hip and thigh - manual muscle tests

Question 1

medial hamstrings - semimembranosus and semitendinosus

Answer 1

▪ Positions patient prone, with the knee positioned between 50 and 70 degrees of flexion with the thigh in medial rotation
and the leg in medially rotated on the thigh
▪ Holds the thigh down firmly on the table
▪ Applies pressure against the leg, proximal to the ankle, in the direction of knee extension (does not apply pressure against
the rotary component)
▪ Instructs patient to flex the knee
▪ Holds appropriate amount of pressure for at least 5 seconds

Question 2

lateral hamstring - biceps femoris

Answer 2

▪ Positions patient prone, with the knee positioned between 50 and 70 degrees of flexion with the thigh in slight lateral
rotation and the leg in slight lateral rotation on the thigh
▪ Holds the thigh down firmly on the table
▪ Applies pressure against the leg, proximal to the ankle, in the direction of knee extension (does not apply pressure against
the rotary component)
▪ Instructs patient to flex the knee
▪ Holds appropriate amount of pressure for at least 5 seconds

Question 3

rectus femoris

Answer 3

▪ Positions patient sitting, with the knees over the end of the table
▪ Instructs patient to hold onto the table
▪ Holds the thigh firmly down on the table, or places one hand under the distal end of the thigh to cushion against the
pressure of the table
▪ Applies pressure against the leg, above the ankle, in the direction of flexion
▪ Instructs patient to extend the knee joint, without rotation of the thigh
▪ Holds appropriate amount of pressure for at least 5 seconds

Question 4

iliopsoas - psoas major and iliacus

Answer 4

▪ Positions patient supine, with the leg positioned in slight abduction and slight lateral rotation
▪ Stabilizes the opposite iliac crest
▪ Applies pressure against the anteromedial aspect of the leg, in the direction of extension and slight abduction, directly
opposite the line of pull of the psoas major from the origin of the lumbar spine to the insertion on the less trochanter of
the femur
▪ Instructs patient to flex the hip
▪ Holds appropriate amount of pressure for at least 5 seconds

Question 5

sartorius

Answer 5

▪ Positions patient supine, with the hip in the position of external rotation, abduction, and flexion
▪ No fixation is necessary, but the patient may hold on to the table
▪ Applies pressure against the anterolateral surface of the lower thigh, in the direction of hip extension, adduction, and
medial rotation, and against the leg, in the direction of knee extension (examiner’s hands are in a position to resist the
lateral rotation of the hip joint by pressure and counterpressure)
▪ Instructs patient to laterally rotate, abduct, and flex the thigh, with flexion of the knee
▪ Holds appropriate amount of pressure for at least 5 seconds

Question 6

tensor fascia latae

Answer 6

▪ Positions patient supine
▪ No fixation is usually necessary, but the patient may hold on to the examination table (if there is instability and the patient
has difficulty maintaining the pelvis firmly on the table, one of the examiner’s hands should support the pelvis anteriorly,
on the opposite side)
▪ Applies pressure against the leg, in the direction of extension and adduction (does not apply pressure against the rotary
component)
▪ Instructs patient to abduct, flex, and medially rotate the hip, with the knee extended
▪ Holds appropriate amount of pressure for at least 5 seconds

Question 7

hip adductors - pectineus, gracilis, adductor magnus, adductor longus, and adductor brevis

Answer 7

▪ Positions patient side-lying, with the body in a straight line and the lower extremities and lumbar spine straight
▪ Holds the upper leg in abduction
▪ Instructs patient to hold on to the examination table
▪ Applies pressure against the medial aspect of the distal end of the thigh, in the direction of abduction (pressure is applied
at the point above the knee to avoid strain of the medial collateral ligament of the knee)
▪ Instructs patient to adduct the underneath extremity upward from the table, without rotation, flexion, or extension of the
hip or tilting of the pelvis
▪ Holds appropriate amount of pressure for at least 5 seconds

Question 8

hip internal (medial) rotators - tensor fascia latae, gluteus minimus, and gluteus medius

Answer 8

▪ Positions patient sitting, with knees bent over the end of the examination table
▪ Applies counterpressure at the medial side of the lower end of the thigh with one hand, and applies pressure to the lateral
side of the leg, above the ankle, pushing the leg inward in an effort to rotate the thigh laterally with the other hand
▪ Instructs patient to hold on to the examination table
▪ Instructs patient to medially rotate the thigh, with the leg in a position of completion of the outward arc of motion
▪ Holds appropriate amount of pressure for at least 5 seconds

Question 9

hip external (lateral) rotators - piriformis, quadratus femoris, obturator internus, obturator externus, gemellus superior, and gemellus inferior

Answer 9

▪ Positions patient sitting, with knees bent over the end of the examination table
▪ Applies counterpressure at the lateral side of the lower end of the thigh with one hand, and applies pressure to the medial
side of the leg, above the ankle, pushing the leg outward in an effort to rotate the thigh medially with the other hand
▪ Instructs patient to hold on to the examination table
▪ Instructs patient to laterally rotate the thigh, with the leg in a position of completion of the inward arc of motion
▪ Holds appropriate amount of pressure for at least 5 seconds

Question 10

gluteus minimus

Answer 10

▪ Positions patient side-lying
▪ Stabilizes the pelvis
▪ Applies pressure against the distal lower leg, in the direction of adduction and very slight extension
▪ Instructs patient to abduct the hip in a position neutral between flexion and extension and neutral in regard to rotation
▪ Holds appropriate amount of pressure for at least 5 seconds

Question 11

gluteus medius

Answer 11

▪ Positions patient side-lying, with the underneath leg flexed at the hip and knee, and the pelvis rotated slightly forward to
place the posterior gluteus medius in an antigravity position
▪ Applies pressure against the leg, near the ankle, in the direction of adduction and slight flexion (does not apply pressure
against the rotary component)
▪ Instructs patient to abduct the hip, with slight extension and slight external rotation, with the knee maintained in
extension
▪ Holds appropriate amount of pressure for at least 5 seconds

Question 12

gluteus maximus

Answer 12

▪ Positions patient prone with knee flexed to 90 degrees or more
▪ Applies pressure against the lower part of the posterior thigh, in the direction of hip flexion
▪ Instructs patient to extend hip, with the knee flexed
▪ Holds appropriate amount of pressure for at least 5 seconds