Stephanie W. Mayer, MD

Layered Concept

1) Bony

2) Inert layer

3) Dynamic muscular layer

4) Neurovascular layer

Labrum

Suction seal

Capsule

Rotational checkreign

Articular Surface

Covers femoral head and acetabulum

Transition zone vs true cartilage

Labrum

Fibrocartilage

Innervation : Nerve to Quadratus femoris, Obturator

Blood supply : Superior and Inferior gluteal vessels form capsular sided vascular ring, penetrates capsule and into acetabular bone

Suction seal

Iliofemoral Ligament (Y Ligament of Bigelow) is strongest

Ischiofemoral and pubofemoral

Muscular insertions onto the capsule

Rectus Femoris

Muscle relationships to the hip joint

MRIs

Muscle relationships to the hip joint

MRIs

Proximal Hamstrings

Common origin of biceps and semi-tendinosus

More lateral origin of semi-membranosus

Hip joint innervation 1° by obturator nerve

Standing Evaluation

Gait Foot progression angle

limp

Leg length discrepancy

Angular alignment

Rotational alignment

Trendelenburg sign

Supine Evaluation

Log roll (really shouldn’t be painful)

Extension – should be at least neutral

Thomas Test, hip flexor contracture?

Supine Evaluation

Flexion – true hip joint flexion vs lumbopelvic motion

Limitation due to bony block or pain with flexion can be a sign of subspine impingement on AIIS

Supine Evaluation

External Rotation / Internal Rotation

Test in 80-90 degrees of flexion, full extension

rough version analysis

Normal ER in flexion - 40-60

Normal IR in flexion - 15-30

Mechanical block vs guarding

IR is generally most limited in a painful hip

Supine Evaluation

Abduction / Adduction

Test with hip in neutral extension

Normal abduction ~ 45

Normal adduction ~ 20

Supine Evaluation

Palpation of psoas, rectus, sartorius, TFL

Strength and pain testing:

Adductors: supine with hips and knees flexed

Abductors: supine vs lateral

Rectus: supine with hip and knee extended

Psoas: supine with hip and knee flexed

Sometimes hard to differentiate tendonitis vs tendon irritating labrum below

Prone Examination

ER/IR

Femoral torsion analysis

Craig’s Test

Hamstring origin

Ely Test - rectus contracture

Lateral decubitus evaluation

Abductor weakness TFL or rectus take over

Palpation of trochanter

Anterior / Superior = abductors

vs posterior = bursitis

Ober Test

FADIR (Flexion/ADduction/IR)

Loads the labrum in the anterosuperior portion, most often involved in FAI

FABER (Flexion/ABduction/ER)

Loads posterior labrum

Pressure on anterior capsule in anteversion/dysplasia

Note the location and type of pain

FABER (Flexion/ABduction/ER)

Bilateral test with posterior pressure loads SI joint

External snapping

Iliotibial Band (ITB) over greater trochanter

Female > male

Increased offset of the trochanter

Bicycle Test in Lateral Position

Internal snapping

Psoas tendon over femoral head

Female > male

Femoral anteversion

Increased joint mobility

Circumduction or supine bicycle test

Sports hernia, athletic pubalgia, core muscle dysfunction

Rectus abdominus and adductors insert onto pubic symphysis

Pain at the pubic symphysis and adductors Often diagnosed with adductor strains

Often seen with FAI Compensatory in FAI with limited IR? Must

rotate through somewhere else?

Tender to palpation at pubic symphysis

Pain with resisted sit up

Pain with resisted adduction