4. OS COXA (HIP BONE) COMPOSED OF
Ilium
• Largest component; it is a fan like wing and an inferiorly positioned
body it forms 2/5 of the hip bone; the wing serves as the insertion
for the gluteal muscles while the anterior portion of the wing serves
as the proximal attachment of the iliacus
Ischium
• Composed of the ischium and the ramus collectively forming the
ischial tuberosity
• Serves as an attachment to several muscles and the sacrotuberous
ligament; the spine serves as the attachment for the sacrospinous
ligament
Pubis
• Smallest bone consists of a body, inferior and superior rami

5. THE OS COXA

6. ACETABULUM
• Deep seated depression in the lateral pelvis which allows for the proximal
transmission of weight from the axial skeleton to the lower extremity
• It faces laterally, inferiorly & anteriorly; acetabular development is determined by
the age of 8 years, the depth of the acetabulum increases additionally at puberty
due to the development of three secondary centers of ossification
• Inverted horseshoe-shaped area covering the anterior superior and posterior
margins,
• Forms the acetabular notch that is occupied by the ligamentum teres and obturator
artery
• Diameter of the acetabulum is slightly less than that of the femoral head resulting
in an incongruous fit of the joint surfaces.
The purpose of this incongruity unloads the joint during partial weight bearing, by allowing
the femoral head to sublux laterally out of the cup while in full weight bearing the femoral
head is forced into the acetabulum.

7. ACETABULUM

8. FEMUR
• The longest bone in the body and consists of a head, neck and greater and lesser
trochanter
• The fovea capitis, serves as the attachment of the ligamentum teres
• The femoral neck serves to extend the weight bearing forces lateral and inferior to the
joint fulcrum
• The head of the femur is angled anteriorly, superiorly and medially. The femoral neck
is externally rotated with respect to the shaft also the neck forms the angle of
anteversion/declination (in a normal adult, forms an angle of about 125 degrees with
respect to the shaft; in children, 160 degrees)
• Trabecular bone core encased in a thin cortical bone shell
• Trabecular bone in the femoral neck and head is specially designed to withstand high
loads
This however has a point of weakness called the ward triangle which is a common site of
osteoporotic change

9. FEMUR

10. Angle within the frontal
plane between the
femoral neck and the
medial side of the
femoral shaft
Adult: 125 degrees
Acquired or congenital
changes
 Coxa vara: < 105 degrees
 Coxa valga: >140 degrees
ANGLE OF INCLINATION

11. TORSION ANGLE
• Relative rotation in the transverse plane existing between the shaft and
neck of the femur
• Normal is 10-15 degrees anterior to the medial/lateral axis through the
femoral condyles, termed “normal anteversion”
• Torsion angle and inclination angle creates maximal congruency
between femur and acetabulum
• Anteversion: > 15 degrees
• Retroversion: < 10 degrees

12. JOINT CAPSULE
• A cylindrical Sleeve
• Proximally : Pelvis
• Laterally : Acetabular labrum and extends laterally to the femoral head
• Anteriorly : Intertrochanteric fossa
• Both the capsule and the articular cartilage are thicker anterosuperiorly
consequently thinner posteroinferiorly
• Supported by muscles and by intra/extra articular ligaments

14. • Coxa valga: increase in the neck-shaft angle
• Coxa vara: decrease in the neck-shaft angle
• Greater and lesser trochanters are large eminences situated at the
junction of the neck & the shaft
• Trochanters are connected anteriorly by the intertrochanteric line
• Trochanters are connected posteriorly by the intertrochanteric crest
• Linea aspera is where the muscles and intermuscular septa attach
• Lateral and medial femoral condyles are separated posteriorly by the
intercondylar notch
• Medial and lateral femoral epicondyles are situated above the
condyles
• Adductor tubercle is continuous with the medial epicondyle

