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Updated: Jun 9 2021

Hip Physical Exam - Adult

  • Inspection
    • Skin
      • Discoloration, wounds, or gross deformity
    • Bony
      • Length - compare to contralateral side
      • Position - internally or externally rotated; flexion contractures
      • Gross deformity
    • Gait
      • Observe the stride length, foot rotation, pelvic rotation, stance phase
      • Antalgic (painful)
        • shortened stance phase on affected side
      • Trendelenberg
        • secondary to abductor weakness
        • weight bearing on the affected hip leads to a contralateral hip drop
  • Palpation
    • Greater Trochanter / Bursea
      • Pain can be attributable to bursitis, tendonitis, infection, or fracture
      • Snapping Iliotibial band
        • ITB can snap over GT and cause pain
    • Anterior Superior Iliac Spine
      • pain with sartorius avulsions / injuries
    • Ischial tuberosity
      • pain with hamstring avulsions / tendinopathy
    • Iliac crest
      • pain with oblique avulsions / hip pointers
    • Iliotibial band / TFL
  • Neurovascular
    • Motor
      • hip adduction - obturator nerve
      • thigh abduction - superior gluteal nerve
      • hip flexion - femoral nerve
      • hip extension - inferior gluteal nerve
    • Sensory
      • proximal anteromedial thigh - genitofemoral nerve
      • inferomedial thigh - obturator nerve
      • lateral thigh - lateral femoral cutaneous nerve
      • anteromedial thigh - femoral nerve
      • posterior thigh - posterior femoral cutaneous nerve
    • Pulses
      • femoral
    • Reflexes
      • none
  • ROM
    • Flexion
      • 120-135 deg
      • Thomas test
        • evaluates hip flexion contractures
    • Extension
      • 20-30 deg
    • Abduction
      • 40-50 deg
    • Adduction
      • 20-30 deg
    • Internal rotation
      • 30 deg
    • External rotation
      • 50 deg
  • Special Tests
    • FADIR test
      • hip Flexed to 90 deg, ADducted and Internally Rotated
      • positive test if patient has hip or groin pain
      • can suggest possible labral tear or FAI
    • FABER test (aka Patrick's test)
      • hip Flexed to 90 deg, ABducted and Externally Rotated
      • positive test if patient has hip or back pain or ROM is limited
      • can suggest intra-articular hip lesions, iliopsoas pain, or sacroiliac disease (posteriorly located pain)
    • Log roll test
      • passive maximal internal and external rotation of lower extremity while supine
      • clicking or popping suggest acetabular labral tear
      • increased total ROM compared to contralateral side suggests ligament or capsular laxity
    • Thomas test
      • with patient supine, fully flex one hip.
      • if contralateral hip lifts off table, there is likely a fixed flexion deformity
    • Ober's test
      • patient placed in lateral position with affected side up
      • with hip in slight extension, abduct the leg then allow it to drop into adduction
      • if unable to adduct leg, suspect tight ITB
    • Stinchfield resisted hip flexion test
      • with patient supine and extended knee, examiner resists active hip flexion past 30-45 deg
      • a positive test ellicits pain which is likely to be associated with an intraarticular hip pathology
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