ASSESSMENT OF HIP

JOINT
ASSESSMENT OF HIP JOINT

Hip joint is one of the largest and most stable joints in

the body.
It is a multiaxial ball and socket joint has maximum
stability because of the deep insertion of the head of
the femur into the acetabulam.
MUSCLES :

Medial rotation – GIT

Lateral rotation – Quacky Princes Sits Only On Silk
Flexion – RIPS AL
Extension – BAGSS
Abduction – Gm Prove Them
Adduction – GAMBL P
PATIENT HISTORY
HISTORY-The examiner should obtain the
following information.
 AGE OF THE PATIENT
 TRAUMA OR MECHANISM OF INJURY
 DETAIL OF THE PRESENT PAIN AND OTHER
SYMPTOMS
 IS THE CONDITION IMPROVING ?
WORSENING?AND STAYING SAME?
 PROBLEM IN ANY MOVEMENT?
 PATIENT USUAL ACTIVITY?
1. AGE OF THE PATIENT
Different condition occur in different age group ,
ROM decrease with age.
-hip dysplasia seen in infancy
 -perthes disease more common in boys 3 to
12 years old.

-osteoporotic changes in elder pt.

2. TRAUMA OR ANY INJURY
EX. Subluxation, labral tear or any loading
activity or fracture.
3. PRESENT PAIN AND OTHER
SYMPTOMS
- Labral tear or impingement -> pain in the groin and
along with the front or middle side of thigh.

- buttock pain -> posterior labral tears and lumbar

spine problem
- adductor pain is caused due to over active adductor.
 snapping hip syndrome
it is also called coxa saltans and dancing hip.
4. ANY CONDITION IMPROVING OR
WORSENING OR STAYING SAME?
5. PROBLEM IN ANY MOVEMENT
- piriformis syndrome
6. WHAT IS THE PT. USUAL ACTIVITY
repetitive or sustained position to
increase pain.
OBSERVATION
1. GAIT
2. POSTURE
3. SYMMETRY OF WEIGHT BEARING
4. BALANCE
5. POSITION OF LIMB
6. SHORTNING OF LIMB
7. TEXTURE OF THE SKIN
8. ANY SCAR
9. MOVEMENT OF JOINT
1. GAIT:
 If the hip is affected at that time pt. will bends
his or her knee slightly.

 the length of the step is shorter so that weight

can be taken off the leg quickly.

 if the hip is stiff, the entire leg and trunk

swing forward together.
IF SOME MUSCLES BECOME WEAK

 Weak abductors – trendelenburg gait

 bilateral hip flexors contracture – lumbar spine to

extend to greater degree or increase lordosis.

 weak extensors – move the trunk backward to

maintain the balance

 if the lateral rotators strong than the medial rotators –

excessive toe out present
2. POSTURE
Watch pelvic obliquity
Muscle contracture
Scoliosis

3. SYMMETRY OF WEIGHT BEARING

ANTERIOR VIEW
Muscle Bulk
Soft Tissue Deposition Around Hip Joint
Swelling

LATERAL VIEW
The buttocks should be observed for any abnormality
for ex.atrophy
hip flexion diformity is best observed in this position.
the examiner should compare both the side.
POSTERIOR VIEW
In this position we mostly observed the spine
for ex.scoliosis.

we observe the gluteal folds, posterior

superior iliac spine.
4.BALANCE
o check the pt’s proprioceptive control in joint.
asking the pt. to balance first on one leg (good
one) then other.
first eye open and then close

STORK STANDING TEST

IN THIS TEST WE CAN ASSESS BOTH HIP AS WELL AS SI
JOINT STABILITY ALSO
5. POSITION OF THE LIMB
 Position of the limb may indicate the type of injury.
For ex. Traumatic posterior hip dislocation – the limb
became short, adducted and medially rotated,
and the greater trochanter is prominent.

 anterior hip dislocation – the limb is abducted ,

laterally rotated.
 intertrochanteric fracture – the limb become
shorten and laterally rotate
6. SHORTENING OF LIMB
Shortening is present or not . If present then check also scoliosis.

7. COLOR OF THE SKIN

Any changes present or not

8. ANY SCAR PRESENT OR NOT

9. MOVEMENT OF JOINT
 Check the hip joint movement - if more pain present then antalgic gait
 if the joint become unstable then the pt. is having more difficulty
controlling movement.
EXAMINATION
When doing an examination of the hip joint, the
examiner must keep in mind that may be referred to
the hip from the SI JOINT or LUMBAR SPINE, and
vise versa.
If there is any doubt as to the location of the lesion, an
assessment of the lumbar spine and sacroiliac joints
should be performed along with the hip.
ACTIVE MOVEMENT
The active movements are done in such a way that
the most painful are done last.