15. JOINT CAPSULE

17. • Runs from the acetabular
notch to the fovis capitis of
the femur attaching the
femoral head to the inferior
acetabular rim
• Tightens during: Adduction,
flexion and external rotation
• Assists in the stabilization
of the hip joint in functional
ROM by preventing
subluxation of the femoral
head superiorly and
laterally and by checking
the extremes of hip rotation
and adduction
LIGAMENTUM TERES/CAPITIS FEMORAL LIGAMENT

18. • Fibrous link from the inferior
acetabular notch that connects the
anteroinferior and posteroinferior
horns of the semilunar surface of the
acetabulum
• Posterior aspect: bone beneath the
lunate surface
• Anterior aspect: labrum
TRANSVERSE ACETABULAR LIGAMENT

19. TRANSVERSE ACETABULAR LIGAMENT

20. ACETABULAR LABRUM
• A ring consisting of fibrocartilage and dense connective tissue
• Encases the femoral head and is attached to the acetabular margin
• Enhances joint stability decreases force transmitted to the articular cartilage and
provides proprioceptive feedback
• Substantial static stability to the hip joint is provided by deepening of the socket
that is provided by the labrum
• Enhances stability by providing negative intra-articular pressure in the hip joint
• Also known to improve mobility of the hip by providing an elastic alternative to
the bony rim
• Composed of: traingular cross section, internal & external articular surface, basal
surface mostly made up of type I collagen fibers

21. ACETABULAR LABRUM

23. • Iliofemoral ligament
• Consists of 2 parts: inferior (medial) & superior (lateral); strongest ligament of
the body and is oriented superior laterally and blends with the iliopsoas muscle;
limits the range of hip extension and allows the maintenance of the upright
posture and reduces the need for contraction of the hip extensors in balanced
stance; tightened through hip adduction
• Pubofemoral ligament
• Blends with the inferior band of the iliofemoral and the pectineus muscle;
orientation of the pubofemoral ligament is more inferior medial; fibers tighten in
extension and abduction and reinforce the joint capsule along the medial surface
• Ischiofemoral ligament
• Winds posteriorly around the femur and attaches anteriorly, strengthening the
capsule; tightens with internal rotation of the hip and is more commonly injured
than other hip ligaments

24. EXTRA-ARTICULAR LIGAMENTS OF THE HIP

25. HIP JOINT (CLOSED)

26. HIP JOINT (OPEN)

28. MUSCLES
• Iliopsoas
• Made of the psoas and iliacus; most powerful hip flexor, weak adductor and external rotator
of the hip
• Pectineus
• Adductor, flexor internal rotator of the hip
• Rectus Femoris
• Injury can cause capsular adhesion of the hip; flexion of the hip & extension at the knee
• Tensor Fascia Latae
• Counteracts the backward pull of the G.Max on the iliotibial band; assists in flexing, abducting
and internally rotating the hip
• Sartorius
• Longest muscle in the body; flexion abduction and external rotation of the hip; some degree
of hip flexion
• Gluteus Maximus
• Largest and most important hip extensor and external rotator; usually active only when the
hip is in flexion like in stair climbing or when extension of the hip is resisted

29. MUSCLES

30. MUSCLES
• Gluteus Medius
• Main abductor of the hip and primary stabilizer of the hip and pelvis; deltoid of the hip; anterior
portion flexes, abducts and internally rotate the hip; posterior portion extends and externally rotates
the hip; provides pelvic support during one legged stance; decelerator of hip adduction
• Gluteus Minimus
• Major internal rotator of the femur and abducts the thigh and helps with pelvic support
• Piriformis
• Most superior of the external rotators of the hip; at 60deg of hip flexion = ER; at 90deg of hip flexion
reverses its muscle action = IR and abductor of the hip
• Obturator Internus
• Normally an External rotator and internal rotator of the ilium but becomes an abductor of the hip at
90deg of hip flexion
• Obturator Externus
• Adductor and external rotator of the hip
• Gemelli
• Has superior and inferior parts both function as a minor external rotator
• Quadratus Femoris
• External rotator of the hip

