REIDER PART 223

Figurę 5-30. Hip adduction in extension.

Chapter 5 Pelvis, Hip, and Thigh 183

Figurę 5-32. Hip adduction in flexion.

toward his or her chest until the foot is adjacent to the contralateral knee. To test abduction in flexion, the hip is then allowed to foli outward into a position of abduction; the examiner assists as necessary. One of the examiner’s hands is placed on the ASIS to detect pelvic rotation sup-plementing the abduction of the hip (Fig. 5-31). The amount of abduction present is assessed by estimating the angle between the patients thigh and an imaginary verti-cal piane drawn down the midline of the patient s body. To measure adduction in flexion, the examincr grasps the patients knee and adducts the thigh back across the midline while gently pressing posteriorly on the ipsilateral ASIS to prevent the pelvis from rotating (Fig. 5-32). The rangę of abduction and adduction in the flexed position is similar to the rangę when measured in extension. Rotation. Hip rotation also may be measured in both the (lexed and the extended positions. The rotational

Figurę 5-31. Hip abduction in flexion.

motions observed in these two positions may differ owing to soft tissue contracturcs about the hip. The rotational ROM in extension affects foot placement (in-toeingor out-toeing) during ambulation, and thus it is physiologically morę important. The loss of external rotation in the flcxcd position may manifest itself by difficulty trimming the toenails or putting on shoes. Patients with early degenerative arthritis of the hip joint frequently lose rotation in the affected hip before losing flexion or abduction. In addition, they often report groin pain at the limits of passivc hip rotation. A careful assessment of hip rotation allows the examiner to detect degenerative changes in the hip at an early stage.

Hip rotation in extension may be assessed in either the supine or the prone position. To assess rotation in the supine position, the patient is asked to lic comfortably on the examination table with the hips and knees extended. Before beginning the examination, notę the resting position of the lower extremities. Normally, the weight of the thigh should cause the hips to externally rotate about 30°, and an imaginary linę drawn along the medial border of the foot can be used as a pointer to indi-cate the position of rotation present. An acute or chronic slipped Capital fernoral epiphysis causes the involved hip to rest in a position of incrcascd external rotation. A malu-nited hip fracture can cause a similar external rotation deformity in an older patient.

To assess the maximal passive external rotation pos-sible, the examiner grasps the patients fcct, then uses them to fully externally rotate the lower extremities at the hip (Fig. 5-33). The orientation of the medial border of the foot may be used to estimatc the amount of external rotation present. This normally averages about 45". The examiner then internally rotates the entire limb and estimates the amount of internal rotation present (Fig. 5-34). This is usually less than the amount of available extcrnal rotation and averagcs about 35°. An inerease in