Hip Goniometry Flashcards
Hip Flexion
Expected AROM: 100-120 degrees
Position:
- supine
- allow tested side knee to bend and lift thigh off the table toward chest
End feel should be soft with firm tension at the end (beware of belly)
Goniometry placement:
- fulcrum: lateral aspect of hip, greater trochanter
- moveable: midline of femur
- stationary arm: midline of pelvis or trunk
Hip extension
Expected AROM: 30 degrees
Position:
- prone
- both knees extended
- hips neutral on the mat
- raise tested leg off the table, maintaining knee extension
End feel should be firm due to the iliofemoral ligament
Goniometry
- fulcrum: lateral aspect of hip, greater trochanter
- movable: midline of femur
- stationary: midline of pelvis and trunk
Hip abduction
Expected AROM: 45 degrees
Position:
- supine with hip neutral, knee extended
- slide the hip to the side (watch for rotation and flexion)
- when pelvis tries to tilt or rotate, you are at the end of the movement
End feel should be firm.
Goniometry
- fulcrum: over the ASIS (anterior superior iliac spine)
- movable: midline of femur
- stationary: horizontal connection between the two ASIS
Hip adduction
Expected AROM: 30 degrees
Position:
- supine
- knee extended, hip at 0
- abduct the contralateral leg
- ask client to slide the leg medially while maintaining knee extension
- end when pelvis begins to tilt or rotate
End feel should be firm.
Goniometry
- fulcrum - ASIS
- movable: midline of femur
- stationary: line between the ASIS
Internal (medial) rotation
Expected AROM: 45 degrees
Position:
- seated
- knee and hip flexion at 90 degrees
- ask client to swing leg to lateral side
End feel should be firm
Goniometry
- fulcrum: anterior aspect of patella
- movable: midline of lower leg
- stationary: perpendicular to floor or parallel to supporting surface
External (lateral) rotation
Expected AROM: 45 degrees
Position:
- seated
- knee and hip flexion at 90 degrees
- ask client to swing leg in (heel to knee)
End feel should be firm
Goniometry
- fulcrum: anterior aspect of patella
- movable: midline of lower leg
- stationary: perpendicular to floor or parallel to supporting surface
Straight leg raise MMT
Assessing the hamstrings
Semitendinosus
O - ischial tuberosity
I - superior tibia
N - Tibial division of sciatic nerve: L5, S1, S2
Semimembranosus
O - ischial tuberosity
I - posterior medial condyle of tibia
N - Tibial division of sciatic nerve: L5, S1, S2
Biceps femoris
O - ischial tuberosity (long head); linea aspera (short head)
I - lateral fibula
N - long head: Tibial division of sciatic nerve: L5, S1, S2
Short head: common fibular L5, S1, S2
- normal is 70-80 degrees
Position:
- supine with both legs and knees extended
- flex the hip until tight, pain, or sub patterns
- check bilaterally
- other leg has to be straight to make sure there isn’t any tilt in the pelvis
Test is positive if there is pain.
Measuring leg length
Position:
- supine
- apply traction to both ankles (pull for like 15 seconds)
- hips should be about 20 cm apart
- measure from ASIS to medial or lateral malleolus
A difference grater than 3/8 of an inch of 1.5 cm is an issue (more than half an inch is an issue)
How do you find greater trochanter?
You can find the greater trochanter in standing by placing your thumb on the side of the iliac crest and reaching down the side of the thigh with the middle finger.
MMT for iliopsoas
Responsible for hip flexion
O: psoas - transverse process of T12-L5; illiacus - illiac fossa
I: lesser trochanter of femur
N: psoas - spinal nerves L1 and L2; illiacus - spinal nerves L2 and L3
Testing:
- position: seated with ip at 90 degrees (rolled towel under knee
- palpation: psoas, have patient bend slightly forward; place hand below rib and above iliac crest
5 = pt lifts leg off table with max resistance
4 = pt lifts leg off table with moderate resistance
3 = pt lifts leg off table
Gravity eliminated
2 = sidelying with powder board
1 = trace
Sartorius MMT
Hip flexion, abduction, and lateral (ext) rotation
O - ASIS
I - medial tibia
N - femoral and spinal nerves L2 and L3
Testing:
- position: client is seated 90 degree knee flexion
- palpation: below and medial to ASIS (crease of leg)
- have patient bring heel to opposite knee
5 = max resistance at knee and medial malleolus
4 = moderate resistance at knee and medial malleolus
3 = full ROM
2 = gravity eliminated, subject is supine, slide foot up opposite leg
1 = trace
To apply resistance push down and in with top hand right above knee and pull lower leg into internal rotation
Substitution patterns:
- straight hip flexion without abduction or lateral rotation
- hip flexion with abduction with medial rotation instead of lateral
Gluteus Maximus MMT
Hip extension
O: gluteal line of ilium, posterior sacrum
I: IT tracts and gluteal tuberosity of femur
N: inferior gluteal a.
