Magee Hip 14

Hip Magee by Devasya Dodia
The Hip Joint:- The hip joint is one of the largest and most stable joints in the
body.
- Pathology or injury to the hip joint is immediately perceptible during walking
and affects the patient's ability to ambulate.
- Pain from the hip can be referred to other areas (e.g., sacroiliac joint, lumbar
spine, abdominal area), so a thorough examination of these areas is important.
- A limp, groin pain, or limited medial rotation is indicative of hip problems.
Applied Anatomy:
- The hip joint is a ball-and-socket joint, highly stable due to the deep insertion
of the femur head into the acetabulum.
- The hip joint has a strong capsule and powerful muscles controlling its
actions.
- The acetabulum is formed by fusion of parts of the ilium, ischium, and pubis.
- The labrum, a horseshoe-shaped fibrocartilaginous structure, deepens and
stabilizes the hip joint, providing proprioceptive feedback and a suction seal to
protect the cartilage.
- Mechanisms of labral injury include hip hyperabduction, twisting, falling,
hyperextension, dislocation, or direct trauma.
- The hip's stability is further supported by three strong ligaments: iliofemoral,
ischiofemoral, and pubofemoral ligaments.
- The ligamentum teres, an intra-articular ligament, acts as a stabilizer,
especially in adduction, flexion, and lateral rotation.
- It may also have a proprioceptive role and distribute synovial fluid.
- Tears of the ligamentum teres can lead to microinstability of the hip,
damaging the labrum and cartilage.
- The hip's stability is enhanced by the fovea capitis, arcuate ligament, and
zona orbicularis.
- Under varying loads, the hip joint can change from incongruous to congruous
to maximize surface contact and reduce load per unit area.
Forces on the Hip:- Forces exerted on the hip depend on activity:

- Standing: 0.3 times body weight
- Standing on one limb: 2.4–2.6 times body weight
- Walking: 1.3–5.8 times body weight
- Walking up stairs: 3 times body weight
- Running: 4.5+ times body weight
Hip Joint Positions:

- Resting position: The hip joint's resting position is characterized by 30° of
flexion, 30° of abduction, and slight lateral rotation.
- Close packed position: The close-packed position of the hip joint occurs when
it is in full extension, medial rotation, and abduction. This position offers
maximum stability to the joint.
Capsular Pattern:
- The capsular pattern of the hip joint refers to the characteristic pattern of
restriction in range of motion caused by capsular tightness or pathology.
- The capsular pattern for the hip joint typically involves limitations in three
main movements:
- Flexion
- Abduction
- Medial rotation- It's worth noting that in some cases, there may be limited
medial rotation in addition to the other restrictions mentioned above.
These positions and the capsular pattern provide valuable information about
the range of motion and limitations in the hip joint, which can be essential for
assessment and diagnosis in clinical practice.
Certainly, here's a summary of the information regarding movement or
kinematics at the hip joint in different contexts:
Hip Joint Kinematics:

- When analyzing movement or kinematics at the hip joint, it's crucial to
consider two main scenarios:
1. Pelvis moving on a stationary femur (weight-bearing).
2. Femur moving on the pelvis (non-weight bearing).
Weight-Bearing Scenario (Pelvis Moving on a Stationary Femur):

- In this scenario, the femur remains stationary while the pelvis moves.
- This scenario is relevant during activities such as walking, where the pelvis
tilts and shifts while the femur provides support and stability.
- Understanding this movement pattern is essential for assessing gait and
weight-bearing functions of the hip joint.
Non-Weight Bearing Scenario (Femur Moving on the Pelvis):

- In this scenario, the femur is mobile and moves within the pelvis.
- This scenario is relevant for non-weight-bearing movements such as when the
leg is lifted or rotated without bearing body weight.
- It's essential to consider this scenario when evaluating hip joint mobility and
range of motion in various clinical assessments.
These considerations are crucial for understanding how the hip joint functions
in different contexts, whether weight-bearing or non-weight-bearing, which is
essential for assessing and diagnosing hip-related issues and conditions.
Patient history that an examiner should consider when evaluating hip issues:
1. Patient's Age:
- Age is a crucial factor to consider as different conditions and range of
motion changes occur at various ages.
- Conditions like congenital hip dysplasia, Legg-Calvé-Perthes disease, and
osteoporotic femoral neck fractures have age-specific occurrences.
2. Mechanism of Injury (if applicable):

- Understanding how the injury occurred is important.
- Mechanical hip symptoms can worsen with activities like twisting, sitting
with hip flexed, rising from a seated position, etc.
- Trauma or repetitive loading activities can lead to specific injuries or
conditions.
3. Details of Present Pain and Symptoms:

- Understanding the characteristics of the pain and other symptoms is crucial.
- Patients may describe pain in various ways, such as deep in the joint or in
the groin.
- It's important to determine what triggers the pain, whether it's static or
dynamic, and whether it's an ache or a sharp, sudden pain.
4. Improvement or Worsening of Condition:

- Knowing whether the condition is improving, worsening, or staying the
same provides insights into the progression of the issue.
5. Activity and Pain Relationship:

- Identifying activities that ease or worsen the pain can help pinpoint the
underlying problem.
- For example, trochanteric bursitis may result from specific running
mechanics, while sitting-related pain may indicate certain issues.
6. Weakness or Abnormal Movements:

- Assessing whether the patient perceives any weakness or abnormal
movements can provide valuable diagnostic information.
- Weakness or feelings of the hip "giving way" can be indicative of various
conditions, including FAI, trauma, labral lesions, and avascular necrosis.
7. Patient's Usual Activity or Pastime:

- Understanding the patient's typical activities and pastimes can help identify
any repetitive or sustained positions that may contribute to the problem.
8. Past Medical and Surgical History:

- Inquiring about past medical and surgical history is important, especially
related to developmental disorders, systemic illnesses, metabolic disorders,
and inflammatory conditions.
- Certain risk factors, such as alcohol, corticosteroid, or tobacco use, can
increase the risk of specific hip issues like osteonecrosis.
This comprehensive patient history-taking process helps the examiner gather
essential information to guide the evaluation and diagnosis of hip-related
problems effectively.
Observations and assessments that should be made during a hip
examination. Here are the key points:
1. Gait Observation:
- Observe the patient's gait as they enter the assessment area.
- Look for signs of hip issues in the gait, such as weight being shifted to the
affected side, a shorter step on the affected side, or a stiff gait.
- Assess for any imbalance in the pelvis while standing, which may indicate
pain in the hip.
- Note whether the patient demonstrates the "C" sign when asked to point
out the location of pain.
2. Muscle Tightness and Weakness:

- Pathology in the hip region can lead to tightness in muscles like adductors,
iliopsoas, piriformis, tensor fasciae latae, rectus femoris, and hamstrings.
- Muscle imbalances may lead to weakness in the gluteus maximus, medius,
and minimus.
3. Gait Abnormalities:
- Look for specific gait abnormalities related to hip issues, such as
Trendelenburg gait (abductor deficiency), pelvic wink, or butt wink (excessive
posterior pelvic rotation).
- Note if the patient shows signs of "toeing out" or "toeing in," which can be
related to hip or pelvic anatomy.
4. Use of Canes:
- If the patient uses a cane, check if it's held in the hand opposite the affected
side to reduce the load on the affected hip.
5. Proper Standing Position:

- Ensure the patient is standing properly and symmetrically.
- Check for any muscle wasting or signs of abnormal posture.
6. Balance and Proprioception: - Evaluate the patient's proprioceptive control
by having them balance on one leg with eyes open and closed.
- Note any differences in balance between the affected and unaffected sides.
7. Limb Position and Symmetry:

- Assess if the positions of the limbs are equal and symmetric.
- Look for any leg length discrepancies or structural abnormalities.
8. Skin and Scar Examination:

- Examine the skin color, texture, and the presence of scars or sinuses in the
hip area.
9. Dynamic Gait Analysis:

- Observe the patient's gait while walking and look for abnormal patterns
related to hip issues.
- Note if the patient avoids certain movements or has difficulty controlling
hip movement.
- Consider the use of ambulatory aids and their effect on gait and pain.
10. Whole Kinetic Chain Consideration:

- Remember that abnormal kinematics in one joint can affect mechanics in
another joint, so it's essential to consider the entire kinetic chain.
- Abnormal hip mechanics, for example, can impact the knee and lead to
conditions like patellofemoral syndrome.
This comprehensive observation and assessment process help clinicians gather

information about the patient's hip condition, including gait abnormalities,
muscle imbalances, and structural issues, to guide further evaluation and
treatment.
1. Referred Pain: Keep in mind that hip pain can be referred from the sacroiliac
joints or the lumbar spine, and vice versa. Therefore, a thorough examination
may be necessary to pinpoint the source of the pain.
2. Comparison with the Opposite Side: Always compare the affected hip with
the unaffected side to identify any differences. This comparison is essential
due to normal variations among individuals.
3. Layered Approach to Assessment: Use a layered approach to assess various

structures around the hip that may be injured. This approach helps in a
systematic evaluation of the hip.
4. Active Movements: Perform active movements of the hip, with the most
painful ones done last. These movements include flexion, extension,
abduction, adduction, lateral rotation, medial rotation, sustained postures,
repetitive movements, and combined movements.
5. Flexion of the Hip: Test hip flexion in the supine position with the knee
flexed. Normal range is about 110° to 120°. Be cautious of pelvic rotation
instead of hip flexion.
6. Extension of the Hip: Test hip extension in the prone position. Differentiate
between hip extension and lumbar spine extension. Elevation of the pelvis
indicates the end of hip extension.
7. Extra-Articular Impingement: Consider extra-articular impingement in the

posterior hip, which can lead to symptoms at the end range of extension,
adduction, and lateral rotation. Types of extra-articular impingement include
ischiofemoral impingement (IFI), deep gluteal syndrome (DGS), greater
trochanteric-pelvic impingement, and psoas impingement.
8. IFI (Ischiofemoral Impingement): IFI occurs in the narrow space between

the ischial tuberosity and the lesser trochanter during extension, adduction,
and lateral rotation. Patients may experience chronic groin or lower buttock
pain. Differentiate IFI from other hip conditions that involve the sciatic nerve.
9. Pain Patterns: Understand the pain patterns associated with different hip
conditions, such as anterior groin pain in femoroacetabular impingement (FAI)
and deep gluteal pain in IFI.
10. Sciatic Nerve Involvement: Be aware of conditions that can involve the
sciatic nerve, causing symptoms like radicular pain and paresthesia into the
affected leg.
11. Differential Diagnosis: Consider the differential diagnosis of hip pain,

