Hip Joint

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Hip Joint

• Part (5)
• Hip External Internal Rotation

2

• Hip External Rotation Goniometry

3

• ? Range of motion ?
• 0 to 45
• ?Testing position ?
• Sitting on a supporting surface with knees flexed
  90 degrees and the hip in 90 degrees of flexion
• ?Stabilization ?
• Stabilize the distal end of femur to prevent
  abduction or further flexion of the hip. Avoid
  rotation and lateral tilting of the pelvis.

4

• ? Goniometer Alignment?
• Fulcrum
• Anterior aspect of the patella
• Proximal Arm
• Align it perpendicular to the floor
• Distal Arm
• Alight it with the anterior midline of the lower
  leg, using the crest of the tibia and a point
  midway between the two malleoli for reference

5

• ? Patient Instruction ?
• Ask the patient to move their leg in toward the
  opposite leg.

6

• ? Normal End Feel ?
• Firm, because of tension in
• Anterior joint capsule
• Iliofemoral ligament
• Pubofemoral ligament
• Anterior portion of gluteus medius
• Gluteus minimus
• Adductor magnus
• Adductor longus
• Pectineus
• Piriformis

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• Hip External Rotation Muscle Testing

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? Hip External Rotation Muscles ?

• Obturator externus
• Obturator internus
• Quadratus femoris (may be absent)
• Piriformis
• Gemellus superior
• Gemellus inferior
• Gluteus maximus (posterior)

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Obturator Externus

• Origin
• Obturator membrane ramus of ischium inferior
  ramus of pubis pelvis

• Insertion
• Trochanteric fossa of femur

• Innervation
• Obturator Nerve (L3-L4)

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Obturator Internus

• Origin
• Inferior ramus of pubis ramus of ischium
  obturator fascia obturator foramen obturator
  membrane upper brim of greater sciatic foramen

• Insertion
• Greater trochanter of femur

• Innervation
• Nerve to obturator internus (L5-S1)

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Quadratus femoris

• Origin
• Ischial tuberosity

• Insertion
• Quadrate tubercle on the trochantric crest of
  femur

• Innervation
• Nerve to quadratus femoris (L5-S1)

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Piriformis

• Origin
• Sacrum ilium sacrotuberous ligament capsule
  of sacroiliac joint

• Insertion
• Greater trochanter of the femur

• Innervation
• Nerve to piriformis (S1-S2)

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Gemellus Superior

• Origin
• Ischium

• Insertion
• Greater trochanter of the femur

• Innervation
• Nerve to obturator internus (L5-S1)

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Gemellus Inferior

• Origin
• Ischial tuberosity

• Insertion
• Greater trochanter of the femur

• Innervation
• Nerve to quadratus femoris (L5-S1)

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Gluteus Maximus

• Origin
• Posterior gluteal line of the ilium Iliac crest
  Sacrum coccyx Aponeurosis over gluteus medius

• Insertion
• Femur (gluteal tuberosity) Iliotibial tract of
  fasia lata

• Innervation
• Inferior Gluteal Nerve (L5-S2)

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• ? Test For Grades 5, 4 and 3 of ?

? Patient Position ? Short sitting, trunk may be
supported by placing hands flat at sides.
? Therapist and Patient Instructions   ? The
therapist sitting or kneeling in front of the
patient, placing one hand on the lateral aspect
of the knee and the other hand just above the
medial malleolus. The resistance will be inward
at the knee and outward at the ankle to create a
sort of rotary resistance. The patient should be
in the end position for testing. End Positioning
means that the patient is trying to hold the
movement at the end of the ROM. Ask the patient
to, bring your leg inward toward your other leg,
dont let me turn your leg out.
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• ? Test For Grade 2 ?

? Patient Position ?   Supine. The test limb is
in internal rotation.

• Therapist and Patient Instructions ?
• The therapist should be standing at side of limb
  to be tested. Patient externally rotates hip in
  available range of motion. One hand may be used
  to maintain pelvic alignment at lateral hip. Tell
  the patient Roll your leg out

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• ? Test For Grades 1 and 0 ?

? Patient Position ? Supine. The test limb is in
internal rotation.
? Therapist Position ? Standing at side of limb
to be tested.
? Patient Instructions  ?   patient attempts to
externally rotate the hip. Ask the patient to,
Try to bring your leg out.
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• Hip Internal Rotation Goniometry

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• ? Range of motion ?
• 0 to 45
• ?Testing position ?
• Sitting on a supporting surface with knees flexed
  90 degrees and the hip in 90 degrees of flexion
• ?Stabilization ?
• Stabilize the distal end of femur to prevent
  abduction, adduction, or further flexion of the
  hip. Avoid rotation and lateral tilting of the
  pelvis.

21

• ? Goniometer Alignment?
• Fulcrum
• Anterior aspect of the patella
• Proximal Arm
• Align it perpendicular to the floor
• Distal Arm
• Alight it with the anterior midline of the lower
  leg, using the crest of the tibia and a point
  midway between the two malleoli for reference

22

• ? Patient Instruction ?
• Ask the patient to bring their leg out to the
  side.

23

• ? Normal End Feel ?
• Firm, because of tension in
• Posterior joint capsule
• Ischiofemoral ligament
• Piriformis
• Obturator internus
• Obturator externus
• Gemellus superior
• Gemellus inferior
• Quadratus femoris
• Posterior fibers of gluteus medius
• Gluteus maximus

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• Hip Internal Rotation Muscle Testing

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? Hip Internal Rotation Muscles ?

• Gluteus minimus
• Gluteus medius
• Tensor fasciae latae

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Gluteus Minimus

• Origin
• Ilium Greater sciatic notch

• Insertion
• Greater trochanter of the femur Fibrous capsule
  of hip joint

• Innervation
• Superior Gluteal Nerve (L4-S1)

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Gluteus Medius

• Origin
• Ilium Fascia over the upper part

• Insertion
• Greater trochanter of the femur

• Innervation
• Superior Gluteal Nerve (L4-S1)

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Tensor Fasciae Lata

• Origin
• Iliac crest Anterior superior iliac spine

• Insertion
• Iliotibial tract

• Innervation
• Superior Gluteal Nerve (L4-S1)

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• ? Test For Grades 5, 4 and 3 of ?

? Patient Position ? Short sitting, arms may be
used for trunk support or may be crossed over
chest.
? Therapist and Patient Instructions   ? The
therapist sitting or kneeling in front of the
patient, placing one hand on the medial aspect of
the knee and the other hand just above the
lateral malleolus. Resistance will be in an
outward direction at the knee and in an inward
direction at the ankle to create a rotary
resistance. The patient should be in the end
position for testing. Ask the patient to, move
your leg outward, dont let me pull it back in.
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• ? Test For Grade 2 ?

? Patient Position ?   Supine. The test limb is
in external rotation.

• Therapist and Patient Instructions ?
• The therapist should be standing at side of limb
  to be tested. Palpate the internal rotators and
  ask the patient to try and roll their leg in
  toward their other leg.

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• ? Test For Grades 1 and 0 ?

? Patient Position ? Supine. The test limb is in
external rotation.
? Therapist Position ? Standing at side of limb
to be tested.
? Patient Instructions  ?   Patient attempts to
internally rotate the hip. One hand is used to
palpate gluteus medius over the posterolateral
surface of the hip above the greater trochanter.
The other hand palpates tensor fasciae latae on
the anterolateral surface of the hip below the
ASIS. Ask the patient to, Try to bring your leg
in.
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? Good Luck To You All ?