31. MUSCLES
Piriformis
G.Med
Gemellus& Obturator

32. HAMSTRINGS
• Biceps Femoris
• Long head: decelerating the limb at the end of swing phase and forceful hip extension;
extends hip flexes knee and externally rotates the tibia
• Semimembranosus & Semitendinosus
• Assist with internal rotation of the thigh and leg
All three muscles of the hamstring complex (except the short head of the biceps) work
with the posterior adductor magnus and the gluteus maximus to extend the hip
Also a knee flexor and a weak hip adductor, long head of biceps femoris: external
rotation of the thigh and leg
• 3 Main functions of the hamstrings while running
1. Decelerate knee extension at the end of forward swing phase, helps provide dynamic
stabilization
2. At foot strike: elongates to facilitate hip extension through an eccentric contraction further
stabilizing the leg
3. Assist the gastrocnemius in extending the knee during takeoff phase of the running cycle

33. HAMSTRINGS

34. HIP ADDUCTORS
• Adductor Magnus
• Most powerful adductor and is active to varying degrees in all hip motions except abduction;
posterior portion is sometimes considered functionally as a hamstring due to anatomic
alignment
• Adductor Longus
• During resisted adduction this is the most prominent muscle and forms the medial border of
the femoral triangle; assists with external rotation, extension and internal rotation;
commonly strained
• Gracilis
• Most superficial and medial also the longest; adducts and flexes the thigh and internally
rotates the leg
Other adductors of the leg include the adductor brevis and pectineus muscles

35. HIP ADDUCTORS

36. HIP FLEXORS SUMMARY
P R I M A R Y
 Iliopsoas
 Sartorius
 Tensor fascia latae
 Rectus femoris
 Pectineus
 Adductor longus
S E C O N D A R Y
 Adductor brevis
 Gracilis
 Gluteus minimus

37. HIP ADDUCTORS
P R I M A R Y
 Adductor longus
 Adductor brevis
 Pectineus
 Gracilis
 Adductor magnus
S E C O N D A R Y
 Biceps femoris
 Quadratus femoris
 Gluteus maximus

38. HIP EXTERNAL ROTATORS
P R I M A R Y
 Gluteus maximus
 Piriformis
 Obturator internus
 Gemellus superior
 Gemellus inferior
 Quadratus femoris
 Sartorius
S E C O N D A R Y
 Gluteus medius
 Gluteus minimus
 Obturator externus
 Biceps femoris

39. HIP INTERNAL ROTATORS
• Gluteus minimus
• Gluteus medius
• Tensor fascia latae
• Adductor longus
• Adductor brevis
• Pectineus
• Semitendinosus
• Semimembranosus

40. HIP EXTENSORS
P R I M A R Y
 Gluteus maximus
 Biceps femoris
 Semitendinosis
 Semimembranosis
 Adductor magnus
S E C O N D A R Y
 Gluteus medius

41. HIP ABDUCTORS
P R I M A R Y
 Gluteus medius
 Gluteus minimus
 Tensor fascia latae
S E C O N D A R Y
 Piriformis
 Sartorius

42. THIGH MOVEMENTS BY COMPARTMENT

44. BURSAE
• Iliopsoas bursa
• Largest and most constant bursa about the hip present in 98% of adult
individuals
• Situated deep to the iliopsoas tendon and serves to cushion the tendon from
the structures on the anterior aspect of the hip joint
• Can become inflamed and distendend MC: RA; can also be associated with
athletic activity; overuse and impingement syndromes; OA; pigmented
villonodular synovitis; villonodular synovitis, synovial chndromatosis,
infection, pseudogout, metastatic bone disease and in rare cases after total
hip athroplasty

45. BURSAE
• Trochanteric bursa
• 2 clinical significant trochanteric bursae: one between the gluteus medius
and minimus and a superficial one located between the greater trochanter
and the TFL; compression and friction of the bursa from an adaptively
shortened TFL can result in trochanteric bursitis
• Ischiogluteal bursa
• Located between the ischium and the gluteus maximus; can be painfully
squeezed between the ischial tuberosity and the hard surface of a chair
during sitting, producing an ischial bursitis (weaver’s bottom)