which may include labral tears, FAI, psoas impingement, and various types of
impingement syndromes.
12. Gender and Age Factors: Some hip conditions are more common in specific
gender and age groups. For example, cam-type FAI is more common in young
adult males, while pincer-type FAI is more common in older females.
13. Examination Techniques: Use specific examination techniques, such as

palpation of the anterior superior iliac spine (ASIS) and observation of pelvic
movements during hip movements.
14. Repetitive Movements: Consider the impact of repetitive movements,
sustained postures, and combined movements on hip symptoms, as these can
provoke pain or discomfort.
15. Patient Presentation: Pay attention to how the patient presents during the
examination, including pain responses and any snapping sensations,
crepitation, or locking.
This comprehensive examination process helps clinicians assess hip conditions

accurately, differentiate between various hip pathologies, and identify the
source of the patient's symptoms.
Different types of hip impingements and conditions:
1. Greater Trochanteric-Pelvic Impingement: This impingement is relatively

rare and occurs when a high greater trochanter (decreased neck-shaft angle,
coxa vara) abuts against the ilium during hip abduction in extension. It is
typically caused by Legg-Calvé-Perthes disease, resulting in morphological
changes in the femoral head and neck. This condition leads to contact between
the ilium and greater trochanter during specific hip movements. Patients may
have a shortened involved leg, and a positive Trendelenburg gait may be
observed. The "gear-stick sign" is a diagnostic test for this condition (see
"Special Tests" section).
2. Coxa Valga and Femoral Anteversion: Coxa valga, characterized by a neck-

shaft angle greater than 135°, and femoral anteversion, often associated with
hip dysplasia, can also limit hip extension, adduction, and lateral rotation.
3. Hamstring Syndrome: Patients with hamstring syndrome, also known as

ischial tunnel syndrome, experience lateral pain near the ischium, particularly
at heel strike during gait. This condition is related to the eccentric action of the
hamstrings during the deceleration of the forward leg. Proximal hamstring
injury, often associated with recurrent hamstring tears, can lead to this
syndrome. Pain is felt in the lower gluteal area and may extend to the popliteal
space. Sitting and forceful leg movements can be painful.
4. Deep Gluteal Syndrome (DGS): DGS includes conditions such as piriformis

syndrome and involves the spinal, sacroiliac, and intrapelvic structures as well
as the gluteal space. Pain in DGS is typically more proximal, around the
piriformis muscle, and is triggered by specific tests, such as Pace's and
Freiberg's tests (see "Special Tests" section). Tenderness is often felt over the
piriformis muscle and retrotrochanteric area. Prolonged sitting can be painful.
Various conditions within DGS may affect the sciatic nerve, leading to
neurological signs.
5. Hip Abduction: Hip abduction is a normal movement ranging from 30° to

50°. During the examination, the patient is in the supine position, and the
examiner ensures that the pelvis is balanced, with level ASISs and
perpendicular lower extremities. The patient is then asked to abduct one leg at
a time. Pelvic motion is monitored by palpating the ASIS. In a normal
abduction, the ASIS on the movement side elevates while the opposite ASIS
may drop or elevate. Adduction contracture can limit this range of motion.
Understanding these different impingement conditions and syndromes is

crucial for diagnosing hip-related issues and ensuring appropriate treatment
approaches. The examination techniques mentioned help in assessing these
conditions accurately.
This section continues to describe various aspects of hip examination, including

movements, range of motion, and flexibility testing:
1. Hip Abduction Assessment: During hip abduction, various movement

patterns may indicate muscle imbalances or weaknesses. For instance, if lateral
rotation and slight flexion occur early in the movement, it might suggest that
the tensor fascia lata is stronger and the gluteus medius/minimus are weak.
Conversely, if lateral rotation occurs later in the range of motion, the iliopsoas
or piriformis might be overactive. Early pelvic tilting in the movement could
indicate overactivity of the quadratus lumborum. These movement patterns
are essential for identifying muscle imbalances.
2. Hip Adduction Assessment: Hip adduction typically has a normal range of

30°, and it is measured from the same starting position as hip abduction. The
examiner ensures that the pelvis does not move during the test. An alternative
method involves having the patient flex the opposite hip and knee, holding the
limb in flexion with their arms, and then adducting the test leg under the other
leg. This method is suitable for thin patients. During adduction, the ASIS on the
same side should move first. If there is an abduction contracture, this
movement may occur earlier in the range of motion.
3. Rotational Movements: Rotational movements, including medial and lateral

rotation, can be assessed with the patient in various positions: supine, prone,
or sitting. The choice of position depends on the specific symptoms and the
need to assess hip movement in flexion or extension. The iliofemoral and
ischiofemoral ligaments' tension varies with hip flexion and extension,
influencing these rotational movements. Medial rotation typically ranges from
30° to 40°, while lateral rotation ranges from 40° to 60°. Asymmetric lateral
rotation may indicate certain hip abnormalities, such as acetabular
retroversion, femoral retrotorsion, or femoral head-neck abnormalities (e.g.,
FAI). Loss of medial rotation is often an early sign of internal hip pathology.
Several tests are mentioned for assessing rotational movement, including
supine leg rolling, sitting and supine methods, and prone testing.
4. Flexibility Testing - Bent-Knee Fall-Out Test: Flexibility of the hip can be

tested using the Bent-Knee Fall-Out Test. In this test, the patient is in the
supine crook-lying position (hip at 45° flexion, knee at 90° flexion) with the
knees together. The patient allows the knees to fall outward while keeping the
feet together. The examiner assesses the end feel at the end of the range of
motion and measures the distance from the head of the fibula to the table
bilaterally. This test helps evaluate hip flexibility.
Understanding these assessment techniques is essential for diagnosing hip

conditions, identifying muscle imbalances, and evaluating hip range of motion
and flexibility. The choice of specific tests may depend on the patient's
presentation and clinical findings.
This section discusses passive movements of the hip during a physical

examination and their significance in assessing hip joint and surrounding
structures:
1. Passive Movements and Their End Feel:** Passive movements of the hip
involve the examiner moving the patient's hip joint through various ranges of
motion (ROM) while the patient remains relaxed. These passive movements
help determine the end feel, which describes the quality of resistance felt
when a joint is moved passively. The end feel can provide valuable information
about the tissues that may be causing problems around the hip.
2. **Types of Passive Hip Movements:** The passive movements of the hip

are similar to the active movements and include:
- **Flexion:** End feel can be described as tissue approximation or tissue
stretch.
- **Extension:** End feel is typically characterized as tissue stretch.
- **Abduction:** End feel is due to tissue stretch.
- **Adduction:** End feel can be described as tissue approximation or tissue
stretch.
- **Medial Rotation:** End feel results from tissue stretch.
- **Lateral Rotation:** End feel is due to tissue stretch.
3. **Capsular Pattern of the Hip:** The capsular pattern of the hip refers to
the characteristic pattern of limited passive movements in hip joint pathology.
In hip conditions, the most limited passive movements typically involve flexion,
abduction, and medial rotation. The order of restriction may vary among
individuals, meaning that one person may experience the most significant
limitation in medial rotation, followed by flexion and abduction.
4. **Interpreting Pain during Passive Movements:** Pain experienced during

passive hip movements can be indicative of specific issues. For example:
- Pain during passive flexion and medial rotation suggests a possible intra-
articular source of the problem within the hip joint.
- Snapping of the iliopsoas tendon can be assessed by passively moving the
hip from a flexed, abducted, and laterally rotated position to one of extension
and medial rotation.
- Limitation of passive hip flexion, adduction, and medial rotation with
associated pain may indicate problems with the acetabular rim or labral tears,
particularly if clicking and groin pain are elicited.
5. **Considerations for Pelvic Stability:** During passive hip movements, it is

essential to ensure that the pelvis remains stable and does not move. Any
groin discomfort or limited ROM observed during passive medial rotation could
suggest hip problems. Movement of the pelvis during these assessments may
indicate muscle imbalances or instability.
6. **Systemic Evaluation:** In some cases, a systemic component may

contribute to hip problems. Therefore, the examiner may check for general
laxity using specific criteria (e.g., Carter and Wilkinson criteria) to determine if
the issue might have a broader systemic origin.
Understanding the end feel and assessing passive hip movements is crucial for
diagnosing and differentiating hip joint problems, muscle imbalances, and
other issues affecting the hip region. It allows healthcare professionals to
gather valuable information during a physical examination to guide further
evaluation and treatment.
This section discusses resisted isometric movements of the hip during a
physical examination and their significance in assessing muscle strength,
stability, and control of the pelvis:
1. **Purpose of Resisted Isometric Movements:** Resisted isometric

movements of the hip are conducted with the patient in a supine position.
These tests evaluate the strength and stability of the muscles surrounding the
hip joint, which play a crucial role in stabilizing the pelvis. The examiner
assesses whether the muscles are weak or strong, tight, and whether muscle
force-couples are functioning correctly.
2. **Key Questions for Pelvic Control:** To evaluate pelvic control effectively,

the examiner must address three essential questions:
- Can the patient actively position the pelvis in a neutral position, especially
during hip movements?
- Can the patient maintain the neutral pelvic position statically while
performing hip movements, even with distal limb movement?
- Can the patient control dynamic pelvic movement while engaging in hip
movements?
3. **Types of Resisted Isometric Hip Movements:** The following resisted

isometric movements of the hip are typically evaluated:
- Hip Flexion
- Hip Extension
- Hip Abduction
- Hip Adduction
- Hip Medial Rotation
- Hip Lateral Rotation
- Knee Flexion
- Knee Extension
4. **Muscle Testing and Compensatory Movements:** To ensure that the

muscle testing is truly isometric and that the patient does not initiate
compensatory movements, the examiner should instruct the patient with
phrases like, "Don't let me move your hip." This prevents the patient from
compensating by grasping the table or rotating the trunk during the test.
5. **Testing the Adductors:** Delahunt et al. recommend testing the

adductors with the hip flexed to 30° to 45° as the optimal test position. The
examiner may use tests like the thigh adductor squeeze test or the fist squeeze
test for this purpose. Testing the adductors bilaterally with the knees extended
(bilateral adductor test) is considered highly diagnostic.
6. **Identifying Muscle Involvement:** By carefully noting which resisted

