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The Essential Hip Exam
Alan Zhang MD
Associate Professor Director, Hip Preservation Center Fellowship Director, Sports Medicine UCSF Department of Orthopaedic Surgery
The Layers of the Hip
To treat hip pathology- 1 st^ task is to understand the source of hip pain Bryan Kelly et al Arthroscopy 2012
- Layer 1- Osteochondral
- Layer 2- Inert
- Layer 3- Contractile
- Layer 4- Neuromechanical 2
Layer 1- Osteochondral
Structures
- Femur
- Acetabulum
- Articular cartilage Pathology
- Cam impingement
- Pincer impingement
- Subspine impingement
- Articular cartilage delamination
Layer 2- Inert
Structures
- Capsule
- Labrum
- Ligamentum teres Pathology
- Labral tear
- Capsular instability
- Adhesive capsulitis
Layer 3- Contractile Structures
- Muscles crossing hip
- Pelvic floor
- Lumbosacral muscles Pathology
- Gluteus medius tear
- Hip flexor strain
- Proximal hamstring strain
- Adductor tendinopathy 5 Layer 4- Neuromechanical Structures
- Neuro-vascular structures in hip region
- Regional mechanoreceptors Pathology
- Pain syndromes
- Neuromuscular dysfunction 6 Location, Location, Location Anterior/groin
- FAI
- Arthritis
- Flexor strain Lateral/thigh
- Trochanteric pathology
- Snapping hip Buttock/posterior
- Low back/sciatic nerve
- Hamstring injury
- Referred pain Physical Exam Ambulation Supine exam
- ROM
- Strength
- Provocative/special maneuvers Lateral Exam Prone Exam
Range of Motion Flexion (0-130) IR @ 90 degrees of flexion (0-30) ER @ 90 (0-60) Abduction (0-60) Extension (0-20) Arthritis- decreased globally FAI- decreased IR and flexion Strength/Muscle Exam Rectus—hip flexion against resistance Abductors—push out legs Adductors—pull in legs Provocative Exams Log roll FADIR FABER Labral stress test/ Scour test Straight leg raise Sports hernia exam SI Joint exam Log Roll Assess for intra-articular hip pathology
Flexion ADduction Internal Rotation FADIR for FAI FABER Test SI pathology Sometimes anterior labral pathology Flexion ABduction External Rotation
Sports Hernia Exam Special maneuvers
- Resisted sit up (legs straight, 10-30 deg trunk flexion)
- Adductor Squeeze test ( deg and 90 deg of hip flexion) – pain/strength
- Valsalva 25 SI Joint Examinations FABER Test Distraction Test Thigh Thrust Test Gaenslen Test Compression Test Sacral Thrust Test 3 or more positive tests indicate SI joint dysfunction 26 Distraction Test Examiner pushed outward and down on both iliac wings Thigh Thrust Test Examiner will flex the hip and knee on injured side to “thrust” while patient pelvis is flat on table
Gaenslen Test Injured side in extension and off the table while uninjured side is flexed 29 Compression Test Lay on side opposite of pain while examiner pushes down 30 Sacral Thrust Test Examiner Pushes down on Sacrum Lateral Exam OBER test
- IT band tightness Palpate Greater Trochanter
- Trochanteric bursitis Gluteus Medius strength testing