47. FEMORAL TRIANGLE
• Superior border : Inguinal Ligament
• Lateral border: Sartorius Muscle
• Medial border: Adductor longus Muscle

48. FEMORAL TRIANGLE

49. NEUROLOGY
• Posterior Gluteal Region (Cutaneous)
• Subcostal nerve
• Iliohypogastric nerve
• Posterior Rami of L1-L3
• Posterior Primary Rami of S1-S3
• Anterior Region (Cutaneous)
• Iliohypogastric nerve (superior to the inguinal ligament)
• Subcostal nerve (inferior to the inguinal ligament)
• Fermal branch of the genitofemoral nerve
• Ilioinguinal nerve
Pain referred from the hip joint may be felt anywhere in the thigh leg or
foot

50. VASCULAR SUPPLY
• Medial and lateral femoral circumflex supplies
proximal femur
• Femoral head is supplied by a small branch off
obturator artery
• Acetabulum is supplied by branches from
superior and inferior gluteal arteries

51. HIP MOBILIZATION
• Flexion: Femur rolls superior and glides inferior on
pelvis
• Abduction: Femur rolls lateral/superior & glides inferior
on pelvis
• IR: Femur rolls medial & glides lateral on pelvis
• Extension: Femur rolls inferior & glides superior on
pelvis
• Adduction: Femur rolls medial/inferior & glides superior
on pelvis
• ER: Femur rolls lateral & glides medial on pelvis

53. OSTEOKINEMATICS AND ARTHROKINEMATICS
• Resting position: 30deg flexion, 30deg
abduction, slight lateral rotation for OPP (slight
ER)
• Convex: Femur
• Concave: Acetabulum
• Motion: Opposite direction
• CPP: Max, ER, ABd
• Capsular Pattern : Flexion, abduction, medial
rotation

54. NORMAL RANGES AND END FEELS AT THE HIP
MOTION ROM (DEGREES) END FEEL
FLEXION 110-120 TISSUE APPROXIMATION/
TISSUE STRETCH
EXTENSION 10-15 TISSUE STRETCH
ABDUCTION 30-50 TIISUE STRETCH
ADDUCTION 25-30 TISSUE APPROXIMATION/TISSUE
STRETCH
EXTERNAL ROT. 40-60 TISSUE STRETCH
INTERNAL ROT. 30-40 TISSUE STRETCH

55. PELVIC MOTIONS
• Hip flexors cause an anterior pelvic tilt
• Hip extensors a posterior pelvic tilt
• Abductors and adductors a lateral pelvic tilt
• Rotators of the hip cause rotation
To prevent excessive pelvic motion when moving
the femur at the hip joint, the pelvis must be
stabilized by the abdominals, erector spinae,
multifidus and quadratus lumborum muscles

56. • Results in hip flexion and
increased lumbar spine
extension
• Caused by hip flexors and
back extensors
• Line of gravity falls
anterior to the axis of the
hip joint, stability is
provided by the
abdominals and hip
extensors
ANTERIOR PELVIC TILT

57. • Results in hip extension
and lumber spine flexion
• Caused by hip extensors
and trunk flexors
• Line of gravity of the tunk
falls posterior to the axis
of the hip joints, dynamic
stability is provided by the
hip flexors and back
extensors and passively
by the iliofemoral ligament
POSTERIOR PELVIC TILT

58. * The pelvic
crossed syndrome
is exhibited by
adaptively
shortened hip
flexors and
hamstrings and
inhibited glutei
muscles and
lumbar errector
spinae

61. NORMAL GAIT (SWING PHASE 40%)
Initial swing Midswing Terminal swing
Flexion 20deg Flexion 20-
30deg
Flexion 30deg
*Requirements for Normal Gait (ROM)
• Hip extension 0-10 deg
• Hip flexion 0-30 deg

62. NORMAL GAIT (STANCE PHASE 60%)
Initial
Contact
Loading
Response
Midstance Terminal
Stance
Pre-swing
Flexion
30deg
Flexion
30deg
Extending
to Neutral
Apparent
Hyperextension
Neutral
Extension

