Updated: 6/17/2018

Hip Physical Exam - Adult

Review Topic
  • 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
  •  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
  •  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
  • 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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