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 range of motion. Top left shows hip flexion. Top right shows hip extension. Bottom left shows hip external rotation. Bottom right shows hip internal rotation

Range of motion testing of the hip

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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