The Hip Exam for the Generalist Alan Zhang MD Assistant Professor - - PDF document

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The Hip Exam for the Generalist

Alan Zhang MD

Assistant Professor Sports Medicine and Hip Arthroscopy UCSF Department of Orthopaedic Surgery

The Layers of the Hip

• To treat hip pathology-
• 1st task is to understand the source of hip pain
• Bryan Kelly et al Arthroscopy 2012
• Layer 1- Osteochondral
• Layer 2- Inert
• Layer 3- Contracile
• Layer 4- Neuromechanical

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Layer 1- Osteochondral

• Structures
• Femur
• Acetabulum
• Articular cartilage
• Pathology
• Cam impingement
• Pincer impingement
• Subspine impingement
• Articular cartilage delamination

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Layer 2- Inert

• Structures
• Capsule
• Labrum
• Ligamentum teres
• Pathology
• Labral tear
• Capsular instability
• Adhesive capsulitis

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Layer 3- Contractile

• Structures
• Muscles crossing hip
• Pelvic floor
• Lumbosacral muscles
• Pathology
• Gluteus medius tear
• Hip flexor strain
• Proximal hamstring strain
• Adductor tendinopathy

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Layer 4- Neuromechanical

• Structures
• Neuro-vascular structures in

hip region

• Regional mechanoreceptors
• Pathology
• Pain syndromes
• Neuromuscular dysfunction

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Location, Location, Location

• Anterior/groin
• FAI
• Arthritis
• Flexor strain
• Lateral/thigh
• Trochanteric pathology
• Snapping hip
• Buttock/posterior
• Low back/sciatic nerve
• Referred pain

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Physical Exam

• Asses ambulation
• Antalgic gait

‒ Arthritis/acute injury

• Trendelenberg gait/Single leg stance

‒ Trochanteric pathology ‒ Gluteus tear

• FAI gait

‒ Loss of peak hip extension

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Trendelenberg Gait FAI gait

• FAI gait
• Loss of peak hip extension
• Zhang et al AJSM 2016
• Increased hip joint loading in

FAI patients

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Supine Exam

• ROM
• Strength testing
• Provocative exams

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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

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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
• Sports hernia exam
• Straight leg raise

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Log Roll

• Assess for

intra-articular hip pathology

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Flexion ADduction Internal Rotation

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FADIR for FAI FABER Test

• SI pathology
• Sometimes anterior labral pathology

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Flexion ABduction External Rotation Labral Testing/Scour Test

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Sports Hernia (Athletic Pubalgia)

• Strain or tear of soft

tissue in lower abdomen

• r groin area
• Inguinal disruption
• Adductor injury
• Abdominal wall injury

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Sports Hernia Exam

• Palpation
• Pubic symphysis/Pubic tubercle
• Insertion of rectus (confluence of structures)
• Adductor origin (AL, AB, pectineus)
• Superficial inguinal ring

‒ Rule out true hernia ‒ Size of ring (dilation indicates weakened area) ‒ Check tenderness of posterior wall

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Sports Hernia Exam

• Special maneuvers
• Resisted sit up (legs

straight, 10-30 deg trunk flexion)

• Adductor Squeeze test (0

deg and 90 deg of hip flexion) – pain/strength

• Valsalva

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Straight Leg Raise

• Hamstring

tightness

• Radiating pain

(lumbar radiculopathy)

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Lateral Exam

• OBER test
• IT band tightness
• Palpate Greater Trochanter
• Trochanteric bursitis
• Gluteus Medius strength testing

Ober Test

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Gluteus Medius Strength Test

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Prone exam

• Hamstring exam
• Palpate for defects
• Evaluate for weakness

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Thank You

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