isometric movements cause pain or demonstrate weakness, the examiner can
identify which specific muscle may be at fault. For example, if a patient
experiences pain during extension, adduction, and lateral rotation, it may
suggest an issue with the gluteus maximus muscle, as it is involved in all these
movements.
7. **Additional Testing:** If the patient's history indicates that symptoms

occur during concentric, eccentric, or econcentric movements, these aspects
should also be assessed after the isometric tests are completed. For instance,
hamstring strength can be evaluated using a supine plank test.
8. **Considerations for Pain and Inflammation:** The examiner should be

aware that intra-abdominal inflammation in the region of the psoas muscle can
lead to pain during resisted hip flexion. This type of inflammation may also
result in a rigid abdominal wall.
9. **Muscle Strength Ratios:** Strength ratios among hip muscles may vary
depending on whether the movements are tested isometrically or
isokinetically. For instance, it has been reported that the adductors are
approximately 2.5 times as strong as the abductors.
Resisted isometric movements of the hip are valuable in assessing muscle

function and identifying potential sources of pain or weakness in the hip and
pelvic region. These tests provide insights into the integrity of the musculature
and pelvic control, helping guide further evaluation and treatment decisions.
Functional assessment of the hip is crucial as hip motion is required for various
activities of daily living (ADLs) beyond walking. Here are key points about
functional assessment of the hip:
**Range of Motion for ADLs:** Hip range of motion (ROM) is necessary for
activities such as sitting, standing, bending, picking up objects, and tying shoes.
Ideally, individuals should have functional ranges of approximately 120° of
flexion, 20° of abduction, and 20° of lateral rotation to perform these ADLs
comfortably.
**Functional Tests of the Hip:** Functional tests are used to assess how well a
person can perform specific movements or activities that mimic real-life
situations. These tests provide insights into hip function and mobility. Some
functional tests of the hip include:
- Squatting
- Going up and down stairs one step at a time
- Crossing legs so that one ankle rests on the opposite knee
- Going up and down stairs two or more steps at a time
- Running straight ahead
- Running and decelerating
- Running and twisting
- One-legged hop (assessing time, distance, and crossover)
- Jumping
**Patient-Reported Outcome Measures:** Various numerical rating scales and

patient-reported outcome measures (PROMs) are available to assess hip
function based on pain, mobility, and gait. These scales help clinicians and
researchers evaluate hip function and monitor changes over time. Some
commonly used hip rating scales and questionnaires include:
- D'Aubigné and Postel Hip Rating Scale
- Harris Hip Function Scale
- Victorian Institute of Sport Australia GTPS (trochanteric bursitis)
Questionnaire (VISA-G)
- Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)
- Lower Extremity Function Scale (LEFS)
- SF-36 Questionnaire
- Iowa Scale
- Oxford Hip Score
- Mayo Hip Score
- Hip Outcome Score
- Other scales and questionnaires
These tools provide a structured way to assess hip function and monitor the
impact of hip conditions or interventions.
**Functional Strength and Endurance Testing:** Functional strength and

endurance of the hip are essential aspects of hip assessment. Functional tests
can help evaluate a person's ability to perform daily activities and sports-
related movements. Table 11.14 likely provides a testing scheme for assessing
functional hip strength and endurance.
Overall, functional assessment of the hip is essential for understanding how

hip conditions affect a person's ability to perform everyday tasks and activities,
and it helps guide treatment and rehabilitation decisions.
It's important to stay updated on the latest outcome scales and assessment
tools for evaluating hip conditions. Here are some newer outcome scales and
functional assessment tools mentioned in your text:
**1. International Hip Outcome Tool (iHOT):** The iHOT has two versions,
iHOT33 and iHOT12, designed for assessing hip problems in young individuals.
These scales focus on hip-related symptoms, function, and quality of life.
**2. Copenhagen Hip and Groin Outcome Score (HAGOS):** The HAGOS
includes six subscales that assess various aspects of hip and groin health,
including pain, symptoms, physical function in activities of daily living (ADLs),
physical function in sport and recreation, participation in physical activities,
and hip/groin-related quality of life.
**3. Walking Tests:** Walking tests are used to assess dynamic stability,
endurance, falls risk, and lower limb musculoskeletal function, especially in the
elderly population. Some of these tests include the Timed Up-and-Go test (TUG
test), 13-minute walk test, 6-minute walk test (6-MWT), self-paced walk test,
2-minute walk test, 10-m walk test, 12-minute walk test, 4-square step test,
step test, and sit-to-stand test. These tests can provide valuable information
about an individual's functional capacity.
**4. Clinical Prediction Rule for Osteoarthritis:** Sutlive developed a clinical

prediction rule for osteoarthritis of the hip. If four out of five specific tests are
positive, it suggests the presence of hip osteoarthritis.
**5. Functional Tests for Athletes:** Functional tests, such as the Functional
Hip Sport Test, may be used for athletes who are recovering from hip
arthroscopy or other hip-related conditions. These tests assess a range of
movements, including single knee bends, lateral movements, diagonal
movements, and forward lunges, to determine an athlete's readiness to return
to sport.
**6. EQ-5D Questionnaire:** The EQ-5D questionnaire assesses a patient's

perceived health status and overall quality of life. It can be useful for gaining
insights into a patient's well-being beyond hip-specific symptoms.
**7. Other Injury Prediction Tools:** Various tools are available to predict
injuries to the lower extremity, which can be important for injury prevention
and rehabilitation planning.
It's essential for healthcare professionals to select appropriate assessment

tools based on individual patient needs and the specific hip condition being
evaluated. Using these tools can help tailor treatment plans and track patient
progress effectively.
Continuing with special tests for hip pathology:
**FADDIR (Flexion, Adduction, and Internal Rotation) Test:** This test is used
to assess for hip labral tears and impingement. The patient is supine with the
hip flexed, adducted, and internally rotated. Pain or clicking during this
maneuver may suggest labral pathology.
**FABER (Flexion, Abduction, and External Rotation) Test:** The FABER test is
used to evaluate hip and sacroiliac joint pathology. The patient lies supine with
the tested leg in a figure-four position, with the ankle resting on the opposite
knee. Pressure is applied to the flexed knee to push it downward gently. Pain
or limitation in this position may indicate hip or SI joint issues.
**Ober's Test:** Ober's test assesses the tightness of the iliotibial (IT) band.
The patient lies on their side with the lower leg bent to 90 degrees and the
upper leg extended. The examiner passively abducts and extends the upper leg
and then slowly releases it. If the leg remains elevated above the examining
table, it suggests IT band tightness.
**Log Roll Test:** The log roll test assesses for intra-articular hip pathology.
The patient lies supine with both legs fully extended. The examiner grasps the
patient's ankle and rolls the leg internally and externally. Pain or clicking during
this maneuver may suggest hip joint or labral issues.
**McCarthy Test:** The McCarthy test is used to assess for intra-articular hip
pathology, such as labral tears. The patient lies supine, and the examiner flexes
and adducts the patient's hip with slight internal rotation while applying axial
pressure through the knee. Pain or reproduction of symptoms suggests hip
joint or labral problems.
**Anterior Apprehension Test (Hyperextension–Lateral Rotation Test):** This

test evaluates for anterior instability or anterior labral tears. The patient is
supine with the buttocks at the edge of the table. The examiner rotates the
test hip laterally, which can reproduce anterior hip pain or apprehension.
**Bryant’s Triangle:** This test involves measuring specific angles using
imaginary lines drawn from anatomical landmarks. It can help assess
conditions such as coxa vara or congenital dislocation of the hip (CDH).
**Craig’s Test:** Craig's test assesses femoral anteversion or retroversion. The

patient lies prone with the knee flexed to 90 degrees. The examiner palpates
the posterior aspect of the greater trochanter and rotates the hip medially and
laterally. The degree of anteversion or retroversion can be estimated based on
the angle of the lower leg with the vertical.
These special tests, in conjunction with a thorough clinical assessment and

imaging when necessary, help healthcare professionals narrow down potential
hip pathology and guide further evaluation and treatment. Remember that no
single test should be used in isolation, and a comprehensive approach is
essential for accurate diagnosis and management.
**Dial Test of the Hip:** The dial test assesses for hip instability. The patient
lies supine with the hips in a neutral position. The examiner rotates the limb
medially and then releases it, allowing the leg to go into lateral rotation. If the
leg rotates passively greater than 45° from vertical in the axial plane and lacks
a mechanical endpoint, it suggests hip instability. This test can help evaluate
hip instability in both limbs.
**Drehmann Sign:** Drehmann sign is observed in adolescents and young

adults with slipped capital femoral epiphysis (SCFE) and indicates excessive
passive lateral rotation and abduction of the hip in flexion. This sign can also be
used to help diagnose femoroacetabular impingement (FAI) due to SCFE.
Diagnostic imaging is typically used to confirm SCFE.
**Flexion-Adduction Test:** This test is used to assess for hip disease in older
children and young adults. The patient lies supine, and the examiner flexes the
hip to at least 90° with the knee flexed. The examiner then adducts the flexed
leg. Limited adduction accompanied by pain or discomfort may indicate hip
pathology.
**Foveal Distraction Test:** The foveal distraction test is performed in the

supine position. The examiner abducts the hip to 30° and applies axial traction
to the leg, reducing intra-articular pressure. Relief of pain during this maneuver
suggests intra-articular hip pathology.
**Hip Scour (Grind) Test (Flexion-Adduction Test):** The hip scour test is used
to assess for hip pathology. The patient lies supine, and the examiner flexes
and adducts the hip so that it faces the opposite shoulder. Resistance to
movement is felt. The examiner then takes the hip into abduction while
maintaining flexion. Any irregularities, pain, or apprehension during this
motion may indicate hip pathology, including femoroacetabular impingement
(FAI).
**Internal Rotation Overpressure (IROP) Test:** In the IROP test, the patient is
supine with the hip held in 90° flexion, with the knee also at 90°. The examiner
rotates the hip medially while stabilizing the knee and pelvis. Resisted range of
motion, pain, or an abnormal end feel during this test may suggest hip
pathology.
**Lateral FABER (Flexion, Abduction, and External Rotation) Test:** The lateral
FABER test is performed with the patient in the side-lying position. The
examiner holds the patient's upper leg while palpating over the hip joint. The
examiner passively takes the test hip through a wide abduction arc from
flexion to extension. Reproduction of pain during this maneuver indicates
possible intra-articular hip involvement.
These special tests provide additional diagnostic information when assessing

