic dysfunction.
Dialogue: 0,0:02:00.09,0:02:04.70,Default,,0000,0000,0000,,The examiner stands behind the patient and\Nplaces hands on the iliac crests with thumbs
Dialogue: 0,0:02:04.70,0:02:08.70,Default,,0000,0000,0000,,over the inferior notch of the posterior superior\Niliac spine.
Dialogue: 0,0:02:08.70,0:02:10.70,Default,,0000,0000,0000,,The patient slowly flexes forward.
Dialogue: 0,0:02:10.70,0:02:15.76,Default,,0000,0000,0000,,If the posterior superior iliac spine moves\Nmore cephalad on one side, the test is positive
Dialogue: 0,0:02:19.45,0:02:21.40,Default,,0000,0000,0000,,indicating dysfunction.\NThe same maneuver should be repeated with
Dialogue: 0,0:02:21.40,0:02:24.73,Default,,0000,0000,0000,,the patient seated, known as the seated flexion\Ntest.
Dialogue: 0,0:02:24.73,0:02:29.84,Default,,0000,0000,0000,,In the seated test the patient should have\Nfeet flat on the floor, shoulder width apart.
Dialogue: 0,0:02:29.84,0:02:32.93,Default,,0000,0000,0000,,Again the examiner notes the PSIS (posterior\Nsuperior iliac spine) positioning on the patient
Dialogue: 0,0:02:32.93,0:02:34.37,Default,,0000,0000,0000,,flexed forward.
Dialogue: 0,0:02:34.37,0:02:41.37,Default,,0000,0000,0000,,If the PSIS moves more cephalad on one side\Nthe test is positive, indicating dysfunction.
Dialogue: 0,0:02:44.52,0:02:48.99,Default,,0000,0000,0000,,The stork test evaluates for a stress fracture\Nof the pars interarticularis in the lumbar
Dialogue: 0,0:02:48.99,0:02:50.16,Default,,0000,0000,0000,,spine.
Dialogue: 0,0:02:50.16,0:02:55.98,Default,,0000,0000,0000,,The patient places hands on hips and stands\Non one leg, and hyper-extends the spine.
Dialogue: 0,0:02:55.98,0:03:02.98,Default,,0000,0000,0000,,Pain in the lumbar region is considered a positive\Ntest.
Dialogue: 0,0:03:03.09,0:03:05.40,Default,,0000,0000,0000,,Next examine the hip in the seated position.
Dialogue: 0,0:03:05.40,0:03:12.40,Default,,0000,0000,0000,,Observe for range of motion with internal\Nrotation and external rotation.
Dialogue: 0,0:03:12.91,0:03:16.22,Default,,0000,0000,0000,,The fulcrum evaluates for femoral stress fractures.
Dialogue: 0,0:03:16.22,0:03:19.07,Default,,0000,0000,0000,,The examiner places one arm beneath the patient's\Nfemur.
Dialogue: 0,0:03:19.07,0:03:22.56,Default,,0000,0000,0000,,A downward force is then applied to the femur\Ndistally.
Dialogue: 0,0:03:22.56,0:03:25.91,Default,,0000,0000,0000,,Pain is suggestive of a femur stress fracture.
Dialogue: 0,0:03:25.91,0:03:30.40,Default,,0000,0000,0000,,With the patient supine a femoral log roll,\Ninternally and externally rotation the femur,
Dialogue: 0,0:03:30.40,0:03:37.21,Default,,0000,0000,0000,,and a heel strike, an axial force on the femur,\Ncan be performed to assess for possible femur
Dialogue: 0,0:03:37.21,0:03:40.44,Default,,0000,0000,0000,,fractures.
Dialogue: 0,0:03:40.44,0:03:43.45,Default,,0000,0000,0000,,Next assess for any leg length discrepancy.
Dialogue: 0,0:03:43.45,0:03:48.78,Default,,0000,0000,0000,,To prevent loss of leg length due to pelvic\Nrotation, ask the patient to raise the pelvis
Dialogue: 0,0:03:48.78,0:03:55.78,Default,,0000,0000,0000,,off of table and reposition before fully extending\Nlegs.
