hip joint part (5) hip external & internal rotation

Hip JointHip Joint

Part (5)Part (5)Hip External & Hip External &

Internal RotationInternal Rotation

Hip External Hip External Rotation Rotation

GoniometryGoniometry

Range of motionRange of motion 0 to 450 to 45

Testing position Testing position Sitting on a supporting surface with knees flexed Sitting on a supporting surface with knees flexed

90 degrees and the hip in 90 degrees of 90 degrees and the hip in 90 degrees of flexionflexion

Stabilization Stabilization Stabilize the distal end of femur to prevent Stabilize the distal end of femur to prevent

abduction or further flexion of the hip. Avoid abduction or further flexion of the hip. Avoid rotation and lateral tilting of the pelvis.rotation and lateral tilting of the pelvis.

Goniometer AlignmentGoniometer Alignment

FulcrumFulcrumAnterior aspect of the patella Anterior aspect of the patella

Proximal ArmProximal ArmAlign it perpendicular to the floorAlign it perpendicular to the floor

Distal ArmDistal ArmAlight it with the anterior midline of the lower Alight it with the anterior midline of the lower

leg, using the crest of the tibia and a point leg, using the crest of the tibia and a point midway between the two malleoli for midway between the two malleoli for referencereference

Patient Instruction Patient Instruction

Ask the patient to move their leg in toward Ask the patient to move their leg in toward the opposite leg. the opposite leg.

Normal End Feel Normal End Feel

Firm, because of tension in:Firm, because of tension in:

Anterior joint capsuleAnterior joint capsule Iliofemoral ligamentIliofemoral ligament Pubofemoral ligament Pubofemoral ligament Anterior portion of gluteus mediusAnterior portion of gluteus medius Gluteus minimusGluteus minimus Adductor magnusAdductor magnus Adductor longusAdductor longus PectineusPectineus PiriformisPiriformis

Hip External Hip External Rotation Rotation Muscle Muscle TestingTesting

Hip External Rotation Muscles Hip External Rotation Muscles

• Obturator externusObturator externus• Obturator internusObturator internus• Quadratus femoris (may be Quadratus femoris (may be

absent)absent)• Piriformis Piriformis • Gemellus superiorGemellus superior• Gemellus inferiorGemellus inferior• Gluteus maximus (posterior)Gluteus maximus (posterior)

Obturator Obturator ExternusExternus

Origin:Origin:

Obturator membrane + ramus of ischium + inferior ramus of pubis Obturator membrane + ramus of ischium + inferior ramus of pubis + pelvis+ pelvis

Insertion: Insertion:

Trochanteric fossa of femurTrochanteric fossa of femur

Innervation: Innervation:

Obturator Nerve (L3-L4)Obturator Nerve (L3-L4)

Obturator InternusObturator Internus

Origin:Origin:

Inferior ramus of pubis + ramus of ischium + obturator fascia + Inferior ramus of pubis + ramus of ischium + obturator fascia + obturator foramen + obturator membrane + upper brim of obturator foramen + obturator membrane + upper brim of greater sciatic foramengreater sciatic foramen


Greater trochanter of femurGreater trochanter of femur


Nerve to obturator internus (L5-S1)Nerve to obturator internus (L5-S1)

Quadratus femorisQuadratus femoris

Origin:Origin:

Ischial tuberosityIschial tuberosity


Quadrate tubercle on the trochantric crest of femurQuadrate tubercle on the trochantric crest of femur


Nerve to quadratus femoris (L5-S1)Nerve to quadratus femoris (L5-S1)

PiriformisPiriformisOrigin:Origin:

Sacrum + ilium + sacrotuberous ligament + capsule of Sacrum + ilium + sacrotuberous ligament + capsule of sacroiliac jointsacroiliac joint


Greater trochanter of the femurGreater trochanter of the femur


Nerve to piriformis (S1-S2)Nerve to piriformis (S1-S2)

Gemellus SuperiorGemellus Superior

Origin:Origin:

IschiumIschium




Nerve to obturator internus (L5-S1)Nerve to obturator internus (L5-S1)

Gemellus InferiorGemellus Inferior

Origin:Origin:

Ischial tuberosityIschial tuberosity




Nerve to quadratus femoris (L5-S1)Nerve to quadratus femoris (L5-S1)

Gluteus MaximusGluteus Maximus

Origin:Origin:

Posterior gluteal line of the ilium + Iliac crest + Sacrum coccyx + Posterior gluteal line of the ilium + Iliac crest + Sacrum coccyx + Aponeurosis over gluteus mediusAponeurosis over gluteus medius


Femur (gluteal tuberosity) + Iliotibial tract of fasia lataFemur (gluteal tuberosity) + Iliotibial tract of fasia lata


Inferior Gluteal Nerve (L5-S2)Inferior Gluteal Nerve (L5-S2)

Test For Grades 5, 4 and 3 of Test For Grades 5, 4 and 3 of

Patient Position Patient Position

Short sitting, trunk may be supported Short sitting, trunk may be supported by placing hands flat at sides.by placing hands flat at sides.

Therapist and Patient Instructions Therapist and Patient Instructions

The therapist sitting or kneeling in front of the patient, placing one hand on the 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 lateral aspect of the knee and the other hand just above the medial malleolusmalleolus.. The resistance will be inward at the knee and outward at the 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 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 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 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.” inward toward your other leg, don’t let me turn your leg out.”

Test For Grade 2 Test For Grade 2

Patient Position Patient Position Supine. The test limb is in internal Supine. The test limb is in internal

rotation.rotation.


