Hip examination Flashcards
Observation
Skin changes - Bumps, Bruises, redness, scars, swelling, muscle wasting, discoloration.
Assess gait – foot drop (L4-5), Antalgic, Hemiplegic, Trendelenburg gait Weak abductors/glutes
Flexion positioning of relief in neurogenic claudication
Lateral pelvic tilt – scoliosis
Hip drop with Trendelenburg Sign - glute medius weakness.
Swelling
o Greater Trochanteric bursitis (also have redness) – maybe d/t direct trauma fall
Scars: hip replacement
Muscle Wastage:
-Glut Medius atrophy Trendelenburg (can get in spontaneous osteonecrosis)
Hamstring atrophy if tendinopathy/tear
Redness:
o Septic arthritis with associated fever & non-weight bearing (and reflex myospasm)
Palpation/Motion Palpation
Anterior Palpation (Hip & Pelvis)
Iliac Crest: Insertion of glute medius/minimus, quadratus lumborum (QL) and IT band attachment laterally.
ASIS: Origin of sartorius
AIIS: rectus femoris origin of rectus femoris
-Greater Trochanter: insertion of external/internal rotators, origin of vastus lateralis, bursitis Gluteal medius & minimus tendinopathy insertion
Posterior Palpation (Pelvis, Hip & Lumbar Spine)
- PSIS Landmark for SI joint.
-Piriformis Muscle - Found between sacrum & greater trochanter. Tenderness suggests piriformis syndrome (sciatic nerve irritation).
Lumbar Spine Palpation
-Spinous Processes (SPs) L1-L5 Feel centrally; step-off deformity suggests spondylolisthesis. Local tenderness may suggest facet irritation or discogenic pain
-Transverse Processes (TVPs) L1-L5 Located laterally; palpation can assess QL tightness or rib
dysfunction.
-Quadratus Lumborum (QL) Muscle Found between iliac crest & lower ribs. Hypertonicity common in low back pain, lateral tilt issues.
-Erector Spinae (Spinalis, Longissimus, Iliocostalis) Runs parallel to the spine; assess for tightness, asymmetry, or trigger points.
-Facet Joints (Zygapophyseal joints) Located slightly lateral to SPs; pain may suggest facet joint syndrome
Active & Passive Range of Motion
Flexion 100-125° Stabilize pelvis to prevent excessive lumbar flexion.
Extension 10-35° Ensure no anterior pelvic tilt or lumbar extension compensation.
Internal Rotation 20-45° Keep femur neutral; excessive range may indicate capsular laxity.
External Rotation 35-70° Ensure proper alignment; check for signs of FAI or instability.
Abduction 30-90° Prevent pelvic hiking; check for gluteal weakness.
Adduction 20-40° Watch for compensatory pelvic tilt or lateral shift.
RIMS
Resisted Hip Flexion – Tests iliopsoas strength; pain may indicate iliopsoas tendinopathy or hip joint pathology.
Prone Lying Resisted Hip Extension – Assesses gluteus maximus strength; weakness may suggest gluteal tendinopathy or lumbar instability.
Resisted Internal & External Rotation (RIMs) – Can sometimes help Differentiates intra-articular vs. extra-articular causes of hip pain if pain only on contraction as opposed to positioning
Side-Lying Resisted Hip Abduction – Tests gluteus medius/minimus; useful for diagnosing gluteal tendinopathy or Trendelenburg weakness.
Knee Squeeze Test – Assesses adductor strength & pubic symphysis dysfunction (SPD, OA,
adductor strain).
Copenhagen Test for Adduction – High-load assessment for adductor tendinopathy or weakness
Special tests
gluteus medius weakness
Trendelenburg sign
Test for Hip Alignment
Craig’s Test – 10-15 degrees normal.
Hip pathology
Faber’s test
HIp scour/Quadrant test
ITB band tightness
Ober’s test
Femoralacetabular impingement or Labral tear
FADDIR - (FAI or Labral)
Mcarhty Test
Fitzgeralnd test
Anterior labral tear test
Posterior labral tear test
Log roll test
Piriformis syndrome
FAIR test (with slr with ir and adduction Bonnets??)
Femoral fracture
Fulcrum test of hip