Testing
Position: standing and leaning over table
Palpation: between sacrum and trochanter
With patient leaning over table, and knee bent to 90º (or in prone)
5=extend the hip, max resistance at the distal femur
4=mod resistance
3=full ROM
2= subject in side lying on powder board
1=trace
Gluteus medius and minimus
Hip abduction
O: medius - lateral surface of ilium; minimus - external surface of ilium
I: medius - lateral surface of greater trochanter of femur; minimus - anterior surface of greater trochanter of femur
N: superior gluteal n.
Testing
Position: pt is in sidelying with the testing leg on top; hips stacked
Palpation: only the medius is palpable at the anterior portion, just lateral to the crest of the illium or proximal to the greater trochanter
With subject in sidelying, place the bottom leg with knee bent to 90, rest the test leg on the table, ask the client to abduct the hip
5=max res; push right above knee for resistance
4=moderate
3=full range
2= subject in supine on a powder board slide to side
1=trace
Other substitution patterns
- Flexion and lateral rotation
- Lateral pelvic tilt (hike)
- Trunk roll
Tensor Fascia Latae MMT
Hip flexion, abduction, and medial rotation
May assist in knee extension
O: lateral surface of ASIS
I: IT tract and lateral tibia
N: superior gluteal n.
Position: subject in sidelying with the test limb on top and at 45 degrees of hip flexion, knee extended (she tests with it flexed)
Palpation: below and lateral to the ASIS
Ask the client to abduct the hip while maintaining the 45 degrees of hip flexion (usually lines up with bottom knee)
5=max
4=mod
3=full ROM
2=subject is in semisitting with hip flexed to 45 degrees, ask pt to slide to the side
1=trace
Adductors
Adductor longus, magnus and brevis
- Longus
* O: anterior crest of pubis
* I: lip of linea aspera of femur
* N: obturator
- Magnus
* O: inferior ramus of pubis
* I: gluteal tuberosity
* N: obturator and sciatic
- Brevis
* O: inferior pubic ramus
* I: distal pectineal line and linea aspera of femur
* N: obturator
Gracilis
- O: inferior pubic ramus
- I: medial condyle of tibia
- N: obturator
Pectineus
- O: superior pubic ramus
- I: pectineal line of femur
- N: femoral
Testing the adductors
Position: subject is sidelying with the nontest limb supported in 25 degrees of abduction, put it on your shoulder
Palpation: Adductor longus- medial side of thigh, below the pelvic arch
Gracilis-medial aspect of knee, round feeling
Others are too deep or uncomfortable to really palpate
5= adduct the hip toward the nontest leg, appox 25 degrees=max resistance
4= moderate
3 = full range 25 degrees
2=supine with non test leg abducted out of way, look for 25 degrees of slide from neutral
1=trace
Thomas Test
Assess hip flexor tightness or contracture
Watch for lumbar lordosis
Ask subject to lay supine
Look at back, for excessive lumbar lordosis
Bring both knees to chest
Hold one and release the other, laying it flat on table
Positive Thomas:
Inability to extend the leg and rest the thigh on the table
Potential contraction if they CANNOT lay leg flat usually people who are sitting in in wheelchairs
Ober’s Test
Tightness of Tensor Fasciae Latae and IT band
Subject in side lying with tested limb on top
Allow them to bend the bottom leg
Passively abduct and extend the top leg
Support the pelvis
Release the upper leg in this position
Hold for 15 seconds, 10-12 times
Positive: if the leg will not rest on
table it is positive for Tensor
Fasciae Latae and iliotibial tightness
Trendelenburg Sign
Weakness of gluteus medius
Look at the posterior pelvis
Subject stands with wt even on both legs
The hips should be even
Then ask to stand on one foot, then the other
Positive if:
The pelvis does not remain level
If positive, the pelvis will drop toward unsupported side, thus the gluteus medius of the wt bearing side is weak or nonfunctional
Piriformis Test
Used to determine if tightness in piriformis is responsible for pain in the buttocks and down the sciatic nerve distribution
Subject is in sideyling with upper test leg at 60-90 degrees of hip flexion and 90 of knee flexion
Then passively push the knee to the table, stabilize the hip
Positive:
Pain in buttocks or down the sciatic
nerve distribution
Seated weight bearing
No name test-Dr. Denham said so
Have the client sit on a firm surface (mat table)
Assess general seated posture
Slide hands under buttocks
Is pressure even
Have the client reach across the midline to both sides, is the wt bearing even
DO NOT want any red or yellow when looking at the seated weight bearing
Weight and weight shifting
Red marks can lead to decubitus (pressure sores)
