1. Hip Lab Exercise Presentation Created By: Jennifer Hurrell, PT, MS
Presentation based on the textbook by Stanley Hoppenfeld:
Physical Examination of the Spine & Extremities
Hip Lab Exercise
Presentation Created By:
Jennifer Hurrell, PT, MS
Associate Professor
Community College of Rhode Island
Rehabilitative Health Department
RHAB1110: Kinesiology

2. Learning Objectives
1) Identify the specified bony landmarks of the bones of the hip on disarticulated bones
2) Identify the joints of the hip on a skeletal model
3) Locate the origins and insertions of the hip muscles on a skeletal model
4) Demonstrate the anatomical course of the hip muscles on a skeletal model
5) Identify bony and soft tissue structures that are palpable in the hip region
6) Palpate specified hip structures by correlating anatomical structures with surface anatomy landmarks
7) Perform, describe and name various special tests that screen for common pathological conditions of the hip

3. Bony Landmarks Identify these landmarks on the disarticulated bones
Femur
Head
Neck
Greater Trochanter
Lesser Trochanter
Intertrochanteric Line
Intertrochanteric Crest
Body
Medial Condyle
Lateral Condyle
Lateral Epicondyle
Medial Epicondyle
Femur cont.
Adductor Tubercle
Linea Aspera
Pectineal Line
Gluteal Tuberosity
Patellar Surface
Tibia
Tibial Tuberosity
Innominate Bone
Acetabulum

4. Joints & Articulations
Identify these joints & articulations on the skeleton
Hip Joint

5. Muscles Locate these muscle origins & insertions on the skeleton
Anterior Muscles
Iliopsoas
Rectus Femoris
Sartorius
Medial Muscles
Pectineus
Adductor Longus
Adductor Brevis
Adductor Magnus
Gracilis
Posterior Muscles
Semitendinosus
Semimembranosus
Biceps Femoris
Gluteus Maximus
Deep Rotator Muscles
Lateral Muscles
Tensor Fascia Latae
Gluteus Minimus
Gluteus Medius

6. Bony Palpation Greater Trochanter
With your patient in supine, place your thumbs on the ASIS’s and move your fingers about 3” posteriorly along the iliac crest to the widest part of the pelvis known as the iliac tubercles. Now, move your fingers caudally from the iliac tubercles until you can palpate the greater trochanters. The posterior edge of the trochanter is most palpable. The examiner can also passively internally and externally rotate the femur to facilitate identification of this landmark.
Hoppenfeld Figure 6-3

7. Hoppenfeld Figure 6-3

8. The Femoral Triangle Borders
Superior Border = Inguinal Crease
Medial Border = Adductor Longus
Lateral Border = Sartorius
*To facilitate palpation of these structures, place your patient in hip flexion, abduction and ER, with their heel resting on the opposite knee
Hoppenfeld Figure 6-12

9. Hoppenfeld Figure 6-12

10. Soft Tissue Palpation Adductor Longus
The adductor longus is the most superficial adductor muscle and the only one accessible for palpation. It is palpable as a cordlike structure proximally near the pubic symphysis and can be felt running toward the middle of the thigh. It is often strained during sports or activity.
Hoppenfeld Figure 6-17

11. Hoppenfeld Figure 6-17

12. Soft Tissue Palpation Sartorius
This long, straplike muscle can be palpated near it’s origin, slightly below the ASIS.
Hoppenfeld Figure 6-16

13. Hoppenfeld Figure 6-16

14. The Femoral Triangle Interior Structures
Inguinal Ligament
Femoral Artery
Femoral Nerve & Vein (not palpable)
*To facilitate palpation of these structures, place your patient in hip flexion, abduction and ER, with their heel resting on the opposite knee
Hoppenfeld Figure 6-15

15. Hoppenfeld Figure 6-15

16. Soft Tissue Palpation Inguinal Ligament
This ligament is palpable between the ASIS and the pubic tubercle. Any unusual bulges along this ligament may be indicative of an inguinal hernia.
Hoppenfeld Figure 6-13

17. Hoppenfeld Figure 6-13

18. Soft Tissue Palpation Femoral Artery
The femoral artery passes under the inguinal ligament at it’s midpoint. Palpate the pulse of this artery just inferior to the ligament at it’s midpoint.
Hoppenfeld Figure 6-15

19. Hoppenfeld Figure 6-15

20. Soft Tissue Palpation Trochanteric Bursae
The trochanteric bursae covers the posterior portion of the greater trochanter. This structure is not distinctly palpable unless it is distended or inflamed, in which case it will feel boggy and be tender to palpation.
Hoppenfeld Figure 6-19

21. Hoppenfeld Figure 6-19

22. Soft Tissue Palpation Gluteus Medius Muscle
This muscle is most easily palpated with the patient in sidelying and with the leg actively raised into a few degrees of abduction. It is palpable just below the iliac crest and also at it’s insertion, on the anterior and lateral aspects of the greater trochanter.
Hoppenfeld Figure 6-51

