Transcript Hip Evaluation

Hip Evaluation
Advanced Sports Medicine
Evaluating the Hip/Pelvis
 Major Complaint(s) (History)
 Needs to be carefully conducted
 The athlete should be questioned extensively
about…
 The specific site and type of pain
 The extent of their disability
 When and how the injury first occurred
Evaluating the Hip/Pelvis
 Observation
 The athlete should be observed for postural
asymmetry while standing on one leg and
while walking
 Do they do any of the following when you
are observing…
 Limp or favor one leg over the other?
 Does their hip/pelvis look crooked?
 Do they stand crooked, leaning to one
side or the other?
 Place their hand on one hip or the other in
an “abnormal” fashion?
Evaluating the Hip/Pelvis
 Bony Palpation
 SPECIAL NOTE!
 Care should be taken to insure patient
privacy and comfort when you start to do
“hands on” evaluation of the hip/pelvis.
 This is a sensitive area of the body for
most people because of the male and
female genitalia that are also located in
this area
 ATCs should always have a witness
present when examining an athlete in this
area, regardless of the sex of the athlete
and should attempt to do the exam in
area that is private from the other areas
of the training room
Evaluating the Hip/Pelvis
 Palpate the following
areas for pain and
deformity:
 The anterior
hip/pelvis
 Anterior
superior iliac
spine
 Iliac crest
 Greater
trochantor
 Pubic tubercles
Evaluating the Hip/Pelvis
 Palpate the
following areas for
pain and deformity:
 The posterior
hip/pelvis
 Posterior
superior iliac
spine
 Ischial
tuberosity
 Sacroiliac joint
Evaluating the Hip/Pelvis
 Soft tissue palpation should include the
following…
 Groin area
 Lymph nodes
 Adductor muscles
 Femoral nerves and blood vessels
 Buttocks area
 Gluteal muscles
 Lateral hip musculature
 Sciatic nerve
 When palpating these areas the ATC should be
looking for pain, swelling, fiber disruption,
discoloration, etc.
Evaluating the Hip/Pelvis
 Functional Evaluation and Special Tests
 Range of motion
 The athlete should be led through all all possible
hip movements first actively; then passively; then
with manual resistance (where appropriate)
 Hip/Pelvis ROMs include…
 Flexion (120 deg)
 Extension (30 deg)
 ADduction (20-30 deg)
 ABduction (45-50 deg)
 Internal Rotation (35 deg)
 External Rotation (45 deg)
 Various combinations of the above such as Flexion
and Adduction (crossing the legs)
Evaluating the Hip/Pelvis
Hip Flexion
Evaluating the Hip/Pelvis
Hip Extension
Evaluating the Hip/Pelvis
Hip Adduction
Evaluating the Hip/Pelvis
Hip Abduction
Evaluating the Hip/Pelvis
Hip Internal/External Rotation
Evaluating the Hip/Pelvis
 Special Tests for the hip/pelvis
 There are several special tests that ATCs
can and do use to evaluate the hip and
pelvis
 These tests are intended to help the ATC
determine a specific injury to a specific
muscle or area of the hip or pelvis
 These special tests include the following…
Evaluating the Hip/Pelvis
Thomas Test
Tests for muscle contracture in the hip
Evaluating the Hip/Pelvis
 Trendelenberg Test
 Designed to
evaluate the
strength of the
gluteus medius
muscle
Evaluating the Hip/Pelvis
 Leg Length Discrepancy
 Involves simply observing and measuring
the legs for differences in length
Evaluating the Hip/Pelvis
 Leg Length Discrepancy,
continued…
Evaluating the Hip/Pelvis
 Ober Test
 Test designed to identify contraction of the
iliotibial band (IT Band)
A final note…
 Hip/Pelvic evaluations can be difficult to do and
can be very time consuming
 It is extremely important, however, to do a
complete evaluation
 It is never inappropriate to refer to a text or
evaluation manual when evaluating an athlete
with a hip or pelvic injury in order to insure that
a complete evaluation has been done
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