The Pattern and Technique in the Clinical Evaluation of the Adult Hip: The Common Physical Examination Tests of Hip Specialists
Received 7 January 2009; accepted 9 July 2009.
Purpose
The purpose of this study was to systematically evaluate the technique and tests used in the physical examination of the adult hip performed by multiple clinicians who regularly treat patients with hip problems and identify common physical examination patterns.
Methods
The subjects included 5 men and 6 women with a mean age (±SD) of 29.8 ± 9.4 years. They underwent physical examination of the hip by 6 hip specialists with a strong interest in hip-related problems. All examiners were blind to patient radiographs and diagnoses. Patient examinations were video recorded and reviewed.
Results
It was determined that 18 tests were most frequently performed (≥40%) by the examiners, 3 standing, 11 supine, 3 lateral, and 1 prone. Of the most frequently performed tests, 10 were performed more than 50% of the time. The tests performed in the supine position were as follows: flexion range of motion (ROM) (percentage of use, 98%), flexion internal rotation ROM (98%), flexion external rotation ROM (86%), passive supine rotation test (76%), flexion/adduction/internal rotation test (70%), straight leg raise against resistance test (61%), and flexion/abduction/external rotation test (52%). The tests performed in the standing position were the gait test (86%) and the single-leg stance phase test (77%). The 1 test in the prone position was the femoral anteversion test (58%).
Conclusions
There are variations in the testing that hip specialists perform to examine and evaluate their patients, but there is enough commonality to form the basis to recommend a battery of physical examination maneuvers that should be considered for use in evaluating the hip.
Clinical Relevance
Patients presenting with groin, abdominal, back, and/or hip pain need to have a basic examination to ensure that the hip is not overlooked. A comprehensive physical examination of the hip will benefit the patient and the physician and serve as the foundation for future multicenter clinical studies.
aOklahoma Sports Science & Orthopaedics, Oklahoma City, Oklahoma, U.S.A.
bHospital for Special Surgery, New York, New York, U.S.A.
Address correspondence and reprint requests to Hal D. Martin, D.O., Oklahoma Sports Science & Orthopaedics, 6205 N Santa Fe, Ste 200, Oklahoma City, OK 73118, U.S.A.
ABSTRACT