63. GAIT DEVIATIONS
Insufficient
Hip flexion at
initial contact
Insufficient
hip extension
at stance
Circumduction
during swing
Hip hiking
during swing
Exaggerated
hip flexion
during swing
 Weak hip
flexors
 Hip flexor
paralysis
 Hip extensor
Spasticity
 Insufficient
hip flexion
ROM
 Insufficient
hip
extension
ROM
 Hip flexion
contracture
 LE flexor
synergy
 Compensation
for weak hip
flexors
 Compensation
for weak
dorsiflexors
 Compenssatio
n for weak
hamstrings
 Compensation
for weak
dorsiflexors
 Compensation
for weak knee
flexors
 Compensation
for externsor
synergy
pattern
 Lower
extremity
flexor
synergy
 Compensati
on for
insufficient
hip flexion or
dorsiflexion

65. • Axis: over the
lateral aspect of
the hip joint using
the greater
trochanter of the
femur for
reference
• Stationary arm:
lateral midline of
the pelvis
• Moveable arm:
lateral midline of
the femur using
the lateral
epicondyle
FLEXION

66. • Axis: over the lateral
aspect of the hip joint
using the greater
trochanter of the
femur for reference
• Stationary arm: lateral
midline of the pelvis
• Moveable arm: lateral
midline of the femur
using the lateral
epicondyle for
reference
EXTENSION

67. • Axis: over the ASIS of
the extremity being
measured
• Stationary arm: align
with imaginary
horizontal line
extending from one
ASIS to the opposite
• Moveable arm:
anterior midline of the
femur using the
midline of the patella
for reference
ABDUCTION

68. • Axis: over the ASIS of
the extremity being
measured
• Stationary arm: align
with imaginary
horizontal line
extending from one
ASIS to the opposite
• Moveable arm:
anterior midline of the
femur using the
midline of the patella
for reference
ADDUCTION

69. • Axis: Anterior aspect
of the patella
• Stationary arm:
perpendicular to the
floor or parallel to the
supporting surface
• Moveable arm:
anterior midline of the
lower leg using the
crest of the tibia and
a point midway
between the two
malleoli for reference
MEDIAL ROTATION

70. • Axis: Anterior aspect
of the patella
• Stationary arm:
perpendicular to the
floor or parallel to the
supporting surface
• Moveable arm:
anterior midline of the
lower leg using the
crest of the tibia and
a point midway
between the two
malleoli for reference
LATERAL ROTATION

72. DIAGNOSIS Physical Findings INTERVENTION
Legg-Calve-Perthes dse. Limited hip abduction,
flexion and internal
rotation
Maintain ROM follow
position of femoral head in
relation to acetabulum
Slipped capital femoral
epiphysis
Pain and limited internal
rotation, leg more
comfortable in external
rot; LLD
NWB and surgical pinning
Avulsion Fracture Pain on passive stretch,
active contraction and
palpation
ROM & Strengthening Ex
Hip Pointer Tenderness over iliac
crest pain on ambulation
and active abduction
Rest, ice, NSAID, local
steroid & anesthesia
Contusion Pain on palpation and
motion and ecchymosis
Rest, ice, compression,
static stretch and NSAIDs

73. DIAGNOSIS PHYSICAL FINDINGS INTERVENTION
Myositis Ossificans Pain on palpation; firm
mass may be palpable
Ice, stretching, NSAIDs, surgical
resection after 1 year if conservative
treatment fails
Femoral Neck
Stress Fx
ROM may be painful,
pain on palpation of
greater trochanter
No weight bearing until evidence of
healing with gradual return to
activities; superior surface fx: ORIF
Osteoid Osteoma Restricted motion and
quadriceps atrophy
Surgical removal; Aspirin NSAIDs
Iliotibial band
syndrome
Positive Ober’s Test Modified activity, footwear, stretching
program, ice, NSAIDs
Trochanteric
Bursitis
Pain on palpation Ice, NSAIDs, stretching and
protection from trauma, steroid
injection
Avascular Necrosis
of the Femoral
Head
Pain on ambulation,
abduction IR ER
Protected weight bearing,
strengthening, THA
Piriformis
syndrome
Pain on active ER;
passive IR and
Stretching, NSAIDs, relative rest and
correction of offending cavity