hip pathology, but they should be interpreted in conjunction with the patient's
history, clinical examination, and other relevant tests or imaging studies for a
comprehensive evaluation.
**Ligamentum Teres Test:** This test assesses the ligamentum teres in the hip
joint. The patient is in a supine position, and the examiner stands beside the
hip to be examined. The examiner passively flexes the patient's knee to 90°
and the hip to 70° while ensuring that the pelvis remains stable. The hip is then
abducted and adducted, creating maximum tension on the ligamentum teres.
If pain occurs during either medial or lateral rotation of the hip, the test is
considered positive, indicating possible ligamentum teres pathology.
**Log Roll (Passive Supine Rotation) Test:** The log roll test is used to assess
for intra-articular hip problems. The patient lies supine with both lower
extremities extended. The examiner passively rotates the femur medially and
laterally, comparing both hips. The test evaluates the rotational mobility of the
hip and can reveal limitations, pain, or irregularities in the hip joint. It can be
useful in identifying intra-articular hip pathology.
**McCarthy Hip Extension Sign:** This test is performed with the patient in
the supine position. The examiner extends the hip from flexion, first with
lateral rotation and then with medial rotation. The test is performed on both
hips, and reproduction of pain or a "pop" during the test may indicate hip
pathology, especially labral pathology. This test simulates the forces
experienced during normal walking.
**Nélaton’s Line:** Nélaton's Line is an imaginary line drawn from the ischial
tuberosity of the pelvis to the ASIS of the pelvis on the same side. If the greater
trochanter of the femur is palpated well above this line, it suggests a dislocated
hip or coxa vara. Comparing both sides helps assess for discrepancies.
**Patrick’s Test (FABER, "Figure-4," or Jansen’s Test):** In this test, the patient
lies supine, and the examiner places the foot of the patient's test leg on top of
the opposite knee, forming the "figure-4" position. The examiner then lowers
the test leg's knee toward the examining table. Pain experienced during the
test can indicate various pathologies, such as superolateral and lateral
femoroacetabular impingement (FAI) for lateral pain, iliopsoas or psoas
impingement for groin pain, ischiotrochanteric impingement for posterolateral
pain, or sacroiliac or lumbar involvement for posterior pain. A positive test is
indicated by pain provocation and the test leg's knee remaining above the
opposite straight leg.
These special tests are valuable tools in assessing hip pathology, helping to
identify specific issues within the hip joint or surrounding structures. They
should be used in conjunction with other clinical information and diagnostic
tests to provide a comprehensive evaluation of the hip.
Rotational deformities in the lower extremities can be present at various
levels, from the hip to the foot. These deformities may be caused by hereditary
factors or cultural habits. One way to assess rotational deformities in the lower
limbs is by examining the orientation of the patellae, which can provide clues
about the rotation of the femur or tibia. Specifically, if the patellae are
observed to be facing inward (squinting patellae), it suggests a possible medial
rotation of either the femur or the tibia.
Assessing rotational deformities is important in understanding lower limb

biomechanics and can have implications for gait and overall function.
Depending on the nature and severity of the deformity, interventions such as
physical therapy, orthotic devices, or surgical correction may be considered to
improve limb alignment and function.
Tests for hip impingement are important for diagnosing conditions like
femoroacetabular impingement (FAI), labral tears, and other hip joint
pathologies. These tests help assess the range of motion and reproduction of
symptoms associated with hip impingement. Here are some tests commonly
used to assess hip impingement:
1. **Anteroposterior Impingement Test:** This test assesses hip dysplasia,

SCFE, and FAI. The patient lies supine with the hip flexed to 90° and the
examiner medially rotates and adducts the hip. Pain is a positive sign, and the
test is performed at different degrees of hip flexion.
2. **Gear-Stick Sign:** This test checks for greater trochanter-pelvic

impingement. The patient lies on their side, and the examiner abducts the hip
in extension to assess for limited range of motion and symptoms. Flexing and
abducting the hip may improve abduction range and relieve symptoms.
3. **Impingement Provocation Test:** In this test, the patient lies supine with
legs extended, and the examiner lowers the test leg into hyperextension,
abduction, and lateral rotation with overpressure. Pain reproduction indicates
a positive test for a posterior labral tear.
4. **Ischiofemoral Impingement Test:** The patient is in a side-lying position,

and the examiner holds the patient's leg with slight hip flexion and knee
flexion. The examiner then extends, adducts, and laterally rotates the hip.
Reproduction of symptoms and a hard end feel suggest ischiofemoral
impingement.
5. **Lateral FADDIR (Flexion, Adduction, and Internal Rotation) Test:** The

patient is in a side-lying position, and the examiner supports the knee while
palpating the hip. The patient is asked to flex, adduct, and medially rotate the
leg. Reproduction of symptoms indicates a positive test for FAI.
6. **Lateral Rim Impingement Test:** In this test, the examiner stands beside
the patient while the hip is abducted without rotation. Lateral pain suggests
impingement of the femoral neck against the acetabular rim.
7. **Posteroinferior Impingement Test:** This test assesses global acetabular
overcoverage and femoral neck offset abnormalities. The patient lies supine
with the legs hanging free, and the examiner quickly rotates and abducts the
hip laterally. Deep-seated posterior groin or buttock pain suggests
posteroinferior impingement.
8. **Dynamic Internal (Medial) Rotation Impingement (DIRI) Test and Dynamic

External (Lateral) Rotation Impingement (DEXRIT) Test:** These tests involve
passive movements of the hip through abduction, medial rotation (DIRI), or
abduction, lateral rotation (DEXRIT) in a flexed hip position. Pain during these
movements indicates impingement.
9. **Squat Test:** In the presence of FAI, performing a full squat may cause
groin pain and decreased range of motion due to abnormal contact between
the femoral head and the acetabulum.
These tests help clinicians identify impingement-related issues in the hip joint
and assist in diagnosing specific hip pathologies. It's important to consider the
patient's symptoms and perform a comprehensive evaluation to make an
accurate diagnosis and determine appropriate treatment options.
Tests for labral lesions are crucial in diagnosing hip conditions that involve
damage to the acetabular labrum. Labral tears are often associated with
structural abnormalities like femoroacetabular impingement (FAI) and may
cause symptoms such as anterior groin pain, catching, clicking, or locking. Here
are some tests commonly used to assess labral lesions:
1. **Anterior Labral Tear Test (FADDIR):** This test is used to assess

anterosuperior impingement syndrome, anterior labral tears, and iliopsoas
tendinitis. The patient is in a supine position, and the examiner takes the hip
into full flexion, lateral rotation, and abduction before extending the hip with
medial rotation and adduction. A positive test is indicated by pain, the
reproduction of symptoms, or apprehension.
2. **External Rotation Test:** In this prone test with hips extended and the
knee flexed, the examiner takes the test leg into lateral rotation while applying
a posteroanterior force on the greater trochanter by extending the hip.
Anterior pain or a feeling of instability suggests an anterior labral lesion or
anterior instability.
3. **Flexion-Internal Rotation Test:** The patient lies supine with extended

legs. The examiner stands beside the hip to be tested and passively takes the
hip to 90° flexion while medially rotating it. Overpressure may be applied, and
a positive test is indicated by pain, locking, clicking, or catching.
4. **Posterior Labral Tear Test:** In the supine position, the examiner takes
the hip into full flexion, adduction, and medial rotation before extending the
hip with abduction and lateral rotation. A positive test is indicated by groin
pain, patient apprehension, or the reproduction of symptoms, with or without
a click.
5. **THIRD (The Hip Internal Rotation with Distraction) Test:** This test
involves the patient lying supine with the hip flexed to 90° and slightly
adducted. The hip is then medially rotated while the examiner applies a
downward compressive force (compression part) and traction (distraction
part). A positive test is characterized by greater pain during compression and
less pain during distraction.
These tests help assess the presence of labral tears and other hip conditions
that may contribute to symptoms. Accurate diagnosis is crucial for determining
appropriate treatment options for patients with hip labral lesions.
Tests for femoral neck stress fractures are important for diagnosing this
potentially serious hip injury. Here are some tests used to assess femoral neck
stress fractures:
1. **Fulcrum Test of the Hip:** This test is used to assess the possibility of a
stress fracture in the femoral shaft. The patient sits with their knees bent over
the end of a bed, and the examiner places an arm under the patient's thigh to
act as a fulcrum. Gentle pressure is applied to the dorsum of the knee with the
examiner's opposite hand, moving from distal to proximal along the thigh. If a
stress fracture is present, the patient may experience sharp pain and
apprehension when the fulcrum arm is under the fracture site. Confirmation of
the diagnosis typically requires a bone scan.
2. **Heel-Strike Test:** In this test, the patient is in a supine position, and the
examiner firmly strikes the heel to simulate heel strike during walking. Pain in
the groin can be suggestive of a femoral neck stress fracture. Performing a
single-leg hop may have a similar effect, with a positive test showing pain in
the groin.
3. **Patellar-Pubic Percussion Sign:** This test involves the patient lying

supine with extended legs. The examiner places the bell of a stethoscope over
the symphysis pubis and then percusses each patella with a finger, starting
with the uninvolved side. Both sides are compared for differences in pitch and
loudness. Normally, the sounds should be equal. If there is bone pathology,
such as a hip fracture, the affected side may produce a duller sound. This test
has been effective in identifying various fractures, including femoral fractures.
These tests help assess for femoral neck stress fractures and other hip injuries
that may present with similar symptoms. Early diagnosis and appropriate
management are crucial for preventing complications associated with femoral
neck stress fractures.
These are various pediatric tests for hip pathology, particularly focusing on
developmental dysplasia of the hip (DDH) or congenital hip dysplasia, which is
a condition where the hip joint doesn't form properly in infants. Early
detection is crucial for effective management. Here are some of the tests:
1. **Abduction Test (Hart's Sign):** Infants with DDH may show asymmetry or
limited movement when both legs are passively abducted while lying supine
with hips and knees flexed to 90°. This test is used to assess for hip dysplasia.
2. **Barlow's Test:** This test is used to evaluate infants for hip dislocation.
With the infant lying supine, the examiner flexes the hips to 90° and fully flexes
the knees. Each hip is assessed individually, with the examiner's fingers over
the greater trochanter. By applying pressure, the examiner checks for any
slipping or dislocation of the femoral head into the acetabulum.
3. **Galeazzi Sign (Allis or Galeazzi Test):** This test is used to assess unilateral
DDH in infants aged 3 to 18 months. The infant lies supine with hips and knees
flexed to 90°. A positive test is indicated if one knee appears higher than the
other.
4. **Ortolani's Sign:** This test helps determine if an infant has DDH. The
examiner flexes the hips and gently abducts the thighs, applying pressure to
the greater trochanters. Resistance to abduction and a palpable click or jerk
can indicate a positive test, suggesting the hip has reduced into the
acetabulum.
5. **Telescoping Sign (Piston or Dupuytren's Test):** This test is used to assess

dislocated hips in infants. The examiner flexes the infant's knee and hip to 90°
and then pushes the femur down onto the table before lifting the leg away.
Excessive movement or telescoping of the femur suggests hip dislocation.
These tests are important for detecting hip pathology, particularly DDH, in
newborns and infants. Early identification and intervention can help prevent
long-term hip problems and improve outcomes.
The assessment of leg length discrepancies is crucial in diagnosing and
managing various musculoskeletal conditions. Leg length discrepancies can be
categorized into true leg length discrepancies, which result from structural
changes in the lower limbs, and functional leg length discrepancies, which
occur due to compensatory mechanisms.
**True Leg Length Discrepancy:**

