hip lab exercise presentation based on the textbook by stanley hoppenfeld: physical examination of...

Hip Lab Exercise

Presentation based on the textbook by Stanley Hoppenfeld:Physical Examination of the Spine & Extremities

Presentation Created By: Jennifer Hurrell, PT, MS

Associate Professor

Community College of Rhode IslandRehabilitative Health DepartmentRHAB1110: Kinesiology

Jennifer Hurrell, PT, MS September 2004/ Rev. May 2007

Learning Objectives1) Identify the specified bony landmarks of the bones of the

hip on disarticulated bones

2) Identify the joints of the hip on a skeletal model

3) Locate the origins and insertions of the hip muscles on a skeletal model

4) Demonstrate the anatomical course of the hip muscles on a skeletal model

5) Identify bony and soft tissue structures that are palpable in the hip region

6) Palpate specified hip structures by correlating anatomical structures with surface anatomy landmarks

7) Perform, describe and name various special tests that screen for common pathological conditions of the hip


Bony Landmarks Identify these landmarks on the disarticulated bones

Femur cont. Adductor Tubercle Linea Aspera Pectineal Line Gluteal Tuberosity Patellar Surface

Tibia Tibial Tuberosity

Innominate Bone Acetabulum

Femur Head Neck Greater Trochanter Lesser Trochanter Intertrochanteric Line Intertrochanteric Crest Body Medial Condyle Lateral Condyle Lateral Epicondyle Medial Epicondyle


Hip Joint

Joints & ArticulationsIdentify these joints & articulations on the skeleton


MusclesLocate these muscle origins & insertions on the skeletonAnterior Muscles Iliopsoas Rectus Femoris Sartorius

Medial Muscles Pectineus Adductor Longus Adductor Brevis Adductor Magnus Gracilis

Posterior Muscles Semitendinosus Semimembranosus Biceps Femoris Gluteus Maximus Deep Rotator Muscles

Lateral Muscles Tensor Fascia Latae Gluteus Minimus Gluteus Medius


Bony PalpationGreater Trochanter With your patient in supine, place your

thumbs on the ASIS’s and move your fingers about 3” posteriorly along the iliac crest to the widest part of the pelvis known as the iliac tubercles. Now, move your fingers caudally from the iliac tubercles until you can palpate the greater trochanters. The posterior edge of the trochanter is most palpable. The examiner can also passively internally and externally rotate the femur to facilitate identification of this landmark.

Hoppenfeld Figure 6-3


The Femoral TriangleBorders Superior Border = Inguinal Crease

Medial Border = Adductor Longus

Lateral Border = Sartorius

*To facilitate palpation of these structures, place your patient in hip flexion, abduction and ER, with their heel resting on the opposite knee



Soft Tissue PalpationAdductor Longus The adductor longus is the most

superficial adductor muscle and the only one accessible for palpation. It is palpable as a cordlike structure proximally near the pubic symphysis and can be felt running toward the middle of the thigh. It is often strained during sports or activity.



Soft Tissue PalpationSartorius This long, straplike muscle can be

palpated near it’s origin, slightly below the ASIS.



The Femoral TriangleInterior Structures Inguinal Ligament

Femoral Artery

Femoral Nerve & Vein (not palpable)

*To facilitate palpation of these structures, place your patient in hip flexion, abduction and ER, with their heel resting on the opposite knee



Soft Tissue PalpationInguinal Ligament

This ligament is palpable between the ASIS and the pubic tubercle. Any unusual bulges along this ligament may be indicative of an inguinal hernia.



Soft Tissue PalpationFemoral Artery

The femoral artery passes under the inguinal ligament at it’s midpoint. Palpate the pulse of this artery just inferior to the ligament at it’s midpoint.



Soft Tissue PalpationTrochanteric Bursae

The trochanteric bursae covers the posterior portion of the greater trochanter. This structure is not distinctly palpable unless it is distended or inflamed, in which case it will feel boggy and be tender to palpation.



Soft Tissue PalpationGluteus Medius Muscle

This muscle is most easily palpated with the patient in sidelying and with the leg actively raised into a few degrees of abduction. It is palpable just below the iliac crest and also at it’s insertion, on the anterior and lateral aspects of the greater trochanter.



