Hips

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1. Hip function is screened by gently log-rolling each lower extremity and noting the freedom of motion of the ball-and-socket joint. Rolling also allows measurement of the internal and external rotation of the hip joint in extension.

2. With one hand fixing the pelvis, the other hand moves each hip to the normal 60 degrees of full abduction and to the normal 30 degrees of adduction while the hip is held in extension.

3. Each hip joint is then examined in flexion; both lower extremities are flexed at knees and hips and carried toward the chest, which gives the maximum angle (120 degrees) of flexion of each hip.

4. Normal hip extension is to minus 10 degrees. To avoid overlooking a hip flexion deformity for which accentuation of lumbar lordosis may compensate, the examiner keeps one lower extremity flexed over the chest, thus flattening the lumbar spine, while instructing the patient to extend fully the opposite leg.

5. With the hip in 90 degrees of flexion, the joint is evaluated for internal rotation (25 degrees), external rotation (35 degrees), abduction (45 degrees), and adduction (25 degrees) (Fig 1-6).

FIG. 1-6. Hip rotation in flexion.

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