Physical Exam Hip

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Introduction

• Follows the IP-PASS examination methodology
  • Inspection
  • Palpation
  • Passive Range of Motion
  • Active Range of Motion
  • Strength & Neurovascular
  • Special Tests

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Inspection

• Skin
  • Color: erythema, ecchymosis, white, black
  • Trophic changes (altered hair growth, sweat production)
  • Scars
  • Swelling
  • Muscle tone: atrophy, hypertrophy
  • Deformity: asymmetry, rotation, amputation
• Areas of emphasis for back exam
  • Resting position of hip/ leg (internal/ external rotation)
  • Leg length discrepency

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Palpation

• Palpate for
  • Effusion
  • Clicking
  • Snapping
  • Crepitus
  • Tenderness
  • Temperature
  • Masses
• Areas of Emphasis
  • Greater Trochanter
  • Piriformis muscle
  • Ischial Tuberosity (if appropriate)
  • Pubic symphysis (if appropriate)
  • Iliopsoas bursa

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Range of Motion

• Hip
  • Flexion: 120
  • Extension: 45
  • Abduction: 40
  • Adduction: 25
  • Internal Rotation: 45
  • External Rotation: 45

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Strength

• Back
  • Extension: Erector Spinae Muscles, Multifidus
  • Lateral Flexion (sidebending): Erector Spinae Muscles, Quadratus Lumborum
• Rotation: Multifidus
  • Flexion: Rectus Abdominis, Internal Obliques, External Obliques
• Hip
  • Hip Flexion (L2, L3): Iliopsoas
  • Hip Adduction (L2, L3): Gracilis, Obturator Externus, Adductor Brevis, Adductor Longus and Adductor Magnus
  • Hip Extension (L5): Gluteus Maximus, Biceps Femoris, Semitendinosus, Semimembranosus, Adductor Magnus
  • Hip Abduction (L5): Gluteus Medius, Gluteus Minimus, Tensor Fasciae Latae
• Knee
  • Knee Extension (L3, L4): Rectus Femoris, Vastus Lateralis, Vastus Medialis, Vastus Intermedius
  • Knee Flexion: Biceps Femoris, Semitendinosus, Semimembranosus, Gracilis, Sartorius, Gastrocnemius, Popliteus
• Ankle
  • Dorsiflexion (L4, L5): Tibialis Anterior
  • Plantarflexion (S1): Gastrocnemius, Soleus, Peroneal Muscles
  • Eversion (S1): Peroneal Muscles
  • Inversion (L5): Tibialis Posterior
• Foot
  • Toe Dorsiflexion (L5): Extensor Hallucis Longus, Extensor Digitorum Longus
  • Toe Plantarflexion (S2): Flexor Hallucis Longus, Flexor Digitorum Longus

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Neurovascular

• Sensory Nerves /Dermatomes
  • L1: Iliac crest, groin
  • L2, L3: Anterior and inner thigh
  • L4: Lateral thigh, anterior knee, medial leg
  • L5: Lateral leg, dorsal foot
  • S1: Posterior Leg
  • S2: Plantar foot
  • S3, S4: Perianal
• Reflexes
  • Commonly Used
    • Patellar (L3, L4)
    • Achilles (S1, S2)
  • Uncommonly Used
    • Medial Hamstring (L5, S1)
    • Lateral Hamstring (S1, S2)
    • Posterior Tibial (L4, L5)
    • Cremasteric (L1, L2)
    • Anal wink/ bulbocavernous (S2)
• Myotomes
  • L2: Hip Adduction, Hip Flexion
  • L3: Knee Extension, Hip Adduction, Hip Flexion
  • L4: Knee Extension, Dorsiflexion
  • L5: Hip Abduction, Hip Extension, Toe Dorsiflexion, Foot Inversion, Dorsiflexion
  • S1 Foot Version, Plantarflexion
  • S2: Toe Plantar Flexion
  • S3: Bowel, bladder function
  • S4: Bowel, bladder function
• Vascular
  • Femoral Artery
  • Popliteal Artery
  • Dorsalis Pedis Artery
  • Posterior Tibial Artery

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Special Tests

• General Hip Joint Pathology (OA, Labrum, FAI, AVN, etC)
  • FABER Test
  • FADIR Test
  • Stinchfield Test
  • Flexion Internal Rotation Test
  • IROP Test (Internal rotation over pressure)
  • Log Roll Test
  • Axial Distraction Test
  • Scour Test
• Hamstring Strain
  • Puranen Orava Test
  • Bent Knee Stretch Test
  • Modified Bent Knee Stretch Test
• Proximal Hamstring Tendinopathy
  • Puranen Orava Test
  • Bent Knee Stretch Test
  • Modified Bent Knee Stretch Test
• Adductor Tendonitis
  • Puranen Orava Test
  • Bent Knee Stretch Test
  • Modified Bent Knee Stretch Test
• Avascular Necrosis of the Hip
  • FADIR Test
  • FABER Test
• Hip Osteoarthritis
  • FADIR Test
  • FABER Test
• Femoroacetabular Impingement
  • FADIR Test
  • FABER Test
  • C Sign
  • Posterior Rim Impingement Test
  • Dynamic Internal Rotatory Impingement Test
  • Dynamic External Rotatory Impingement Test
• Piriformis Syndrome
  • FADIR Test
  • Thomas Test
  • Beatty Test
  • Active Piriformis Test
  • Pace Test
  • Straight Leg Raise Test
  • Seated Piriformis Stretch Test
  • Freibergs Sign
  • Passive Piriformis Stretch Test
• Hip Flexor Tendonitis (including Tightness, Contracture)
  • Thomas Test
  • Snapping Hip Sign
  • Modified Thomas Test
  • Pelvifemoral Angle
  • Elys Test
  • Rectus Femoris Contracture Test
  • Prone Hip Extension Test
• Rectus Femoris Contracture or Tightness
  • Rectus Femoris Contracture Test
  • Elys Test
• Hip Extensor Tightness or Contracture
  • Knee Extension Angle
• Greater Trochanteric Pain Syndrome
  • Single Leg Stance Test
  • Jump Sign
  • FABER Test
  • Ober Test
  • Resisted External Derotation Test
  • Passive Adduction With Resisted Abduction
  • Resisted Internal Rotation
• Ischial Bursitis
  • FABER Test
  • Straight Leg Raise Test
• Acetabular Labrum Tear
  • Anterior Hip Impingement Test
  • Posterior Hip Impingement Test
  • FABER Test
  • Resisted Straight Leg Raise Test
  • Log Roll Test
  • Scour Test
  • Anterior Labrum Test
  • Posterior Labrum Test
• Meralgia Paresthetica
  • Pelvic Compression Test
  • Neurodynamic Testing
  • Tinels Sign
• Snapping Hip Syndrome
  • Ober Test
  • FADIR Test
  • FABER Test
  • Thomas Test
• Femoral Neck Stress Fracture
  • Fulcrum Test
  • Hop Test

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See Also

• Clinical Exam (Main)
• Hip Pain (Main)
• Hip Anatomy (Main)

External

• Sports Medicine Review Hip Pain: https://www.sportsmedreview.com/by-joint/hip/
• https://www.sportsmedreview.com/blog/special-tests-for-physical-exam-of-the-hip/

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