74. COMMON CAUSES OF HIP AND THIGH PAIN
CONDITION DESCRIPTION OF FINDINGS
OA of the hip Tenderness over ant. hip capsule; pain by passive rotation; restricted
ROM; +Stinchfield test; abductor limp, Functional LLD
Hip fx Tenderness over the ant. hip capsule or intertrochanteric region; Limb
ER and shortened; +Stinchfield test
Meralgia
Parasthetica
Altered Sensation over anterolateral thigh; symptom reproduced by
pressure or percussion just medial to the anterior-superior iliac spine
Piriformis
Tendinitis
Tenderness to deep palpation near the hook of the greater trochanter;
Pain reproduced by piriformis stretch
G.Max
Tendinitis
Tenderness near the gluteal fold at the inferior aspect of the gluteus
max; +Yeoman’s test

75. COMMON CAUSES OF HIP AND THIGH PAIN
CONDITION DESCRIPTION OF FINDINGS
G.Med
tendinitis
Tenderness just proximal to the greater trochanter; Pain by resisted
abduction of the hip
Trochanteric
bursitis
Tenderness over the lateral aspect of the greater trochanter; +Popping
and Crepitation with flexion-extension of hip; tight ITB +Ober’s test
Quads strain
or contusion
Tenderness and swelling of the involved area; weakness; restriction of
knee flexion esp with hip extended; warmth and firmness
Hamstring
strain
Localized tenderness and swelling; ecchymosis; restricted knee
flexion and straight leg raising; abnormal tripod sign
Pelvis fx or
disruption
Tenderness of the pubic symphysis, iliac crest, sacroiliac jts; pain
+lateral pelvic compression test, anteroposterior pelvic compression
test, pubic symphysis test, Patrick’s test or Gaenslen’s test

76. POTENTIAL CAUSES OF HIP PAIN
Type of Pain/Structure Cause
Articular cartilage Chondral lesion; OA
Childhood d/o Congenital Dysplasia; Legg-Calve-
Perthes; Slipped capital femoral
epiphysis
Inflammation Trochanteric bursitis; Psoas
bursitis; Tendinitis; Toxic Synovitis
Infection Septic arthritis; Osteomyelitis
Labra tear None specified
Neoplasm None specified
Neurologic Local Nerve entrapment

77. POTENTIAL CAUSES OF HIP PAIN
Type of Pain/Structure Cause
Overuse Stress fx of femur; strains; inguinal
hernia; femoral hernia
Referred Lumbar disk pathology; lumbar
spine DJD; athletic pubalgia;
radiculopathy; piriformis syndrome;
SI jt pathology; GUT pathology;
Abdominal wall pathology
Systemic RA; Crohn’s dse; Psoriasis;
Reiter’s Syndrome; SLE
Trauma Soft tse contusion; fx of femoral
head; dislocation of femoral head;
avulsion injury; Myosistis
ossificans
Vascular Avascular Necrosis; Osteonecrosis

78. MEDICAL RED FLAGS
• Pain at McBurney’s point: 1/3 the distance from R ASIS to umbilicus = appendicitis
• Blumberg’s Sign: rebound tenderness in supine select a site away from the painful
area, place your hand perpendicular to the abdomen and pushdown deep and slow lift
up quickly = (+) peritonitis
• Psoas test: supine, SLR to 30deg & resist hip flexion = (+) pelvic inflammation or
infection in lower quad abdominal pain; hip or back pain if (-)
• Enlarged inguinal lymph nodes
• Hip pain 18-24 screen for testicular cancer
• Systemic causes of hip pain
Bone tumors
Crohn’s Disease
Inflammatory bowel
Pelvic inflammatory disease
Ankylosing spondylitis
Sickle Cell anemia
Hemophilia

