Evaluating the Hip Joint.
So the hip joint—what we want
to do is to start with
just looking at any sort of asymmetry.
Usually when the patient is walking, you observe their gait.
If there’s hip problems, usually
they might limp.
They might have issues
when they’re ambulating or
how they’re standing.
If they’re crooked when they’re standing.
You want to see how they’re able
to maneuver and walk,
how they could get on the table
and get off the table.
Sometimes hip pathologies could lead to
and point towards back pains
and back issues
so we want to look at the hip first
and do our observation,
and then we’re going to palpate
some key landmarks.
So we’re going to start with
the iliac crest here
and then the ASIS anteriorly.
Then we’re going to come down laterally
and you’ll feel for the greater
trochanter of the hip.
You could also feel for the AIIS.
That’s going to be about an inch medial
and an inch below the ASIS.
The AIIS is the attachments of
the quadriceps muscles,
and so you want to check
any muscle tone around the area.
Sometimes the lateral hip
could have tightness
of the iliotibial band as it blends
into the tensor fascia latae
attaching to the ASIS.
So just kind of checking the hip,
seeing if there’s good tone.
If there’s any disruption
of the bony structure
and working our way down.
So the hip joint is the articulation
between the femur and the acetabulum.
And so to motion test the area
what we need to do is to move
the hip in several planes.
So in a sagittal plane,
we have hip flexion and hip extension.
Hip flexion we could perform
by flexing up the leg.
Now if you keep the leg straight,
the hamstring muscle is
going to prevent you
from fully flexing the hip so you
want to bend the knee here
to relieve stress on the hamstring
to be able to fully flex the hip.
And so you want to see how far
you’re able to flex the hip.
Now for extension,
we’re going to have the patient
turn onto their stomach
and now you could easily extend the hip
by grabbing above the knee
and slowly bringing the hip into extension.
You want to note both sides and see
how far they could extend.
I’m going to have you turn
back on your back.
So that’s flexion and extension
in the sagittal plane.
You could motion test the hip
in abduction and adduction
in the coronal plane.
So what we’re going to do is
to support the leg here
and slowly abduct the leg out
and we see how far we can move.
Then we could adduct the leg
and you can see that
in order to avoid running into
the opposite leg,
we could flex the leg up a little bit
and come across so we could
better adduct the leg.
So abduction and adduction of the hip.
Now to test motion in the transverse plane,
we’re going to internally and
Now if we internally and externally
rotate the hip with the leg straight,
it’s really hard to tell exactly how
much motion you have.
So a better way to do it is to flex the hip
and flex the knee
and have the ankle be the marker
with the leg straight.
So what we’re measuring is how much
internal rotation by bringing
the ankle laterally
and then how much external rotation
by bringing the ankle medially.
So in this way, we could really measure
the amount of rotation from neutral.
So if we have a somatic dysfunction
present in the hip
what we’re going to note is there’s
decreased range of motion
in one of those planes.
And so before when we tested
the internal and external rotation,
you could note that
external rotation is fairly free here
internal rotation is pretty limited.
So as I move into internal rotation,
there’s not as much motion
as I would suspect.
So the internal rotation is the restriction,
so we name this for its freedoms
so this would be an external rotation
hip somatic dysfunction.
so this would be an internal rotation
hip somatic dysfunction.
So based on your range of motion findings,
you could find somatic dysfunctions
in the joint and you want to name it
for its freedom
when you localize the restriction.
So there are special tests we could perform
to better rule in or rule out
different pathologies of the hip.
So if a patient comes in
complaining of neuropathic pain
where they have shooting pain
going all the way down their leg
that may be from a lumbar
nerve root compression.
And so a test that we could perform
is called the straight leg raise test.
So the straight leg raise test really says
what we’re going to be doing.
We’re going to be taking the leg, keeping
it straight and raising it up.
What that does is that it
pulls on the nerve.
As it pulls when we’re raising the leg up,
it’s going to recreate the pain
if there’s some sort of inflammation
or some sort of impingement.
We’re going to have the
patient relax their leg
and I’m going to slowly flex
the leg up to about 70°.
If there’s no pain then that
would be a negative test,
but if there’s pain shooting down the leg
then that’s a positive test.
If the patient just complains
and pain behind their knee,
that’s more hamstring tightness
because as you flex the hip you’re
stretching the hamstring also.
What you want to detect is whether
or not you recreate
the shooting neuropathic pain
going down into the feet.
So a positive test is with
flexion of the leg,
you’re going to get pain
shooting all the way down recreating
Not just tightness posteriorly in
the hamstring region.
So a positive straight leg raise
would increase your suspicion of having to
do more diagnostic studies looking at
where that nerve might be compressed,
perhaps a lumbar herniated disk.
If a patient has pain in the back
along the tailbone in the SI joints,
we could perform a test called
So Erichsen’s test is a test
that is going to screen for SI joint
pain and problems.