Dialogue: 0,0:04:01.43,0:04:05.68,Default,,0000,0000,0000,,You want to measure the distance between the\NASIS (anterior superior iliac spine) and the
Dialogue: 0,0:04:05.68,0:04:12.68,Default,,0000,0000,0000,,medial malleolus and compare the distance from\None side to the other side.
Dialogue: 0,0:04:13.43,0:04:15.92,Default,,0000,0000,0000,,Next evaluate active range of motion.
Dialogue: 0,0:04:15.92,0:04:20.47,Default,,0000,0000,0000,,If pain or limitation exists, repeat with\Npassive range of motion.
Dialogue: 0,0:04:20.47,0:04:25.18,Default,,0000,0000,0000,,Check straight leg hip flexion, isolating\Nthe rectus femoris muscle.
Dialogue: 0,0:04:25.18,0:04:32.18,Default,,0000,0000,0000,,Then bent knee flexion isolating the \Niliopsoas muscle.
Dialogue: 0,0:04:33.73,0:04:36.55,Default,,0000,0000,0000,,Also check resisted strength.
Dialogue: 0,0:04:36.55,0:05:04.55,Default,,0000,0000,0000,,Next check internal rotation, external rotation,\Nabduction, and resisted adduction.
Dialogue: 0,0:05:05.66,0:05:11.15,Default,,0000,0000,0000,,Palpate anatomic landmarks for tenderness\Nincluding the abdomen to evaluate for abdominal
Dialogue: 0,0:05:11.15,0:05:30.85,Default,,0000,0000,0000,,fascial hernia, anterior superior iliac spine,\Nanterior inferior iliac spine, the iliac crests,
Dialogue: 0,0:05:31.10,0:05:33.32,Default,,0000,0000,0000,,and pubic symphysis.
Dialogue: 0,0:05:33.32,0:05:38.81,Default,,0000,0000,0000,,A passive straight leg raise should be performed\Nto evaluate for lumbar radiculopathy.
Dialogue: 0,0:05:38.81,0:05:43.84,Default,,0000,0000,0000,,The test is considered positive if the patient\Nhas reproduction of radicular symptoms before
Dialogue: 0,0:05:43.84,0:05:46.73,Default,,0000,0000,0000,,70 degrees of hip flexion.
Dialogue: 0,0:05:46.73,0:05:51.10,Default,,0000,0000,0000,,Hamstring flexibility testing can also be\Nperformed with the hip and knee flexed to
Dialogue: 0,0:05:51.10,0:05:54.63,Default,,0000,0000,0000,,90 degrees, followed by passive extension\Nof knee.
Dialogue: 0,0:05:54.63,0:06:01.30,Default,,0000,0000,0000,,Full extension is desired, but if not, the\Nangle short of full extension is recorded.
Dialogue: 0,0:06:01.30,0:06:06.63,Default,,0000,0000,0000,,Thomas' Test assesses for hip flexure contracture.
Dialogue: 0,0:06:06.63,0:06:11.10,Default,,0000,0000,0000,,One hip is maximally flexed to the patient's\Nchest, flattening the lumbar spine.
Dialogue: 0,0:06:11.10,0:06:17.52,Default,,0000,0000,0000,,If the contralateral leg flexes at the knee\Nand rises off the table, the test is positive.
Dialogue: 0,0:06:17.52,0:06:26.92,Default,,0000,0000,0000,,Patrick's or Faber Test can be performed\Nto evaluate for hip and sacroiliac pathology.
Dialogue: 0,0:06:27.11,0:06:31.49,Default,,0000,0000,0000,,One leg is flexed, abducted, and externally\Nrotated in position resting the foot on the
Dialogue: 0,0:06:31.49,0:06:32.72,Default,,0000,0000,0000,,other knee.
Dialogue: 0,0:06:32.72,0:06:36.46,Default,,0000,0000,0000,,If the leg does not lower into a position\Nparallel to the exam table, there may be a
Dialogue: 0,0:06:36.46,0:06:40.74,Default,,0000,0000,0000,,hip flexor contracture or protective iliopsoas\Nspasm.
Dialogue: 0,0:06:40.74,0:06:45.74,Default,,0000,0000,0000,,Pressure on the knee with counter-pressure\Non the opposite pelvic brim may elicit pain
Dialogue: 0,0:06:45.74,0:06:50.11,Default,,0000,0000,0000,,at the hip or sacroiliac joint.