23. Hoppenfeld Figure 6-51

24. Soft Tissue Palpation Sciatic Nerve
When the hip is extended, the sciatic nerve is covered by the gluteus maximus, but is exposed during hip flexion. Place your patient sidelying with the hip flexed. In some individuals the sciatic nerve is palpable midway between the greater trochanter and the ischial tuberosity.
Hoppenfeld Figure 6-22

25. Hoppenfeld Figure 6-22

26. Soft Tissue Palpation Rectus Femoris
The rectus femoris is the only two-joint muscle of the quadriceps muscles. Except in individuals with very developed musculature, it is not distinctly palpable from the other three heads of the quadriceps, however tenderness over the area of it’s origin at the AIIS can indicate avulsion. The quadriceps muscle group covers the vast area on the anterior aspect of the femur. Palpate the vicinity of this muscle.
Hoppenfeld Figure 6-27

27. Hoppenfeld Figure 6-27

28. Soft Tissue Palpation Gluteus Maximus
It is difficult to palpate the origin and insertion of this massive muscle, but palpation the muscle belly of the gluteus maximus is facilitated with the patient prone, with the buttocks squeezed together. It’s outline can also be estimated by the following imaginary lines:
Line between the PSIS to just above the greater trochanter
Line between the coccyx and the ischial tuberosity
Hoppenfeld Figure 6-29 (depicted in sidelying)

29. Hoppenfeld Figure 6-29

30. Soft Tissue Palpation Hamstring Muscles
The common origin of the hamstring muscles is palpable at the ischial tuberosity. Palpation is facilitated by having the patient in sidelying with their knees flexed to the chest. Tenderness to palpation in this region may be indicative of tendonitis or ischial bursitis.
Hoppenfeld Figure 6-20

31. Hoppenfeld Figure 6-20

32. Special Tests Thomas Test
The patient lies supine with the buttocks at the edge of the table. The patient holds the non-test leg in maximal flexion and the examiner stabilizes the test-side pelvis to prevent anterior tilting or increased lumbar lordosis. The test leg is lowered off the edge of the table. A negative test is when the posterior thigh fully contacts the table and the knee is in greater than 45 degrees of flexion.
Konin Figure 9-8B

33. Konin Figure 9-8B

34. Special Tests Thomas Test (cont)
The following indicate a positive Thomas Test
Lack of hip extension with knee flexion greater than 45 degrees = Iliopsoas tightness
Full hip extension with less than 45 degrees knee flexion = Rectus Femoris tightness
Lack of hip extension with less than 45 degrees of knee flexion = Iliopsoas & Rectus Femoris tightness

35. Special Tests Ober Test
The patient lies on the non-test side with their back at the edge of the table. The examiner stands behind the patient with one hand stabilizing the ilium, one hand supporting the test leg, and their body leaning against the posterior aspect of the patient. The test leg is slightly extended and allowed to drop off the back edge of the table. Inability of the leg to adduct to the level of the table is indicative of iliotibial band/ tensor fascia latae tightness.
Konin Figure 9-6C

36. Konin Figure 9-6C

37. Special Tests Trendelenburg Test
Observe the alignment of the patient’s pelvis by noting the level of the PSIS or the iliac crest. Ask the patient to lift the non-test leg off the ground. A negative test is when the pelvis on the non-test side elevates. A positive test is when the pelvis on the non-test side remains in the same position or descends. A positive test is indicative of gluteus medius weakness.
Hoppenfeld Figure 6-56

38. Hoppenfeld Figure 6-56

39. Special Tests 90-90 Straight Leg Raise Test
The patient lies supine, stabilizing both hips in 90 degrees of flexion with their hands, and both knees in the flexed position. The patient actively extends the knee on the test side. If the knee is flexed more than 20 degrees in the end position, the hamstrings are considered tight.
Konin Figure 9-3B

40. Konin Figure 9-3B

41. Special Tests Ely’s Test
The subject lies prone while the examiner stabilizes the pelvis over the PSIS. The examiner passively flexes the subject’s knee. If passive flexion of the hip occurs during this maneuver it is considered a positive test and is indicative of Rectus Femoris tightness.
Konin Figure 9-11B

42. Konin Figure 9-11B

43. References
Hoppenfeld, Stanley. (1976). Physical Examination of the Spine and Extremities. Norwalk: Appleton & Lange
Konin, J.G. et al. (2006). Special Tests for Orthopedic Examination. 3rd Ed. Thorofare: SLACK Inc.
Lippert, Lynn S. (2000). Clinical Kinesiology for Physical Therapist Assistants. 3rd Ed. Philadelphia: F.A. Davis Company.
Minor, M.D. & L.S. Lippert. (1998). Kinesiology Lab Manual for Physical Therapist Assistants. Philadelphia: F.A. Davis Company.
Netter, Frank H. (2003). Atlas of Human Anatomy. Teterboro: Icon Learning Systems.