79. SYNERGY PATTERNS OF THE HIP
F L E X O R S Y N E R G Y
• Abduction and
lateral rotation
E X T E N S O R S Y N E R G Y
• Extension and
medial rotation
and adduction

80. ASSESSMENT OF THE HIP

82. • Asses for tight
hip flexors
• Supine with
lumbar spine
stabilized &
involved LE
extended
• Flex
contralateral
hip to the
abdomen
THOMAS TEST

83. • Assess for tight
rectus femoris
• Sidelying to
prone, hip
extension
• Flex knee
• Inability to
maintain hip
extension when
knee is flexed
ELY’S TEST

84. • Assess for tight
ITB
• Sidelying with
involved hip up
• Extend involved
hip & allow LE
to drop into
adduction
• (+) if LE fails to
drop
OBER’S TEST

85. • Assess for labral tear
• Supine flex hip to 90
• IR/ER hip with abd/add while applying a
compressive force down femur
• (+) clicking, grinding or pain due to arthritis,
labral tear, avascular necrosis, osteochondral
defect
SCOUR TEST

86. ANTERIOR AND POSTERIOR LABRAL TESTS
• Assess for labral tear
•Ant: Supine in PNF D2 flexion (flex, ER & Abd)
•Post: Supine in PNF D1 flexion (flex, IR & Add)
•To test Ant: Resist D2 extension (ext, IR &Add)
Post: Resist D1 extension (ext, ER & Abd)
• (+) reproduction of pain or click

87. • Assess SI jt pathology
• Supine – passiely flex,
abd & ER so that the
lateral malleolus of the
involved LE is on the
other knee
• Apply overpressure to
flexed knee
• (+) pain 2dary to OA,
osteophytes,
intracapsular FX or
LBP 2dary to SI Px:
tightness without pain
is (-) may indicate
problem with sartorius
muscle
FABER (PATRICK’S) TEST

88. • Weakness of
G.Med
• Standing
• Flex the
contralateral LE:
iliac crest on WB
side should be
lower than the
NWB side
• (+) dropping of the
NWB limb is 2dary
to abductor
weakness
TRENDELENBURG’S TEST

89. • Assess for tight
piriformis
• Supine or contralateral
sidelying
• Flex hip to 70-80 with
knee flexed & maximally
adduct LE (apply
downward force to the
knee)
• (+) pain in buttock &
sciatica; IR stresses
superior fibers; ER
stresses inferior fibers
PIRIFORMIS TEST

90. ORTOLANI’S AND BARLOW’S TESTS
O R T O L A N I ’ S T E S T
• Asses for congenital hip
dislocation
• Supine knees and hip flexed
to 90; clinician’s thumbs are
on the medial thigh and
fingers on the lateral thigh
• Firmly traction the thigh while
gently abducting the leg so
that the femoral head is
translated anterior into the
acetabulum
• (+) reduction of the hip and
audible clunk
B A R L O W ’ S T E S T
• Assess for hip dysplasia
• Supine 90/90; clinician’s
thumbs are on the infant’s
medial thigh & fingers on
the lateral thigh
• Apply a posterior force
thru the femur as the thigh
Is gently adducted
• (+) examiner’s finger that
is on the greater
trochanter will detect a
palpable dislocation

93. AVASCULAR NECROSIS OF THE HIP
• Medications
Acetamenophen for pain
NSAIDs for pain/inflammation
Corticosteroids contraindicated since they may be causative factor
Steroid dose for other pathology should be decreased
• PT goals, outcomes and intervention
Joint and bone protection
Maintain/Improve joint mechanics and connective tissue functions
Implementation of aerobic capacity/endurance conditioning or
reconditioning such as aquatic programs
Postsurgical Intervention: regaining functional flexibility, improving
strength/endurance/coordination and gait training

95. LEGG-CALVE-PERTHES DISEASE
• Medications
Acetaminophen for pain
NSAIDs for pain and inflammation
• PT goals, outcomes and intervention
Joint/bone protection strategies
Maintain/Improve joint mechanics and connective tissue functions
Implementation of aerobic capacity/endurance conditioning or
reconditioning such as aquatic programs
Post surgical intervention: regaining functional flexibility, improving
strength/endurance/coordination and gait training