The therapist should be standing at side of limb to be tested. The therapist should be standing at side of limb to be tested. Patient externally rotates hip in available range of motion. One Patient externally rotates hip in available range of motion. One hand may be used to maintain pelvic alignment at lateral hip. hand may be used to maintain pelvic alignment at lateral hip. Tell the patient “Roll your leg out”Tell the patient “Roll your leg out”

Test For Grades 1 and 0 Test For Grades 1 and 0

Patient Instructions: Patient Instructions: patient attempts to externally rotate the hip. Ask the patient attempts to externally rotate the hip. Ask the

patient to, “Try to bring your leg out.”patient to, “Try to bring your leg out.”

Patient Position Patient Position Supine. The test limb is in internal rotation.Supine. The test limb is in internal rotation.

Therapist Position Therapist Position Standing at side of limb to be tested. Standing at side of limb to be tested.

Hip Internal Hip Internal Rotation Rotation

GoniometryGoniometry

Range of motionRange of motion 0 to 450 to 45

Testing position Testing position Sitting on a supporting surface with knees flexed Sitting on a supporting surface with knees flexed

90 degrees and the hip in 90 degrees of 90 degrees and the hip in 90 degrees of flexionflexion

Stabilization Stabilization Stabilize the distal end of femur to prevent Stabilize the distal end of femur to prevent abduction, adduction, or further flexion of the abduction, adduction, or further flexion of the

hip. Avoid rotation and lateral tilting of the hip. Avoid rotation and lateral tilting of the pelvis.pelvis.

Goniometer AlignmentGoniometer Alignment

FulcrumFulcrumAnterior aspect of the patella Anterior aspect of the patella

Proximal ArmProximal ArmAlign it perpendicular to the floorAlign it perpendicular to the floor

Distal ArmDistal ArmAlight it with the anterior midline of the lower Alight it with the anterior midline of the lower

leg, using the crest of the tibia and a point leg, using the crest of the tibia and a point midway between the two malleoli for midway between the two malleoli for referencereference

Patient Instruction Patient Instruction

Ask the patient to bring their leg out to the Ask the patient to bring their leg out to the side. side.

Normal End Feel Normal End Feel

Firm, because of tension in:Firm, because of tension in:

Posterior joint capsulePosterior joint capsule Ischiofemoral ligamentIschiofemoral ligament PiriformisPiriformis Obturator internusObturator internus Obturator externusObturator externus Gemellus superiorGemellus superior Gemellus inferiorGemellus inferior Quadratus femoris Quadratus femoris Posterior fibers of gluteus mediusPosterior fibers of gluteus medius Gluteus maximusGluteus maximus

Hip Internal Hip Internal Rotation Rotation Muscle Muscle TestingTesting

Hip Internal Rotation Muscles Hip Internal Rotation Muscles

• Gluteus minimusGluteus minimus• Gluteus mediusGluteus medius• Tensor fasciae lataeTensor fasciae latae

Gluteus MinimusGluteus Minimus

Origin:Origin:

Ilium + Greater sciatic notchIlium + Greater sciatic notch


Greater trochanter of the femur + Fibrous capsule of hip jointGreater trochanter of the femur + Fibrous capsule of hip joint


Superior Gluteal Nerve (L4-S1)Superior Gluteal Nerve (L4-S1)

Gluteus Gluteus MediusMedius

Origin:Origin:

Ilium + Fascia over the upper partIlium + Fascia over the upper part





Tensor Fasciae Tensor Fasciae LataLata

Origin:Origin:

Iliac crest + Anterior superior iliac spineIliac crest + Anterior superior iliac spine


Iliotibial tractIliotibial tract



Test For Grades 5, 4 and 3 of Test For Grades 5, 4 and 3 of

Patient Position Patient Position

Short sitting, arms may be used for Short sitting, arms may be used for trunk support or may be crossed trunk support or may be crossed over chest.over chest.


The therapist sitting or kneeling in front of the patient, placing one hand 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 on the medial aspect of the knee and the other hand just above the lateral malleoluslateral malleolus.. Resistance will be in an outward direction at the Resistance will be in an outward direction at the knee and in an inward direction at the ankle to create a rotary 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 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.”the patient to, “move your leg outward, don’t let me pull it back in.”

Test For Grade 2 Test For Grade 2

Patient Position Patient Position Supine. The test limb is in external Supine. The test limb is in external

rotation.rotation.


The therapist should be standing at side of limb to be The therapist should be standing at side of limb to be tested. tested. Palpate the internal rotators and ask the patient Palpate the internal rotators and ask the patient

to try and roll their leg in toward their other leg.to try and roll their leg in toward their other leg.

Test For Grades 1 and 0 Test For Grades 1 and 0

Patient Instructions: Patient Instructions: Patient attempts to internally rotate the hip. One hand is used to palpate Patient attempts to internally rotate the hip. One hand is used to palpate

gluteus medius over the posterolateral surface of the hip above the gluteus medius over the posterolateral surface of the hip above the greater trochanter. The other hand palpates tensor fasciae latae on greater trochanter. The other hand palpates tensor fasciae latae on the anterolateral surface of the hip below the ASIS. Ask the patient to, the anterolateral surface of the hip below the ASIS. Ask the patient to, “Try to bring your leg in.”“Try to bring your leg in.”

Patient Position Patient Position Supine. The test limb is in external rotation.Supine. The test limb is in external rotation.

Therapist Position Therapist Position Standing at side of limb to be tested. Standing at side of limb to be tested.

Good Luck To You All Good Luck To You All

hip joint part (5) hip external & internal rotation

Documents

reference slide

obturator internus l5s1

obturator internus origin

obturator externus origin

quadratus femoris l5s1

piriformis s1s2 slide

hip joint

gluteus medius insertion