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