Dialogue: 0,0:06:50.11,0:06:54.14,Default,,0000,0000,0000,,In the lateral position, again test active\Nrange of motion and resisted strength for
Dialogue: 0,0:06:54.14,0:07:01.14,Default,,0000,0000,0000,,hip abduction and adduction.
Dialogue: 0,0:07:02.60,0:07:14.31,Default,,0000,0000,0000,,Palpate the greater trochanter of the femur,\Nthe iliotibial band,
Dialogue: 0,0:07:14.31,0:07:18.33,Default,,0000,0000,0000,,and the tensor fasciae latae.
Dialogue: 0,0:07:18.33,0:07:22.59,Default,,0000,0000,0000,,Ober's Test assesses for iliotibial band\Nsyndrome.
Dialogue: 0,0:07:22.59,0:07:26.40,Default,,0000,0000,0000,,With the patient in the lateral position the\Nknee is supported and flexed to 90 degrees
Dialogue: 0,0:07:26.40,0:07:28.65,Default,,0000,0000,0000,,while the hip is slightly extended and abducted.
Dialogue: 0,0:07:28.65,0:07:34.28,Default,,0000,0000,0000,,When the examiner releases knee support, failure\Nof the knee to adduct is considered a positive
Dialogue: 0,0:07:34.28,0:07:35.89,Default,,0000,0000,0000,,test.
Dialogue: 0,0:07:35.89,0:07:42.89,Default,,0000,0000,0000,,With the patient prone complete testing of\Nactive range of motion with leg extension.
Dialogue: 0,0:07:43.01,0:07:45.76,Default,,0000,0000,0000,,Palpate anatomic landmarks for tenderness.
Dialogue: 0,0:07:45.76,0:08:06.76,Default,,0000,0000,0000,,The lumbar spine, the sacroiliac joint, the\Nsacrum, the gluteus maximus muscle, the piriformis
Dialogue: 0,0:08:06.76,0:08:26.100,Default,,0000,0000,0000,,muscle, the sciatic notch, the ischial tuberosity,\Nand the adductor tubercle of the proximal femur.
Dialogue: 0,0:08:26.100,0:08:31.84,Default,,0000,0000,0000,,The Piriformis Test evaluates for pain from\Nsciatic nerve irritation caused by piriformis
Dialogue: 0,0:08:31.84,0:08:32.82,Default,,0000,0000,0000,,muscle.
Dialogue: 0,0:08:32.82,0:08:37.18,Default,,0000,0000,0000,,With the patient prone, the knees are flexed\Nto 90 degrees and the hips are internally
Dialogue: 0,0:08:37.18,0:08:38.00,Default,,0000,0000,0000,,rotated.
Dialogue: 0,0:08:38.00,0:08:41.48,Default,,0000,0000,0000,,Provide resistance against external rotation.
Dialogue: 0,0:08:41.48,0:08:43.85,Default,,0000,0000,0000,,Reproduction of the pain is a positive test.
Dialogue: 0,0:08:44.85,0:08:49.41,Default,,0000,0000,0000,,Ely's Test assesses for rectus femoris spasticity.
Dialogue: 0,0:08:49.41,0:08:53.00,Default,,0000,0000,0000,,With the patient prone, the examiner resists\Nknee flexion.
Dialogue: 0,0:08:53.00,0:08:58.43,Default,,0000,0000,0000,,If the buttocks raise or a pelvic tilt appears,\Nit is a positive test.
Dialogue: 0,0:08:58.43,0:09:02.42,Default,,0000,0000,0000,,In concluding the hip exam it is important\Nto document neurovascular exam.
Dialogue: 0,0:09:02.42,0:09:08.32,Default,,0000,0000,0000,,Here a dorsalis pedis artery, posterior tibial\Nartery, and capillary refill testing are tested.
Dialogue: 0,0:09:08.32,0:09:10.81,Default,,0000,0000,0000,,Further neurovascular exam may be indicated\Nby history.
Dialogue: 0,0:09:10.81,0:09:14.00,Default,,0000,0000,0000,,Acknowledgement: The Japanese translation of this video was made as part of Shizuoka-University of Michigan Advanced Residency Training, Education and Research in Family Medicine (SMARTER FM) Project supported by Shizuoka Prefecture and funded by the Community Healthcare Revival Fund.