And what you’re going to do
is you’re going to place the palms
of your hands on the ASIS
and compress them together.
So you’re bringing your hands together.
And as you bring your hands together,
if the patient has pain on either
side of the SI joint,
that is a positive test.
Because what you’re doing is when
you compress the ASIS’s together,
you’re kind of bringing the innominates
laterally in the back.
So if there’s any sort of inflammation
or problems at the SI joints,
this motion should recreate
pain that you have in the SI joint.
Stinchfield’s test is a test
that checks for intra-articular
So what we’re going to do is to put a strain
on the hip joint,
and if there’s a problem intra-articularly,
the pelvis and the innominates
at the acetabulum and the femoral head,
then that’s going to recreate pain.
So what we’re going to do
is have the patient,
with their legs straight,
push your leg up towards the ceiling.
At about 30°, I’m going to push
down and resist
and you’re going to see if
that recreates pain.
You can relax.
So having the patient push against
will activate muscles and also
activate the hip.
And so if you have intra-articular
that is going to cause pain
and give you a positive Stinchfield test.
So FABER’s test or Patrick’s test
is a range of motion test of the hip
and it also helps to test the SI joint.
So FABER’s is an acronym
for the motions that we’re going
to be doing at the hip here.
So we’re going to start by adding flexion
for the F;
so as we abduct we’re bringing the knee down
and then external rotation.
So flexion, abduction, and external
rotation at the same time.
And the patient should be able to make
ike a number 4 with their legs and that
would be normal range of motion.
To now also test the SI joint,
we could add the extension part.
So we’re going to stabilize
at the opposite ASIS
and then gently extend the knee
and the hip a little bit more,
and if that recreates pain,
then that’s sensitive for SI joint pathology.
So FABER’s test,
you’re going to bring the leg up,
make a number 4,
and then when you push down on the knee
that’s going to test the SI joint.
If the patient is unable to
create that figure 4,
then there’s a restriction in hip
range of motion
and we need to further motion test the hip
to see if there’s other pathologies
that’s preventing full range
of motion of the hip.
A range of motion test for internal
rotation and flexion is FADIR.
So FADIR stands for flexion,
and internal rotation.
Here, we’re moving the ankle laterally
to create internal rotation
and so the FADIR test
checks for range of motion of the
hip. So you could flex,
adduct and internally rotate
and if you’re unable to do it
or if you get pain in the back as you do it,
then that’s a sign of potential
because the piriformis externally rotates
so once you try to internally
rotate the hip
you will test that muscle also.
So the FADIR test
checks range of motion and also checks for
possible piriformis spasms.
Ober’s test is a test to check
for iliotibial band contracture.
So the iliotibial band
is lateral leg and could sometimes
cause hip and knee pains.
And this is very frequent in runners
and so what we want to do is
to see if it’s contracted.
So to test this with Ober’s test,
what we’re going to do is support the leg
and test the affected side.
I’m going to put my hand underneath
the knee to support the leg
and I’m going to abduct the hip.
So as I abduct the hip,
it’s going to shorten the IT band,
and if he does have contractures,
as I release his leg down it won’t be smooth.
What you’ll see is as I release the
leg down, it’s going to be
contracted so it’s going to ratchet
down or it may even stay up
based on the severity of the IT band spasms.
So Ober’s test, you’re going
to bring the leg up
and then let it down to see if it’s smooth.
If it’s not smooth, if it ratchets
down or if it stays up,
that’s a positive test for iliotibial
The Trendelenburg test is a test
for gluteus medius weakness.
So what we want to do is to test
to see if the gluteus medius is weak.
We’re going to have our patient
lift up one side
and we’re going to be testing
the gluteus medius
on the side that they’re standing up on.
So here we’re going to have you
pick up your right foot,
good, and bring it back down.
So if they’re able to pick up the leg
and keep it up without their hip dropping
down or falling over,
that means that the gluteus
medius is intact.
You want to do this bilaterally.
So pick up your left side,
good, and back down.
So that would be a negative test.
A positive test would be if someone
picks up their leg
and they kind of fall over or drop down.
So that would be a positive
And since it was positive picking
up the right foot,
and we’re testing the left gluteus medius,
o that would be a positive Trendelenburg
with a sign of possible left gluteus
The hip drop test is a test
that we could perform
to assess lumbar sidebending.
So we’re moving the hips to see
how the lumbar accommodates.
So we want to get eye level
with the lumbar spine.
I’m going to ask the patient to place
his hands on his hips
and we’re going to assess
how the lumbar spine moves when
the patient drops their hips.
So first, bend this knee and keep
this leg straight
and you can see how that drops the hip.
And I’m looking at the lumbar sidebending
when he does that.
We’re going to do the other side.
And now bend the left knee keeping
the right leg straight
and that bends the left side down
and you’re appreciating the curve
as they’re bending the hip.
Straighten up for me.
The side of the greatest drop
is the side of the restricted sidebending.