True leg length discrepancy is caused by anatomic or structural changes in the
lower limbs. This can result from congenital maldevelopment, trauma, or other
bony abnormalities. Here are some considerations for assessing true leg
length:
1. **Proper Alignment:** Ensure that the pelvis is set square, level, or in

balance with the lower limbs before measuring leg length. The lower limbs
should be parallel and about 15 to 20 cm (4 to 8 inches) apart.
2. **Measurement Points:** Leg length is typically measured from the anterior

superior iliac spine (ASIS) to either the medial or lateral malleolus. Measuring
to the lateral malleolus is less likely to be affected by muscle bulk.
3. **Thumb Technique:** To measure leg length, use your thumb to press the
tape measure firmly against the ASIS and the medial or lateral malleolus.
Ensure that the legs are in comparable positions relative to the pelvis to
prevent measurement errors.
4. **Normal Variation:** A slight difference (up to 1 to 1.5 cm) in leg length is

considered normal. However, even small differences can potentially lead to
symptoms.
5. **Weber-Barstow Maneuver:** This visual method involves comparing the

positions of the medial malleoli with the patient lying supine, hips and knees
flexed, and then lifting the pelvis. Different levels of malleoli indicate leg length
asymmetry.
**Functional Leg Length Discrepancy:**

Functional leg length discrepancy results from compensation for changes that
may have occurred due to positioning or other factors. These are some
considerations for assessing functional leg length:
1. **Pelvic Tilt and Compensation:** Apparent shortening or functional

shortening of the leg may occur due to adaptations the patient has made in
response to pathology or contracture somewhere in the spine, pelvis, or lower
limbs. A lateral pelvic tilt is often observed.
2. **Measurement Technique:** When assessing functional shortening,

measure the distance from the tip of the xiphisternum or umbilicus to the
medial malleolus.
3. **Caution:** Be aware that measurements for functional leg length

discrepancies can be affected by factors such as muscle wasting, obesity,
asymmetric positions of anatomical landmarks (xiphisternum or umbilicus), or
asymmetric positioning of the lower limbs.
It's essential to distinguish between true and functional leg length

discrepancies to guide appropriate treatment and interventions for patients
with musculoskeletal issues.
Assessing standing (functional) leg length is an important clinical evaluation for
detecting potential issues related to leg length discrepancies, sacroiliac joint
dysfunction, or muscle imbalances. Here's a step-by-step guide on how to
perform this assessment:
**1. Initial Assessment:**

- Ask the patient to stand in a relaxed stance with their feet together.
- Begin by palpating the Anterior Superior Iliac Spines (ASIS) and Posterior
Superior Iliac Spines (PSIS) on both sides of the pelvis.
- Note any asymmetry or differences in height between the ASIS and PSIS.
This initial assessment can provide valuable information about potential leg
length discrepancies or pelvic asymmetry.
**2. Symmetric Stance:**

- Next, instruct the patient to assume a symmetric stance:
- Ensure that the patient's feet are hip-width apart, with the toes facing
straight ahead.
- The knees should be fully extended.
- The subtalar joint (located in the ankle) should be in a neutral position.
**3. Reassessment:**
- While the patient maintains this symmetric stance, reevaluate the ASIS and
PSIS for any remaining asymmetry.
- Pay close attention to any differences in height or position between these
landmarks.
- If differences are still noticeable in this stance, it suggests a functional leg
length discrepancy or other issues.
**4. Interpretation:**
- Differences in ASIS and PSIS height in a relaxed stance that persist in a
symmetric stance may indicate functional leg length discrepancies.
- Functional leg length discrepancies can result from issues such as sacroiliac
joint dysfunction or muscular imbalances, particularly involving the gluteus
medius or quadratus lumborum muscles.
- Further assessment and diagnostic tests may be needed to determine the
underlying cause of the functional leg length difference and guide appropriate
treatment.
**5. Additional Evaluation:**

- To pinpoint the specific cause, consider conducting tests and assessments
for sacroiliac joint dysfunction and muscle imbalances.
- Assessment of gait, posture, and range of motion in the lower limbs and
pelvis can also provide valuable information.
It's essential to perform a thorough evaluation and consider all potential

contributing factors when assessing standing leg length, as this information can
guide appropriate interventions and treatment plans for patients with
musculoskeletal issues.
Here are several tests for muscle tightness or pathology in the hip and thigh
region:
**1. Abduction Contracture Test:**

- Purpose: To assess the length of the abductor muscles (gluteus medius and
minimus).
- Procedure: The patient lies supine with the ASISs level. If a contracture is
present, the affected leg forms an angle of more than 90° with a line joining
each ASIS.
- Interpretation: A positive test indicates tightness in the abductor muscles.
**2. Active Piriformis Stretch Test:**
- Purpose: To assess the piriformis muscle's involvement in hip symptoms.
- Procedure: The patient is in the side-lying position with the hip flexed and
the foot resting on the examining table. The patient actively abducts and
laterally rotates the leg while resistance is applied at the knee.
- Interpretation: A positive test reproduces the patient's neurological
symptoms, suggesting piriformis muscle or obturator internus/gemelli complex
involvement.
**3. Adduction Contracture Test:**

- Purpose: To assess the length of the adductor muscles.
- Procedure: The patient lies supine with the ASISs level. A contracture is
indicated if the affected leg forms an angle of less than 90° with the line joining
the two ASISs.
- Interpretation: A positive test indicates tightness in the adductor muscles.
**4. Adductor Squeeze Test (Fist Squeeze Test):**

- Purpose: To assess for adductor pathology.
- Procedure: The patient is supine with hips flexed to 45° and knees at 90°.
The examiner places a fist (or a dynamometer) between the knees and asks the
patient to squeeze.
- Interpretation: Reproduction of patient's pain indicates adductor pathology.
**5. Beatty’s Test or Maneuver:**

- Purpose: To assess for piriformis pathology.
- Procedure: The patient is in the side-lying position with the test leg
uppermost and flexed. The patient lifts the flexed knee off the table.
- Interpretation: Buttock pain during the test is a positive sign of piriformis
pathology.
**6. Bent-Knee Stretch Test for Proximal Hamstrings:**

- Purpose: To assess for hamstring tightness near the ischial origin.
- Procedure: The patient lies supine, and the examiner maximally flexes the
hip and knee of the test leg. The knee is then slowly extended.
- Interpretation: Pain in the hamstrings at the ischial origin indicates a
positive test.
**7. Eccentric Hip Flexion:**

- Purpose: To assess for iliopsoas snapping.
- Procedure: The patient lies supine and actively lifts the lower extremity into
full hip flexion with full knee extension. The patient then eccentrically slowly
lowers the leg to the table.
- Interpretation: A click, clunk, or pain during this test may indicate iliopsoas
snapping.
**8. Ely’s Test (Tight Rectus Femoris, Method 2):**

- Purpose: To assess rectus femoris muscle tightness.
- Procedure: The patient lies prone, and the examiner passively flexes the
patient’s knee.
- Interpretation: If the hip on the same side spontaneously flexes during knee
flexion, it indicates tight rectus femoris.
**9. External De-rotation Test:**

- Purpose: To differentiate between greater trochanteric pain syndrome
(GTPS) and osteoarthritis.
- Procedure: The patient is supine, and resistance is applied during hip lateral
rotation.
- Interpretation: Lateral hip pain may suggest GTPS, while groin pain may
indicate osteoarthritis.
**10. Freiberg’s Maneuver:**

- Purpose: To assess for piriformis muscle tightness or strain.
- Procedure: The patient is prone, and the examiner rotates the hip medially
with the thigh extended.
- Interpretation: Buttock pain or tenderness in the sciatic notch suggests
piriformis muscle involvement.
These tests are valuable for assessing muscle tightness, contractures, or

pathologies in the hip and thigh region, helping clinicians diagnose and plan
appropriate interventions for patients with musculoskeletal issues.
Here are additional tests for assessing hip and thigh function, tightness, and
pathology:
**11. Hip Lag Sign:**

- Purpose: To test the hip abductors, specifically the gluteus medius.
- Procedure: The patient is in the side-lying position. The examiner passively
abducts and medially rotates the extended leg to about 45° and asks the
patient to actively hold the position for 10 seconds.
- Interpretation: A positive test occurs if the leg drops more than 10 cm or if
medial rotation decreases, indicating a gluteus medius tear.
**12. Lateral Step-Down Maneuver (Pelvis Drop Test):**

- Purpose: To assess hip and pelvic stability and the strength of lateral
rotators.
- Procedure: The patient stands on a stool or step with one foot and slowly
lowers the non-weight-bearing leg to the floor.
- Interpretation: Deviations in arm position, trunk inclination, hip adduction,
or medial rotation suggest hip or lateral rotator weakness.
**13. Long-Stride Heel-Strike Test:**

- Purpose: To assess for ischial pain.
- Procedure: The patient takes a long stride forward, ensuring the heel strikes
the ground firmly.
- Interpretation: Ischial pain upon heel strike is considered a positive test.
**14. 90–90 Straight Leg Raising Test (Hamstring Contracture Test):**

- Purpose: To assess hamstring flexibility.
- Procedure: The patient lies supine with hips flexed to 90° and knees bent.
The patient actively extends each knee.
- Interpretation: Knee extension should be within 20° of full extension. Less
than 125° is indicative of tight hamstrings.
**15. Gluteus Maximus Length Test:**

