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Hip Joint

Hip Joint. Part (5) Hip External & Internal Rotation. Hip External Rotation Goniometry.  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 

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Hip Joint

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  1. 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

  7. Hip External Rotation Muscle Testing

  8.  Hip External Rotation Muscles  • Obturator externus • Obturator internus • Quadratus femoris (may be absent) • Piriformis • Gemellus superior • Gemellus inferior • Gluteus maximus (posterior)

  9. Obturator Externus Origin: Obturator membrane + ramus of ischium + inferior ramus of pubis + pelvis Insertion: Trochanteric fossa of femur Innervation: Obturator Nerve (L3-L4)

  10. 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)

  11. Quadratus femoris Origin: Ischial tuberosity Insertion: Quadrate tubercle on the trochantric crest of femur Innervation: Nerve to quadratus femoris (L5-S1)

  12. Piriformis Origin: Sacrum + ilium + sacrotuberous ligament + capsule of sacroiliac joint Insertion: Greater trochanter of the femur Innervation: Nerve to piriformis (S1-S2)

  13. Gemellus Superior Origin: Ischium Insertion: Greater trochanter of the femur Innervation: Nerve to obturator internus (L5-S1)

  14. Gemellus Inferior Origin: Ischial tuberosity Insertion: Greater trochanter of the femur Innervation: Nerve to quadratus femoris (L5-S1)

  15. 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)

  16.  Patient Position  Short sitting, trunk may be supported by placing hands flat at sides.  Test For Grades 5, 4 and 3 of   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, don’t let me turn your leg out.”

  17.  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”

  18.  Patient Position  Supine. The test limb is in internal rotation.  Test For Grades 1 and 0   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.”

  19. Hip Internal Rotation Goniometry

  20.  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

  24. Hip Internal Rotation Muscle Testing

  25.  Hip Internal Rotation Muscles  • Gluteus minimus • Gluteus medius • Tensor fasciae latae

  26. Gluteus Minimus Origin: Ilium + Greater sciatic notch Insertion: Greater trochanter of the femur + Fibrous capsule of hip joint Innervation: Superior Gluteal Nerve (L4-S1)

  27. Gluteus Medius Origin: Ilium + Fascia over the upper part Insertion: Greater trochanter of the femur Innervation: Superior Gluteal Nerve (L4-S1)

  28. Tensor Fasciae Lata Origin: Iliac crest + Anterior superior iliac spine Insertion: Iliotibial tract Innervation: Superior Gluteal Nerve (L4-S1)

  29.  Patient Position  Short sitting, arms may be used for trunk support or may be crossed over chest.  Test For Grades 5, 4 and 3 of   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, don’t let me pull it back in.”

  30.  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.

  31.  Patient Position  Supine. The test limb is in external rotation.  Test For Grades 1 and 0   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.”

  32.  Good Luck To You All 

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