96. OSTEOCHONDROSIS

97. SLIPPED CAPITAL FEMORAL EPIPHYSIS
• Medications
Acetaminophen for pain
NSAIDs for pain and inflammation
• PT goals, outcomes and intervention
Joint/bone protection strategies
Maintain/Improve joint mechanics and connective tissue functions
Implementation of aerobic capacity/endurance conditioning or
reconditioning such as aquatic programs
Post surgical intervention: regaining functional flexibility, improving
strength/endurance/coordination and gait training

98. SLIPPED CAPITAL FEMORAL EPIPHYSIS

99. FEMORAL ANTEVERSION AND ANTETORSION
• PT goals, outcomes and intervention
•Maintain/Improve joint mechanics and
connective tissue functions

100. COXA VARA AND COXA VALGA
• PT goals, outcomes and intervention
•Maintain/Improve joint mechanics and
connective tissue functions

101. TROCHANTERIC BURSITIS
• Medications
Acetaminophen for pain
NSAIDs for pain and inflammation
• PT goals, outcomes and interventions
Implementation of flexibility exercises
Manual therapy for joint mechanics
oSoft tissue massage techniques and joint oscillations to reduce pain or
muscle guarding
oBiomechanical causes corrected with joint mobilization
Implementation of aerobic capacity/endurance conditioning exercises
Application of thermal agents for pain reduction, edema reduction and
muscle performance
Patient education and training for instrumental activities (IADL)

102. TROCHANTERIC BURSITIS

103. ITB TIGHTNESS/FRICTION DISORDER
• Medications
Acetaminophen for pain
NSAIDs for pain and inflammation
• PT goals, outcomes and interventions
Reduction of pain and inflammation using modalities, soft tissue
techniques and manual therapy techniques (PJM/massage)
Correction of muscle imbalances and biomechanical faults using
strengthening, endurance, coordination and flexibility on ITB, hamstrings,
quads, hip flexors
Gait training and patient education regarding the selection of running
shoes and running surfaces
Orthoses may be fabricated

104. ITB TIGHTNESS/FRICTION DISORDER

105. PIRIFORMIS SYNDROME
• Medications
Acetaminophen for pain
NSAIDs for pain and inflammation
• PT goals, outcomes and interventions
Reduction of pain and inflammation using modalities, soft tissue techniques and
manual therapy techniques (PJM/massage)
Correction of muscle imbalances and biomechanical faults using strengthening,
endurance, coordination and flexibility exercises
Restore muscle balance and patient education regarding protection of the
sacroiliac joint (instruction not to step off a curb into dysfunctional lower
extremity)
Correction of biomechanical faults may include orthoses or orthotic devices for
feet

106. PIRIFORMIS SYNDROME

107. TOTAL HIP REPLACEMENT
• PT goals, outcomes, interventions
Patient should avoid the position of hip flexion >90deg with
adduction and internal rotation, partial weight bearing to
tolerance is initiated on the second postsurgery day using
crutches or a walker with typical surgical procedures
Focus on mobility, transitional movements, ambulation and
return to premorbid ADL

108. TOTAL HIP REPLACEMENT

109. BURN PROFILE OF THE HIP
• Anticipated deformity: Flexion and adduction
• Splinting type: Anterior hip spica, abduction splint
• PT intervention and goals
Positioning
Splinting
Edema control
Scar management
PROM
Massage
Conditioning and Endurance training
PJM, electrotherapeutic modalities, compression devices, hydrotherapy,
physical agents

110. References:
Orthopaedic
examination, evaluation,
intervention – Mark
Dutton
Therapeutic Exercise –
Kisner & Colby
NPTE Review and
Study guide 2011 –
Susan B. O’Sullivan &
Raymond P. Siegelman
OrthoNotes – Dawn
Guilick
PT EXAM The Complete
Study guide – Scott M.
Gilles
Orthopedic Physical
Assessment – Magee