- Purpose: To assess gluteus maximus tightness.
- Procedure: The patient assumes the same starting position as the hamstring
contracture test. The examiner flexes the hip with the knee flexed.
- Interpretation: If the ASIS moves up before the thigh reaches the trunk, it
indicates tight gluteus maximus.
**16. Gluteus Strength Tests:**

- Purpose: To assess the strength of gluteus muscles.
- Procedure:
- Gluteus Maximus: The patient is placed prone with the hip straight and
the knee flexed to 90°. The patient extends the hip while the examiner resists.
- Gluteus Medius and Minimus: The patient is in the side-lying position, and
the examiner stabilizes the pelvis while the patient abducts the leg against
resistance.
- Interpretation: Weakness or inability to perform the actions may suggest
gluteal muscle weakness.
**17. Noble Compression Test:**

- Purpose: To diagnose iliotibial band friction syndrome near the knee.
- Procedure: The patient lies supine with the knee flexed to 90° and the hip
flexed. Pressure is applied to the lateral femoral epicondyle while the patient
extends the knee.
- Interpretation: Severe lateral femoral condyle pain at approximately 30° of
flexion suggests iliotibial band friction syndrome.
**18. Ober’s Test:**

- Purpose: To assess the iliotibial band, gluteus medius, minimus, and hip
joint capsule for contracture.
- Procedure: The patient is in the side-lying position, and the examiner
passively abducts and extends the patient’s upper leg with the knee straight.
- Interpretation: A contracture is indicated if the leg remains abducted and
does not fall to the table.
**19. Pace’s (Pace and Nagle) Maneuver:**

- Purpose: To test for piriformis strain.
- Procedure: The patient is seated and asked to abduct both legs as far as
possible.
- Interpretation: Pain on contraction indicates a piriformis strain.
**20. Phelps’ Test:**

- Purpose: To assess for gracilis muscle contracture.
- Procedure: The patient lies prone with the knees extended. The examiner
passively abducts the patient’s legs as far as possible, and then the knees are
flexed to 90°.
- Interpretation: If abduction increases when the knees are flexed, it suggests
contracture of the gracilis muscle.
These tests are valuable for diagnosing various hip and thigh conditions,
including muscle tightness, weakness, and potential pathologies, aiding in the
development of effective treatment plans.
Here are additional tests related to hip and thigh assessments:
**21. Piriformis (Flexion, Adduction, and Internal Rotation - FAIR) Test:**

- Purpose: To assess for piriformis syndrome (DGS) where the sciatic nerve
may pass through the piriformis muscle.
- Procedure: The patient is in the side-lying position with the test leg
uppermost. The patient flexes the test hip to 60° with the knee flexed and the
leg slightly rotated medially (FAIR position). The examiner applies downward
pressure to the knee.
- Interpretation: Pain in the piriformis muscle or neurologic pain in the
buttock and sciatica may suggest piriformis syndrome.
**22. Prone-Lying Test for Iliotibial Band Contracture:**

- Purpose: To assess iliotibial band contracture, more commonly done in
children.
- Procedure: The patient lies prone, and the examiner holds the ankle of the
test leg, abducting it at the hip while applying pressure to the buttock on the
same side. The hip is kept in neutral rotation with the knee flexed to 90°.
- Interpretation: A firm end feel during adduction is compared to the other
side.
**23. Puranen-Orava Test:**

- Purpose: To assess hip flexion contracture.
- Procedure: The patient stands about 2 to 3 feet from an examining table,
flexes one hip to 90°, and attempts to extend the knee.
- Interpretation: A difference in knee angle compared to the opposite side
suggests hip flexion contracture.
**24. Rectus Femoris Contracture Test (Kendall Test):**

- Purpose: To assess rectus femoris contracture.
- Procedure: The patient lies supine with knees bent over the edge of the
table, flexes one knee onto the chest, and maintains it at 90° while the
opposite knee is flexed to the chest.
- Interpretation: Lack of maintaining 90° knee flexion suggests a contracture.
**25. Seated Piriformis Stretch Test:**

- Purpose: To stretch the piriformis and assess deep hip rotators.
- Procedure: The patient is seated, and the examiner extends the knee (to
stretch the sciatic nerve) while passively moving the flexed hip into adduction
and medial rotation.
- Interpretation: Pain at the level of the piriformis may indicate a positive
test.
**26. Sign of the Buttock:**
- Purpose: To identify lesions in the buttock or hip.
- Procedure: After a straight leg raising test, if there is limitation, the
examiner flexes the patient’s knee to see if further hip flexion can be obtained.
- Interpretation: If hip flexion does not increase, it suggests a lesion in the
buttock or hip.
**27. "Taking off the Shoe" Test (TOST):**

- Purpose: To assess biceps femoris strain or greater trochanteric pain.
- Procedure: The patient stands and removes the shoe on the affected side
using the heel of that foot.
- Interpretation: Sharp pain in the biceps femoris during the maneuver may
indicate muscle strain or pain in the greater trochanter.
**28. Thomas Test:**

- Purpose: To assess hip flexion contracture.
- Procedure: The patient lies supine, and the examiner checks for lordosis.
One hip is flexed to 90° with the knee to the chest, and the other knee is flexed
to the chest.
- Interpretation: If the straight leg rises off the table, it suggests hip flexion
contracture.
**29. Tightness of Hip Rotators:**

- Purpose: To assess the tightness of medial and lateral hip rotators.
- Procedure: The patient is placed in the supine position with the hip and
knee flexed to 90°. Medial rotation and lateral rotation are tested separately.
- Interpretation: Reduced rotation and muscle stretch end feel suggest tight
rotators.
These tests help assess various hip and thigh conditions, including
contractures, muscle tightness, and potential pathologies, providing valuable
information for diagnosis and treatment planning.
The text you provided contains information about several tests and
assessments related to hip and thigh evaluation. Let's summarize the key
points:
**Trendelenburg Sign:**
- Purpose: Assess the stability of the hip and the ability of hip abductors to
stabilize the pelvis on the femur.
- Procedure: Patient stands on one leg and holds the position for 6 to 30
seconds. Normally, the pelvis on the opposite side should rise.
- Interpretation: A positive test (pelvis dropping on the non-stance side)
suggests a weak gluteus medius or an unstable hip on the stance side.
**Tripod Sign (Hamstring Contracture Test):**

- Purpose: Assess hamstring muscle tightness.
- Procedure: Patient is seated with both knees flexed to 90° over the edge of
the table. One knee is passively extended. If the hamstring muscles are tight,
the patient extends the trunk to relieve tension.
- Interpretation: Extension of the spine is indicative of a positive test. It can
also indicate nerve root problems.
**Femoral Nerve Tension (Prone Knee Bending) Test:** For evaluating femoral
nerve tension, refer to Chapter 9.
**Timed "Up and Go" (TUG) Test:**

- Purpose: Assess mobility and fall risk.
- Procedure: The patient rises from a seated position, walks 3 meters, turns,
and returns to the seat while being timed.
- Interpretation: Taking more than 24 seconds to complete the task is
considered a positive test and predicts a higher risk of falls within 6 months of
hip fracture surgery.
**Reflexes and Cutaneous Distribution:**

- Dermatomal patterns and sensory distribution of peripheral nerves should be
assessed.
- Sensation is checked by running hands and fingers over the pelvis and legs
anteriorly, posteriorly, and laterally, noting any differences in sensation.
- True hip pain may be referred to the groin, ankle, knee, lumbar spine, or
sacroiliac joints. In children with hip issues, sensory symptoms may manifest in
the knee. Conversely, pain from the knee, sacroiliac joints, or lumbar spine
may refer to the hip.
**Table 11.16: Muscles of the Hip and Referral Patterns:** This table likely
provides information about various hip muscles and their corresponding
referral patterns if injured, but the details are not provided in the text you
provided.
These assessments and tests are valuable for evaluating hip and thigh
conditions, assessing muscle tightness, and identifying potential issues related
to stability, mobility, and neurological function in the hip region. They provide
essential information for diagnosis and treatment planning.
The text provides information about peripheral nerve injuries around the hip,
including the nerves affected, potential causes, and symptoms associated with
these injuries. Here's a summary:
**Pudendal Nerve (L2 to S4):**
- Main nerve of the perineum, providing sensation to the external genitalia and
perineum, and innervating some pelvic muscles.
- Injury can lead to numbness in the pelvic floor and genitals, making sitting
painful.
- Compression may occur between the piriformis and coccygeus muscles in the
gluteal region near the ischial spine.
**Sciatic Nerve (L4 to S3):**

- Commonly injured nerve in the hip region, with potential injuries along its
path from the lumbosacral spine down the leg to the knee.
- Injuries in the pelvis or upper femoral area (e.g., posterior hip dislocation) can
affect hamstrings and muscles below the knee, causing a high steppage gait,
inability to stand on the heel or toes, sensory alterations, and muscle atrophy.
- Piriformis muscle compression (piriformis syndrome) can result in pain and
weakness during hip abduction and lateral rotation.
- Symptoms may include burning pain, hyperesthesia, and pain in the sacral,
gluteal, and sciatic nerve distribution.
**Superior Gluteal Nerve (L4 to S1):**

- Compression may occur between the piriformis and the inferior border of the
gluteus minimus or during hip surgery.
- Symptoms include acute gluteal pain, hip medial rotation, and weakness in
hip abduction, leading to a Trendelenburg gait.
- Tenderness may be palpated just lateral to the greater sciatic notch.
**Femoral Nerve (L2 to L4):**

- Less commonly injured but may be compressed during childbirth, anterior
femoral dislocation, hernia surgery, hip surgery, or fractures.
- Symptoms include an inability to flex the thigh on the trunk, extend the knee,
and loss of the deep tendon knee reflex.
- Quadriceps wasting is evident, and sensory loss affects the medial aspect of
the distal thigh and the medial aspect of the leg and foot.
**Obturator Nerve (L2 to L4):**

