Orthopedic Management of the Hip

EDUCATION

Medical Training Campus

  • Location: Fort Sam Houston, TX
  • Department of the Army, United States of America

Course Overview

Subject: Orthopedic Management I

Unit 8: Orthopedic Management of the Hip

  • Lesson Number: 8.5
  • Title: Hip Range of Motion
  • Instructor: HM1(SW/AW) Teal
  • Course Code: PTT 104

Lesson Objectives

Objective 8.5.1: Identify the Procedures for Performing Hip ROM Measurements

  • Perform hip range of motion (ROM) measurements as part of the clinical examination
  • Assess the quality, quantity, and pain response during motion testing

Objective 8.5.2: Perform Hip ROM Assessment

  • Includes patient position, goniometer placement, measurement procedures, and documentation

Detailed Content

Topic 1: Hip Flexion

Overview

  • Motion occurs in the sagittal plane around a frontal (medial–lateral) axis.
  • Normal hip flexion ROM values for adults: generally 120 to 130 degrees.

Patient Position

  • Patient is supine with pelvis neutral and knees extended.
  • Patella should face anteriorly.
  • Note: In supine, the pelvis may tilt, and the thigh may externally rotate.

Stabilization

  • Body weight and the plinth usually provide stability.
  • Keep the contralateral lower extremity flat on the table in a neutral position.

Procedure

  1. Instruct the patient to flex the hip by lifting the thigh off the table, bringing the knee towards the chest.
  2. Allow the knee to flex passively during the motion; this reduces tension in the hamstring muscles.
  3. Maintain neutral rotation and abduction/adduction throughout the motion.
  4. Stop when resistance to further motion is felt, noting that attempts to push further may cause posterior pelvic tilting.

Normal End-Feels

  • Soft: Due to contact between muscle bulk of anterior thigh and lower abdomen.
  • Firm: Due to tension in the posterior joint capsule and/or gluteus maximus muscle.

Goniometer Alignment

  • Center the fulcrum of the goniometer on the greater trochanter.
  • Align the proximal arm with the lateral midline of the pelvis and trunk.
  • Align the distal arm with the lateral midline of the femur, referencing the lateral epicondyle.

Topic 2: Hip Extension

Overview

  • Motion occurs in the sagittal plane around a medial–lateral axis.
  • Normal hip extension ROM values for adults: approximately 15 to 20 degrees.

Patient Position

  • Prone with knees extended and hip/pelvis in neutral.
  • Note: In the prone position, the pelvis may tilt, and the thigh may be abducted and rotated.

Stabilization

  • Body weight and the plinth generally provide stabilization.
  • Keep contralateral lower extremity flat on the table in neutral position.

Procedure

  1. Instruct the patient to extend the hip by lifting the lower extremity up from the table, bringing their heel towards the ceiling.
  2. Maintain the knee in extension throughout the movement to avoid limiting hip extension ROM.
  3. Stop when resistance to further motion of the femur is felt; attempts to overcome this may cause anterior pelvic tilting or lumbar extension.

Normal End-Feels

  • Firm: Due to tension in the anterior joint capsule, iliofemoral ligament, and anterior hip/thigh muscles.

Goniometer Alignment

  • Center the fulcrum over the greater trochanter of the femur.
  • Align the proximal arm with the lateral midline of the pelvis and trunk.
  • Align the distal arm with the lateral midline of the femur using the lateral epicondyle as a reference.

Topic 3: Hip Abduction

Overview

  • Motion occurs in the frontal plane around an anterior–posterior axis.
  • Normal abduction ROM values for adults: approximately 40 to 55 degrees.

Patient Position

  • Supine with knees extended and hips/pelvis in neutral. Patella faces anteriorly.
  • Position the individual at the edge of the plinth opposite to the limb being tested.

Stabilization

  • Body weight and the plinth generally stabilize the position.
  • Keep contralateral lower extremity flat on the table in the neutral position to ensure stability.

Procedure

  1. Abduct the hip by moving the lower extremity laterally.
  2. Avoid external rotation or flexion of the hip during abduction.
  3. Stop when resistance to femur movement is felt; attempts to overcome may lead to lateral pelvic tilting or trunk flexion.

