Magee Hip

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.
The provided text describes various aspects of a hip examination. Here are the key points:
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.

Magee Hip

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Magee Hip

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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:

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:

6. Balance and Proprioception: - Evaluate the patient's proprioceptive control by having

7. Limb Position and Symmetry:

8. Skin and Scar Examination:

9. Dynamic Gait Analysis:

10. Whole Kinetic Chain Consideration:

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

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

14. Repetitive Movements: Consider the impact of repetitive movements, sustained

Different types of hip impingements and conditions:

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

Understanding these different impingement conditions and syndromes is crucial for

Understanding these assessment techniques is essential for diagnosing hip conditions,

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

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

1. **Purpose of Resisted Isometric Movements:** Resisted isometric movements of the hip

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

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

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

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

Assessing rotational deformities is important in understanding lower limb biomechanics and

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

7. **Posteroinferior Impingement Test:** This test assesses global acetabular overcoverage

**True Leg Length Discrepancy:**

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

**Functional Leg Length Discrepancy:**

1. **Pelvic Tilt and Compensation:** Apparent shortening or functional shortening of the

2. **Measurement Technique:** When assessing functional shortening, measure the

**1. Initial Assessment:**

**2. Symmetric Stance:**

**5. Additional Evaluation:**

**1. Abduction Contracture Test:**

**2. Active Piriformis Stretch 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:**

**18. Ober’s Test:**

**19. Pace’s (Pace and Nagle) Maneuver:**

**20. Phelps’ Test:**

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

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

1. Purpose of Resisted Isometric Movements: Resisted isometric movements of the hip

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

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

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

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

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

7. Posteroinferior Impingement Test: This test assesses global acetabular overcoverage

True Leg Length Discrepancy:

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

Functional Leg Length Discrepancy:

1. Pelvic Tilt and Compensation: Apparent shortening or functional shortening of the

2. Measurement Technique: When assessing functional shortening, measure the

1. Initial Assessment:

2. Symmetric Stance:

5. Additional Evaluation:

1. Abduction Contracture Test:

2. Active Piriformis Stretch 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:

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:

26. Sign of the Buttock:

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:

Pudendal Nerve (L2 to S4):

Sciatic Nerve (L4 to S3):

Superior Gluteal Nerve (L4 to S1):

Femoral Nerve (L2 to L4):

Obturator Nerve (L2 to L4):

1. Caudal Glide (Long Leg Traction or Long-Axis Extension):

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:

2. Greater Trochanter and Sciatic Nerve:

3. Sacroiliac, Lumbosacral, and Sacrococcygeal Joints:

Common X-Ray Views of the Hip Depending on Pathology:

26. Signs of an SCFE (Slipped Capital Femoral Epiphysis): An SCFE is characterized by

30. FAI (Femoroacetabular Impingement) Diagnosis: Different types of FAI, including