- Compression can occur as the nerve leaves the pelvis and enters the leg, in
areas like the obturator tunnel or canal, obturator externus tunnel, or deep
fascial plane.
- Causes of injury include surgery, pregnancy, hemorrhaging, fascial
entrapment, fractures, or tumors.
- Symptoms include impaired hip adduction, knee flexion, and hip lateral
rotation.
- Sensory deficits affect a small area in the middle medial part of the thigh.
- Repetitive extension and lateral leg movement may worsen the condition,
leading to abnormal hip position during ambulation.
**Vascular Considerations:**
- The text suggests checking vascular pulses, including the popliteal, posterior
tibial, and dorsalis pedis pulses, to assess the vascular system's integrity when
nerve-related symptoms are present.
This information helps in understanding potential nerve injuries and their

associated symptoms around the hip, aiding in diagnosis and appropriate
management.
The text provides information about joint play movements of the hip, which
are typically assessed with the patient in the supine position. These
movements help evaluate the hip joint's mobility and stability. Here's a
summary of the joint play movements for the hip:
**1. Caudal Glide (Long Leg Traction or Long-Axis Extension):**
- The examiner places both hands around the patient's leg slightly above the
ankle.
- The examiner leans back, applying a long-axis extension (traction) to the
entire lower limb.
- Part of the movement occurs in the knee.
- If knee pathology is suspected or the knee is stiff, the hands can be placed
around the thigh just proximal to the knee, and traction force can be applied.
- Excessive telescoping or movement in the hip joint during this maneuver
may indicate an unstable joint or ligament laxity.
**2. Compression:**
- The examiner places the patient's knee in the resting position.
- A compressive force is applied to the hip through the longitudinal axis of the
femur by pushing through the femoral condyles.
- The normal end feel is hard, and there should be no pain.
**3. Lateral Distraction:**

- A lateral distraction force is applied to the hip.
- The examiner places a wide strap around the patient's leg as high up in the
groin as possible.
- The strap is then wrapped around the examiner's buttocks.
- The examiner leans back, using the buttocks to apply the distraction force
to the hip.
- The proximal hand is used to palpate hip or greater trochanter movement,
while the distal hand prevents abduction of the leg and torque to the hip.
These joint play movements help assess the hip joint's range of motion,
stability, and the presence of any abnormal or excessive motion that may
indicate joint or ligament issues. Comparing the movements on both sides can
provide valuable diagnostic information.
In anterior palpation of the hip, several structures and areas are assessed for
tenderness and signs of pathology. Here's a summary of the key points
mentioned in the text:
**1. Iliac Crest, Greater Trochanter, and Anterosuperior Iliac Spine (ASIS):**
- The iliac crests should be palpated for tenderness.
- The iliac tubercle is located along the lateral aspect of the iliac crest.
- ASIS is checked for any tenderness.
- The greater trochanter is located approximately 10 cm (4 inches) distal to
the iliac tubercle and should be palpated for tenderness.
**2. Trochanteric Bursae:**

- About 20 bursae are located around the greater trochanter.
- Swelling or tenderness in these bursae may indicate conditions like
trochanteric bursitis (GTPS).
**3. Gluteal Muscles and Tendons:**

- The gluteus medius and minimus muscles are palpated for tenderness,
which may indicate gluteal tendinopathy.
- Tenderness in the tensor fascia lata or iliotibial band may also be assessed.
**4. Inguinal Ligament and Femoral Triangle:**

- Palpation continues along the inguinal ligament to the pelvic tubercles
(symphysis pubis).
- The psoas bursa may be palpable under the inguinal ligament if swollen.
- The femoral triangle is defined by the inguinal ligament, sartorius muscle,
and adductor longus muscle.
- The examiner may check for swollen lymph glands and the femoral artery
within the femoral triangle.
- Signs of an inguinal hernia may be assessed in males.
**5. Hip Joint and Head of the Femur:**

- The hip joint itself is deep and not easily palpable.
- The head of the femur is located 1 to 2 cm below the middle third of the
inguinal ligament and can be palpated.
- Surrounding structures may show signs of pathology even if the hip joint is
not directly palpable.
**6. Palpation of Hip Flexor, Adductor, Abductor, and Rectus Abdominus

Muscles:**
- Hip flexors, adductors, abductors, and rectus abdominus muscles are
palpated for signs of tenderness and muscle pathology.
- Palpation can be performed while the patient does resisted contractions.
These palpation techniques help assess various structures around the hip for
tenderness and signs of underlying conditions, providing valuable diagnostic
information.
In posterior palpation of the hip and surrounding structures, the examiner
assesses various anatomical landmarks and tissues for tenderness and signs of
pathology. Here's a summary of the key points mentioned in the text:
**1. Iliac Crest, Posterosuperior Iliac Spine (PSIS), and Ischial Tuberosity:**
- Palpation begins by following the iliac crests posteriorly to the PSIS.
- The gluteal muscles (maximus, medius, and minimus) and sacroiliac joint
can be palpated along the way.
- Ischial tuberosities, located approximately at the level of the gluteal folds,
are palpated.
- The ischial bursa may be palpable over the ischial tuberosities if swollen.
- Tenderness of the hamstring muscle insertions at the ischial tuberosities is
assessed.
**2. Greater Trochanter and Sciatic Nerve:**

- The posterior aspect of the greater trochanter is palpated laterally.
- The distance between the ischial tuberosity and greater trochanter is
divided in half, placing the fingers over the sciatic nerve's pathway into the
lower limb.
- While the sciatic nerve is typically not palpable, the examiner can assess the
posterior muscles that insert into the greater trochanter (lateral rotators).
- Palpation may also be done about 1 to 1.5 inches (2.5 to 3.8 cm) below the
PSIS and just lateral to the lateral edge of the sacrum.
- Tenderness of the lateral rotators, especially the piriformis muscle, is
checked.
- Gluteal and hamstring muscle bellies are palpated for signs of pathology.
**3. Sacroiliac, Lumbosacral, and Sacrococcygeal Joints:**

- Palpation of these joints is performed if there are suspicions of pathology.
- Detailed descriptions of their palpation can be found in Chapters 9 and 10.
Posterior palpation helps the examiner assess the condition of the hip and
surrounding structures for tenderness, muscle tone, and signs of underlying
issues, providing valuable diagnostic information.
This passage discusses the diagnostic imaging and radiographic views used to
assess the hip joint. Here are the key points mentioned:
**Common X-Ray Views of the Hip Depending on Pathology:**

1. Anteroposterior view of the hip.
2. Lateral view (cross table, only affected hip).
3. Lateral axial ("frog-leg") view.
4. Anteroposterior view of both hips and pelvis.
5. Anteroposterior oblique view.
6. Anteroposterior internal (medial) rotation view.
**What to Look for in Plain Radiographs:**

1. Assess the neck-shaft angle, femoral head uncovering, and head-teardrop
distance for abnormalities like pistol-grip deformity.
2. Examine joint spaces, pelvic lines, and landmarks.
3. Check for bone diseases such as Legg-Calvé-Perthes disease, bony cysts, or
tumors.
4. Evaluate the neck-shaft angle, coxa vara, or coxa valga.
5. Observe the shape of the femoral head, which can show changes in
conditions like DDH, Legg-Calvé-Perthes disease, SCFE, and FAI.
6. Ensure the obturator foramen is symmetrical.
7. Measure the distance from the symphysis pubis to the tip of the coccyx.
8. Look for coxa profunda or coxa protrusion.
9. Check for protrusio acetabuli.
10. Assess acetabular anteversion or retroversion using signs like the crossover
sign and posterior wall sign.
11. Verify the position of the femoral head and its distance from the ilioischial
line.
12. Confirm femoral head and acetabular congruency.
13. Examine both femoral heads and acetabula for signs of dysplasia.
14. Calculate the femoral head extrusion index.
15. Check for osteophytes and signs of arthritis.
16. Assess Shenton's line for its normal curvature.
17. Measure the acetabular (Tonnis) angle or index.
18. Examine the lateral central edge angle.
19. Look for evidence of femoroacetabular impingement (FAI).
20. Detect any signs of fracture or dislocation.
21. Assess pelvic distortion or counterrotation of the ilia.
22. Ensure Hilgenreiner's and Perkins' lines are within normal limits.
23. Observe the "sagging rope" sign in Legg-Calvé-Perthes disease.
24. Check for the "teardrop" sign indicating femoral head migration in
conditions like osteoarthritis.
25. **"Head at risk" signs:** These are signs observed in Legg-Calvé-Perthes
disease on an anteroposterior film. They include the Cage sign, calcification
lateral to the epiphysis, lateral subluxation of the head, an angle of the
epiphyseal line, and metaphyseal reaction. Patients with three or more of
these signs often have a poor prognosis and may require surgery.
26. **Signs of an SCFE (Slipped Capital Femoral Epiphysis):** An SCFE is

characterized by various x-ray signs, including a widened epiphyseal line,
lipping or stepping, non-transecting superior femoral neck line, and disrupted
Shenton's line. These signs may indicate this hip disorder.
27. **Shoemaker's Line:** Normally, lines projected from the greater

trochanter to the ASIS should intersect at or above the umbilicus. If they
intersect below or are off-center, it could indicate femoral neck fracture,
upward dislocation of one femur, or malalignment.
28. **Lateral Coverage Index (LCI):** Used to determine hip dysplasia, it is

calculated as the center-edge (CE) angle minus the acetabular inclination.
29. **Acetabular Coverage:** The lateral center-edge (LCE) angle, anterior LCE
angle, acetabular inclination (Tönnis angle), and acetabular index are used to
assess acetabular coverage of the femoral head. These measurements help
diagnose acetabular dysplasia.
30. **FAI (Femoroacetabular Impingement) Diagnosis:** Different types of