FLEXION (110 -120)

EXTENSION (10-15 )
ABDUCTION (30-50)
ADDUCTION(30)
LATERAL ROTATION (40-60 )
MEDIAL ROTATION (30-40 )
If the history is indicated that repetitive movements,
sustained postures or combined movements have
caused symptoms, the examiner should ensure that these
movements are tested as well.

For ex, sustained extension of hip may provoke gluteal pain in

the presence of claudication in the common or internal iliac
artery.

During the active movements , the examiner should always

watch for the possibility of muscle or force-couple imbalances
that lead to abnormal muscle recruitment patterns.
FOR EX.
During extension, the normal pattern is
CONTRACTION OF GLUTEAL MAXIMUS
followed by

ERECTOR SPINAE ON THE OPPOSITE SIDE AND THE

HAMSTRINGS
If the erector spinae contract first, the pelvis rotate
anteriorly and hyper extension of the lumbar spine
will occur.
So, when we examine active movements , we should
watch the pelvis and the ASIS and the PSIS.
During hip movements, if the pelvis force couple are
normal, the pelvis and ASIS/PSIS will not move. If they
do, it may be an indication of muscle imbalance.
If sometime sharp groin pain occur during flexion and
medial rotation of hip it indicate anterior
impingement of femoral neck against the acetabular
rim.
When abdominals are weak at that time pelvis rotate
ant. And hip flexors are weak , the pelvis rotate post.
When we performe active hip abduction or
adduction before that we check the level of the
pelvis.
The pt. is then asked to do abduction . This
movement is stopped when the pelvis begins to
move.
During abduction opposite side of ASIS move first.
During adduction same side ASIS move first.
PASSIVE MOVEMENTS
If the ROM is not full and examiner unable to test end
feel during active movements, passive movement
should be performed at that time .
CAPSUAR PATTERN OF THE HIP JOINT IS FLEXION,
ABDUCTION, MEDIAL ROTATION.
NORMAL END FEEL
flexion (tissue approximation or tissue stretch)
extension (tissue stretch)
abduction (tissue stretch)
adduction (tissue stretch )
medial rotation (tissue stretch )
lateral rotation (tissue stretch)
RESISTED ISOMETRIC MOVEMENTS
The examiner should position the pt’s hip properly and
say to the pt., Don’t let me move your hip to insure
that the movement is isometric.
For ex, the gluteus maximus is the only muscle that is
involved in all of the following movements extension,
abduction, and lateral rotation.
Therefore , if pain occur during this 3 movements, the
examiner should suspect the gluteus maximus
muscle.
FUNCTIONAL ASSESSMENT
Hip motion is necessary for more activities than just
ambulation.
In fact more hip motion is required for ADL.
Activities such as shoe tying , sitting , getting up from
chair , picking up thing from the floor.
PALPATION
The examiner should note any tenderness,
temperature, muscle spasm, or any other symptoms
that may indicate the source of pathology.
ANTERIOR ASPECT

 Iliac crest, greater trochanter, and anterior superior

iliac spine.
 The iliac crests are easily palpated and should be level.
 The crest should be palpated for any tenderness .
 In athelets, a condition called a “hip pointer”.
 Then examiner moves to the ASIS .

 The greater trochenter , located approximately 10 cm

distal to the iliac tubercle .
Inguinal ligament – the psoas bursa may swollen , is
usually palpable under the inguinal ligament as its
mid point.
Moving distal to the ligament , the examinar palpates
the femoral triangle.

But this is difficult to palpate

Hip joint –the head of femur is 1 to 2 cm below the
middle third of inguinal ligament.
to palpate the hip joint for any pathological condition
present or not.
POSTERIOR ASPECT

posterior superior iliac spine

ischial tuberosity
greater trochanter
DIAGNOSTIC IMAGINE
Antero posterior view
the examiner should compare the two hips

 The neck shaft angle – abnormal head neck

(flattening of superior femoral head )

PISTOL GRIP DEFORMITY

 observe joint space
 Presence of any bony disease
for ex, perthes disease
 Shape of femoral head
 Presence of osteophytes or arthritis

 To show the shenton’s line - normally , it is curved ;

drawn along the medial curved edge of the femur and
continuing upward in a smooth arc along the inferior
angle of the pubis.
 hilgenreiner’s line and perkin’ line
horizontal line drawn between inferior part of
ilium.
vertical line drawn through the upper outer point
of the acetabulum .
 Sagging rope sign in perthes disease
LATERAL VIEW
Pt. is in supine with the hips in flexion , abduction ,
lateral rotation.
the examiner looks for any slipping of the femoral
head , it may be seen in slipped capital femoral
epiphysis.