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In a session entitled "Anatomy for the Clinician: Hip Pain Not from the Hip Joint - Anterior Hip Pain," Ingrid Moller reviewed the anatomy of the hip and how it can relate to clinical syndromes. As we know, the hip joint is complex and made up of interdependent structures. This makes imaging a challenge and many tests are non-specific. Therefore, correlating the findings on imaging with clinical history and physical examination is of the utmost importance.
Clinical examination is the gold standard for assessing the hip, and a detailed history is necessary. We know that hip flexor tests have low accuracy and poor predictive value, and they correlate poorly with MRI findings. Other techniques that may help our physical diagnosis include musculoskeletal ultrasound (MSUS).
Key components of the clinical examination of the hip include:
Palpation
Active movement (standing)
Passive movements (supine, lateral, prone)
Resisted movements (supine)
Special tests, which can include the Active SLR (for quadriceps and lumbopelvic stability), Elvy's test (prone knee flexion – if the hip flexes too we know the hip is tight), Kendall's test or Thomas' test to differentiate Rectus Femoris vs TFL vs Iliopsoas tightness
Neurovascular exam
Fascia is connected to the tendons of the hip muscles and helps dissipate loads, forms mechanical chains and improves mechanical efficiency. Fascia can also connect abdominal muscles to hip adductors, which helps control the shearing force across the anterior pubic arch. Clinically this means that we cannot treat the hip in isolation and it underscores the importance of strengthening not only the hip flexors and adductor muscles but also strengthening the abdominal muscles as part of the rehabilitation of groin injuries. It also means that areas of weakness in the fascia can lead to other areas of weakness such as hernias.
All of these syndromes can be affected by altered body mechanics in any part of the hip joint including muscles, tendons, fascia, or bony alterations. Using MSUS may help you see this more clearly. MSUS may uncover enthesitis, gout crystals or other rheumatology abnormalities that you may be attributing incorrectly to sports, activities or other abnormalities.
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About the Author
Marlene Thompson
Marlene Thompson is an Associate Clinical Professor in Physical Therapy at Western University and an Advanced Physiotherapy Practitioner in Arthritis Care. MarleneÔǦs research interests include models of care, triage, advanced practice roles, and arthritis education.
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