FAI, including cam and pincer types, can be diagnosed based on various factors
like the alpha angle, pistol-grip deformity, acetabular index, and more.
31. **Acetabular Orientation:** The orientation of the acetabulum can affect

hip stability. Retroverted acetabulum and anteverted acetabulum or femoral
neck can lead to different types of instability.
32. **Osteopenia:** Osteopenia may not be visible on plain films until there is
a significant (40%) loss in bone mineral density.
33. **Signs of Joint Effusion:** Joint effusion in the hip can be indicated by
lateral subluxation of the femoral head, absence of a vacuum effect, and
demineralization of subchondral bone.
Additionally, various radiographic views are mentioned, such as the Cross-
Table Lateral View for measuring head-neck offset, False-Profile Hip
Radiograph for the anterior CE angle, and the Lateral (Axial "Frog-Leg") View
for assessing femoral head and neck position, pelvic distortion, and slipping of
the femoral head.
These imaging techniques and measurements help diagnose and assess

different hip conditions and provide valuable information for treatment
decisions.
Arthrography is used in cases where the hip cannot be reduced following a

dislocation. It can help identify issues like an inverted limbus or an hourglass
configuration due to a contracted capsule. It's also useful in developmental hip
dysplasia (CDH) to visualize the position of the unossified femoral head relative
to the labrum. A normal hip arthrogram provides a baseline for comparison.
Diagnostic Ultrasound Imaging is an effective method for evaluating the hip. It

can visualize various intra- and extraarticular structures, including the femoral
head, neck, acetabulum, joint recess, labrum, iliopsoas, and surrounding
tendons, arteries, and nerves. Ultrasound is particularly helpful for assessing
soft tissue abnormalities.
**Anterior Hip:** The ultrasound examination begins with the patient supine,
and the transducer is positioned along the femoral neck's long axis, allowing
clear visualization of the femoral head, neck, and acetabulum. The anterior
joint recess and labrum are also assessed for any signs of swelling or
abnormalities.
**Lateral Hip:** For lateral hip examination, the patient rolls onto the
contralateral hip, and the transducer is placed over the greater trochanter. This
view allows visualization of the anterior and lateral facets, gluteus minimus,
and gluteus medius tendons.
**Posterior Hip:** The posterior hip examination involves assessing the sacral
foramen, sacroiliac joint, and piriformis tendon. The piriformis tendon's
movement during passive hip rotation can also be observed.
Computed Tomography (CT) is particularly valuable for evaluating bony

abnormalities in the hip. It can assess conditions like femoral anteversion,
retroversion, acetabular size and shape, and the position of the femoral head
relative to the acetabulum. CT is often used for assessing femoroacetabular
impingement (FAI). However, in newborns, the lack of ossification limits its
use.
Magnetic Resonance Imaging (MRI) is highly effective for studying the hip as it
can visualize both soft tissue and osseous structures. It can detect various soft
tissue abnormalities, including labral and cartilage lesions, bursitis,
ligamentous teres lesions, and tendon abnormalities, along with osseous
conditions such as osteonecrosis and femoral neck stress fractures. MRI is
often used to evaluate congenital hip abnormalities and unexplained hip pain.
It's essential to correlate MRI findings with clinical symptoms, as hip
abnormalities can be present in asymptomatic individuals.
Scintigraphy, or bone scanning, may be employed to diagnose stress fractures,

necrosis, and tumors in the hip region. It can be a valuable tool for identifying
certain pathologies.
These diagnostic imaging techniques play essential roles in assessing and

diagnosing various hip conditions, allowing healthcare providers to make
informed decisions about treatment and management.

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Hip Magee by Devasya Dodia

Forces on the Hip:- Forces exerted on the hip depend on activity:

Hip Joint Positions:

Hip Joint Kinematics:

Weight-Bearing Scenario (Pelvis Moving on a Stationary Femur):

Non-Weight Bearing Scenario (Femur Moving on the Pelvis):

2. Mechanism of Injury (if applicable):

3. Details of Present Pain and Symptoms:

4. Improvement or Worsening of Condition:

5. Activity and Pain Relationship:

6. Weakness or Abnormal Movements:

7. Patient's Usual Activity or Pastime:

8. Past Medical and Surgical History:

2. Muscle Tightness and Weakness:

5. Proper Standing Position:

7. Limb Position and Symmetry:

8. Skin and Scar Examination:

9. Dynamic Gait Analysis:

10. Whole Kinetic Chain Consideration:

This comprehensive observation and assessment process help clinicians gather

3. Layered Approach to Assessment: Use a layered approach to assess various

7. Extra-Articular Impingement: Consider extra-articular impingement in the

8. IFI (Ischiofemoral Impingement): IFI occurs in the narrow space between

11. Differential Diagnosis: Consider the differential diagnosis of hip pain,

13. Examination Techniques: Use specific examination techniques, such as

This comprehensive examination process helps clinicians assess hip conditions

Different types of hip impingements and conditions:

1. Greater Trochanteric-Pelvic Impingement: This impingement is relatively

2. Coxa Valga and Femoral Anteversion: Coxa valga, characterized by a neck-

3. Hamstring Syndrome: Patients with hamstring syndrome, also known as

4. Deep Gluteal Syndrome (DGS): DGS includes conditions such as piriformis

5. Hip Abduction: Hip abduction is a normal movement ranging from 30° to

Understanding these different impingement conditions and syndromes is

This section continues to describe various aspects of hip examination, including

1. Hip Abduction Assessment: During hip abduction, various movement

2. Hip Adduction Assessment: Hip adduction typically has a normal range of

3. Rotational Movements: Rotational movements, including medial and lateral

4. Flexibility Testing - Bent-Knee Fall-Out Test: Flexibility of the hip can be

Understanding these assessment techniques is essential for diagnosing hip

This section discusses passive movements of the hip during a physical

2. **Types of Passive Hip Movements:** The passive movements of the hip

4. **Interpreting Pain during Passive Movements:** Pain experienced during

5. **Considerations for Pelvic Stability:** During passive hip movements, it is

6. **Systemic Evaluation:** In some cases, a systemic component may

1. **Purpose of Resisted Isometric Movements:** Resisted isometric

2. **Key Questions for Pelvic Control:** To evaluate pelvic control effectively,

3. **Types of Resisted Isometric Hip Movements:** The following resisted

4. **Muscle Testing and Compensatory Movements:** To ensure that the

5. **Testing the Adductors:** Delahunt et al. recommend testing the

6. **Identifying Muscle Involvement:** By carefully noting which resisted

7. **Additional Testing:** If the patient's history indicates that symptoms

8. **Considerations for Pain and Inflammation:** The examiner should be

Resisted isometric movements of the hip are valuable in assessing muscle

**Patient-Reported Outcome Measures:** Various numerical rating scales and

**Functional Strength and Endurance Testing:** Functional strength and

Overall, functional assessment of the hip is essential for understanding how

**4. Clinical Prediction Rule for Osteoarthritis:** Sutlive developed a clinical

**6. EQ-5D Questionnaire:** The EQ-5D questionnaire assesses a patient's

It's essential for healthcare professionals to select appropriate assessment

**Anterior Apprehension Test (Hyperextension–Lateral Rotation Test):** This

2. Types of Passive Hip Movements: The passive movements of the hip

4. Interpreting Pain during Passive Movements: Pain experienced during

5. Considerations for Pelvic Stability: During passive hip movements, it is

6. Systemic Evaluation: In some cases, a systemic component may

1. Purpose of Resisted Isometric Movements: Resisted isometric

2. Key Questions for Pelvic Control: To evaluate pelvic control effectively,

3. Types of Resisted Isometric Hip Movements: The following resisted

4. Muscle Testing and Compensatory Movements: To ensure that the

5. Testing the Adductors: Delahunt et al. recommend testing the

6. Identifying Muscle Involvement: By carefully noting which resisted

7. Additional Testing: If the patient's history indicates that symptoms

8. Considerations for Pain and Inflammation: The examiner should be

Patient-Reported Outcome Measures: Various numerical rating scales and

Functional Strength and Endurance Testing: Functional strength and

4. Clinical Prediction Rule for Osteoarthritis: Sutlive developed a clinical

6. EQ-5D Questionnaire: The EQ-5D questionnaire assesses a patient's

Anterior Apprehension Test (Hyperextension–Lateral Rotation Test): This

Craig’s Test: Craig's test assesses femoral anteversion or retroversion. The

Drehmann Sign: Drehmann sign is observed in adolescents and young

Foveal Distraction Test: The foveal distraction test is performed in the

1. Anteroposterior Impingement Test: This test assesses hip dysplasia,

2. Gear-Stick Sign: This test checks for greater trochanter-pelvic

4. Ischiofemoral Impingement Test: The patient is in a side-lying position,

5. Lateral FADDIR (Flexion, Adduction, and Internal Rotation) Test: The

1. Anterior Labral Tear Test (FADDIR): This test is used to assess

3. Flexion-Internal Rotation Test: The patient lies supine with extended

3. Patellar-Pubic Percussion Sign: This test involves the patient lying

5. Telescoping Sign (Piston or Dupuytren's Test): This test is used to assess

True Leg Length Discrepancy:

1. Proper Alignment: Ensure that the pelvis is set square, level, or in

2. Measurement Points: Leg length is typically measured from the anterior

4. Normal Variation: A slight difference (up to 1 to 1.5 cm) in leg length is

5. Weber-Barstow Maneuver: This visual method involves comparing the

Functional Leg Length Discrepancy:

1. Pelvic Tilt and Compensation: Apparent shortening or functional

2. Measurement Technique: When assessing functional shortening,

3. Caution: Be aware that measurements for functional leg length

1. Initial Assessment:

2. Symmetric Stance:

5. Additional Evaluation:

1. Abduction Contracture Test:

3. Adduction Contracture Test:

4. Adductor Squeeze Test (Fist Squeeze Test):

5. Beatty’s Test or Maneuver:

6. Bent-Knee Stretch Test for Proximal Hamstrings:

7. Eccentric Hip Flexion:

8. Ely’s Test (Tight Rectus Femoris, Method 2):

9. External De-rotation Test:

10. Freiberg’s Maneuver:

11. Hip Lag Sign:

12. Lateral Step-Down Maneuver (Pelvis Drop Test):

13. Long-Stride Heel-Strike Test:

14. 90–90 Straight Leg Raising Test (Hamstring Contracture Test):

15. Gluteus Maximus Length Test:

16. Gluteus Strength Tests:

17. Noble Compression Test:

18. Ober’s Test:

19. Pace’s (Pace and Nagle) Maneuver:

20. Phelps’ Test:

21. Piriformis (Flexion, Adduction, and Internal Rotation - FAIR) Test:

22. Prone-Lying Test for Iliotibial Band Contracture:

23. Puranen-Orava Test:

24. Rectus Femoris Contracture Test (Kendall Test):

25. Seated Piriformis Stretch Test:

27. "Taking off the Shoe" Test (TOST):

28. Thomas Test:

29. Tightness of Hip Rotators:

Tripod Sign (Hamstring Contracture Test):

Timed "Up and Go" (TUG) Test:

Reflexes and Cutaneous Distribution:

Sciatic Nerve (L4 to S3):

Superior Gluteal Nerve (L4 to S1):

Femoral Nerve (L2 to L4):

Obturator Nerve (L2 to L4):

3. Lateral Distraction:

2. Trochanteric Bursae:

3. Gluteal Muscles and Tendons:

4. Inguinal Ligament and Femoral Triangle:

5. Hip Joint and Head of the Femur: