CLINICAL EDUCATION (LABORATORY 3) – HIP CONDITION

EBORA, O’SANTOS, QUINONES, TUTOR

1) Assessment and Tests:

a. OI – to check if there is any gross deformity that may happen on the hip. Postural and
gait deviation can also be seen.
b. Palpation – Palpation is used to check if there is if there is swelling, tenderness,
temperature and redness on the incisional area. Also it is needed to check if there is any
muscle guarding or tightness on the muscles affected on the surgery, and check if there
is muscle atrophy.
c. Sensory Assessment – To rule out other neurological pathology that may developed and
if there is nerve affectation on the area.
d. Range of Motion - Patients may elicit LOM due to weakness of the gluteus muscles that
is affected in THR, it can be also d/t muscle contractures that may developed on the
operated hip. Also there is a limitation on ROM on the THR patient so ROM should be
limited in protected ranges.
e. MMT –Patient gluteus muscles may elicit weakness because of the surgery, and
surrounding muscles also needed to be checked if there are any contractures that may
developed. The patient may have muscle weakness because of aging d/t sarcopenia or
loss of muscle mass associated c aging.
f. Special Tests
a. Thomas test – to check if there is flexion contracture on the operated hip.
Flexion contracture is common and needed to be prevented in patients post
THR.
b. Ober test – to check if the ITB band contracture of the operated leg. Contracture
is common with patients that are post-surgery.
c. Balance and Tolerance – to check if the operated hip can maintain balance in
standing position, weight shifting, and can be challenged. Poor balance may be
cause of postoperative weakness.
g. Postural analysis – it is needed to check if there are any postural deviation like guarding
posture that may signifies post-operative pain and fear for any danger that may cause
stress on the operated hip.
h. Gait Analysis – it is needed as soon as the weight bearing clearance is given. This is to
check if there are any deviation because of malalignment of the operated hip it can be
seen in walking. Or if there are any protective mechanism that the patient do, so that it
can be corrected.
i. Anthropometrics Assessment
a. LLD – It is needed to measure if the operated hip is aligned with the other leg. 1
-1.5 cm difference on the legs are still considered normal. The limping of the
patient may be from the discrepancy on the legs or if the other leg is shorter.
 j. ADL analysis – to check if the surgery procedure taken affects the patient activities of
daily living. And to be able to make any modifications in doing it due to the limitations of
some movements in THR.

2) Problem List:
1. Intermittent deep, dull, nagging pain (PS 6/10) on (R) hip
2. LOM of (R) LE towards hip ext (0-10°)
3. Muscle weakness of hip extensors (3+/5)
4. Antalgic gait
5. Swelling on R LE

Long Term Goal (3 PT sessions/week for 3 mos.)

1. Pt. will be able to perform ADLs and ambulate independently characterized by (N) ROM,
(N) muscle strength and (N) gait pattern.
2. Pt. will be able to maintain safe and proper functional activities to prevent post-
operative dislocation.

Short Term Goal

1. Pt will decrease pain on (R) hip from PS 6/10 to PS 4/10 p 6 PT sessions

2. Pt will increase ROM on (R) hip ext (0-10°) to (0-15°) p 5 PT sessions
3. Pt will increase strength on (R) hip extensors from (3+/5) to (5/5) p 7 PT sessions
4. Pt will able to perform amb c walker c a symmetrical and stable gait pattern p 6 PT
sessions
5. Pt will have decreased swelling on (R) LE P 6 PT sessions

3) PT Management

a. HMP on (R) hip x 6-8 layers x 20 mins to decrease pain

b. AROME of (R) hip ext x 10 reps x 3 reps to increase ROM
c. Isometric contraction of gluteus medius x 8 SH x 5 reps to strengthen the muscle and
increase ext
d. Isometic exercises of of (R) hip extensors x 6 SH x 5 reps to increase the strength of
muscles
e. Gait training on levelled surface using walker c supervision x ~30m x 2 sets
f. (R) ankle pumps x 10 reps x 3 sets to decrease swelling
4) Functional Assessment Tool – Oxford Hip Scale

OHS is a patient reported outcomes assessment type. It is a 12-item subjective

questionnaire to measure the outcome of THR. Areas of assessment are ADLs, coordination,
functional mobility, gait, negative affect, occupational performance, pain, seating, and sleep.

Each of the items has 5 categories of response and is scored 1 to 5 (from least difficult to
most difficult) and then the items are added together. Minimum score is 12 indicating least
difficulty and maximum score is 60 indicating most difficulty. (Please see attachment for the
questionnaire)