Soft Tissue PalpationSciatic Nerve

When the hip is extended, the sciatic nerve is covered by the gluteus maximus, but is exposed during hip flexion. Place your patient sidelying with the hip flexed. In some individuals the sciatic nerve is palpable midway between the greater trochanter and the ischial tuberosity.



Soft Tissue PalpationRectus FemorisThe rectus femoris is the only two-joint muscle of the quadriceps muscles. Except in individuals with very developed musculature, it is not distinctly palpable from the other three heads of the quadriceps, however tenderness over the area of it’s origin at the AIIS can indicate avulsion. The quadriceps muscle group covers the vast area on the anterior aspect of the femur. Palpate the vicinity of this muscle.



Soft Tissue PalpationGluteus Maximus

It is difficult to palpate the origin and insertion of this massive muscle, but palpation the muscle belly of the gluteus maximus is facilitated with the patient prone, with the buttocks squeezed together. It’s outline can also be estimated by the following imaginary lines:

1) Line between the PSIS to just above the greater trochanter

2) Line between the coccyx and the ischial tuberosity

Hoppenfeld Figure 6-29 (depicted in sidelying)


Soft Tissue PalpationHamstring Muscles

The common origin of the hamstring muscles is palpable at the ischial tuberosity. Palpation is facilitated by having the patient in sidelying with their knees flexed to the chest. Tenderness to palpation in this region may be indicative of tendonitis or ischial bursitis.



Special TestsThomas Test

The patient lies supine with the buttocks at the edge of the table. The patient holds the non-test leg in maximal flexion and the examiner stabilizes the test-side pelvis to prevent anterior tilting or increased lumbar lordosis. The test leg is lowered off the edge of the table. A negative test is when the posterior thigh fully contacts the table and the knee is in greater than 45 degrees of flexion.

Konin Figure 9-8B

Konin Figure 9-8B


Special TestsThomas Test (cont)

The following indicate a positive Thomas Test

1) Lack of hip extension with knee flexion greater than 45 degrees = Iliopsoas tightness

2) Full hip extension with less than 45 degrees knee flexion = Rectus Femoris tightness

3) Lack of hip extension with less than 45 degrees of knee flexion = Iliopsoas & Rectus Femoris tightness


Special TestsOber TestThe patient lies on the non-test side with their back at the edge of the table. The examiner stands behind the patient with one hand stabilizing the ilium, one hand supporting the test leg, and their body leaning against the posterior aspect of the patient. The test leg is slightly extended and allowed to drop off the back edge of the table. Inability of the leg to adduct to the level of the table is indicative of iliotibial band/ tensor fascia latae tightness.

Konin Figure 9-6C

Konin Figure 9-6C


Special TestsTrendelenburg TestObserve the alignment of the patient’s pelvis by noting the level of the PSIS or the iliac crest. Ask the patient to lift the non-test leg off the ground. A negative test is when the pelvis on the non-test side elevates. A positive test is when the pelvis on the non-test side remains in the same position or descends. A positive test is indicative of gluteus medius weakness.



Special Tests90-90 Straight Leg Raise TestThe patient lies supine, stabilizing both hips in 90 degrees of flexion with their hands, and both knees in the flexed position. The patient actively extends the knee on the test side. If the knee is flexed more than 20 degrees in the end position, the hamstrings are considered tight.

Konin Figure 9-3B

Konin Figure 9-3B


Special TestsEly’s TestThe subject lies prone while the examiner stabilizes the pelvis over the PSIS. The examiner passively flexes the subject’s knee. If passive flexion of the hip occurs during this maneuver it is considered a positive test and is indicative of Rectus Femoris tightness.

Konin Figure 9-11B

Jennifer Hurrell, PT, MS September 2004/ Rev. May 2007 Konin Figure 9-11B


References Hoppenfeld, Stanley. (1976). Physical

Examination of the Spine and Extremities. Norwalk: Appleton & Lange

Konin, J.G. et al. (2006). Special Tests for Orthopedic Examination. 3rd Ed. Thorofare: SLACK Inc.

Lippert, Lynn S. (2000). Clinical Kinesiology for Physical Therapist Assistants. 3rd Ed. Philadelphia: F.A. Davis Company.

Minor, M.D. & L.S. Lippert. (1998). Kinesiology Lab Manual for Physical Therapist Assistants. Philadelphia: F.A. Davis Company.

Netter, Frank H. (2003). Atlas of Human Anatomy. Teterboro: Icon Learning Systems.

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