Normal End-Feel

  • Firm: Due to ligamentous tension and passive tension in the groin musculature.

Goniometer Alignment

  • Center falcrum of the goniometer over the anterior superior iliac spine (ASIS) of the extremity being measured.
  • Align the proximal arm with an imaginary horizontal line extending from one ASIS to the other.
  • Align the distal arm with the anterior midline of the femur, referencing the midline of the patella.

Topic 4: Hip Adduction

Overview

  • Motion occurs in a frontal plane around an anterior–posterior axis.
  • Normal adduction ROM values: approximately 20 to 25 degrees for adults.

Patient Position

  • Supine with knees extended and the hip tested in neutral; patella faces anteriorly.
  • Abduct the contralateral extremity to provide sufficient space to complete the full ROM in adduction.

Stabilization

  • Body weight and the plinth generally stabilize the position.
  • Keep contralateral lower extremity flat on the table in neutral position.

Procedure

  1. Adduct the hip by moving the lower extremity medially towards the contralateral limb.
  2. Stop when resistance is felt; attempts to overcome may lead to lateral pelvic tilting or trunk flexion.

Normal End-Feel

  • Firm: Due to ligamentous tension and muscle tension in the lateral hip.

Goniometer Alignment

  • Center fulcrum of the goniometer over the ASIS of the extremity being measured.
  • Align the proximal arm with an imaginary horizontal line extending from one ASIS to the other.
  • Align the distal arm with the anterior midline of the femur, using midline of the patella as a reference.

Topic 5: Hip Internal Rotation

Overview

  • Motion occurs in a transverse plane around a vertical axis.
  • Normal internal rotation ROM values for adults: approximately 30 to 45 degrees.

Patient Position

  • Seat the individual on a firm surface with knees flexed to 90 degrees off the edge.
  • Place a towel roll under the distal thigh to maintain the femur in a horizontal position.
  • Ensure the patient maintains proper upright posture using arms for support.

Stabilization

  • Proper seated posture with weight-bearing through the ischial tuberosities assists stabilization, avoiding pelvis rotation or lateral tilting.

Procedure

  1. Internally rotate the hip by moving the foot laterally, away from the body.
  2. Stop when resistance is felt; attempts to push further cause pelvic tilting or trunk flexion.

Normal End-Feel

  • Firm: Due to ligamentous tension and tension in the deep external rotator musculature.

Goniometer Alignment

  • Center the fulcrum of the goniometer over the anterior aspect of the patella.
  • Align the proximal arm so it is perpendicular to the floor or parallel to the supporting surface.
  • Align the distal arm with the anterior midline of the lower leg referencing the tibia and a point midway between malleoli.

Topic 6: Hip External Rotation

Overview

  • Motion occurs in a transverse plane around a longitudinal axis.
  • Normal external rotation ROM values for adults vary widely.

Patient Position

  • Same as internal rotation: seated on a firm surface with knees flexed over the edge and a towel roll under the thigh for horizontal femur support.

Stabilization

  • Proper sitting posture with weight-bearing through the ischial tuberosities reduces pelvic rotation and lateral tilting.

Procedure

  1. Externally rotate the hip by moving the foot medially toward the body.
  2. Stop when resistance is felt; attempts to continue cause pelvic tilting or trunk flexion.

Normal End-Feel

  • Firm: Due to ligamentous tension and tension in lateral hip musculature and adductors.

Goniometer Alignment

  • Center the fulcrum over the anterior aspect of the patella.
  • Align the proximal arm perpendicular to the floor or parallel to the supporting surface.
  • Align the distal arm with the anterior midline of the lower leg referencing the tibia up to the malleoli position.

Conclusion

  • Objectives Summary:

Objective 8.5.1: Procedures for Hip ROM Measurements

  • Topics Covered: Hip Flexion, Hip Extension, Hip Abduction, Hip Adduction, Hip Internal Rotation, Hip External Rotation.

Objective 8.5.2: Performance of Hip ROM

  • Includes specifics on patient positioning, goniometer placement, measurement procedures, and documentation.

Questions?

  • Open for discussion on Lesson 8.5.