Hip Joint range of movement

[janecam]

I am looking for a validated and reliable means of measuring joint range of motion for research purposes. Is the goniometer the best we have??

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[alanes1]

Goniometry or electro-goniometry are the easiest measuring methods but depending on the assessor of varying degrees of accuracy and reliability. The literature tells us an experienced physio should be with 5 degrees of accuracy if it is intratester this will obviously go down if it is inter-tester. Electro-goneometry is about 3 degrees but requires a lot more time and effort to get it right.
More accurate is radiography but it is difficult to get past Ethics these days because of the radiation.
Without teaching you to suck eggs if you can standardise the start and finish positions hand held goniometry might be the way to go. In addition it is a clinically relevant tool.
If you wish to discuss more email me at: [email protected]
Hope it goes ok.
Alan Esnouf.

[arkesh_physio]

hi
goniometer is ok but electrogoniometry is very accurate tool.
regards
ark.

[Physiobase]

You could endevour to make a useful and practical clinical measure such as having the subject ly in supine. then with a relaxed knee measure the distance from the inferpole of the patelly to a boney landmark such as the AC joint. As long as you maintain the alignment of one to the other then any change in flexion range sould be able to be measured easily. You would insist that the coccyx remain down on the table to standardise the pelvic postion. 8o Not sure about the extension but let me think about it.

Any other practical ideas?

[neurospast]

I am wondering if an acurate measurement of e.g. flexion can be made at all. The reason is that the hip joint does not function in 1 plain but has 3 dimensional movements and therefor e.g. more or less abduction or in/external rotation will affect measurements. The slights difference in muscle tension could easily cause some changes in e.g. abduction would cause changes in flexion as well.

[Physiobase]

I would tend to agree with you on this point. And even more could it be suggested that an increase in hip felxion can often be achieved with a corresponding reduction in hip extension?

We certainly see that excessive external hip joint rotation can be coupled with a reduction in internal rotation, yet overall movement might remain rather constant.

It might be worth while to discuss what one is actually trying to achieve in measuring hip flexion. Perhaps it is not the best measure for the question being asked?

[sdkashif]

Have a look over the method of goniometric measurements of different joints including the hip joint as an attached file with this post.

[guy909uk]

Hi Physiobase,
Just noticed you mention that a greater degree of external rotation, coupled with a reduction in internal rotation can occur, even though the "total" ROM is still relatively preserved. Just interested if this is usually a pathological finding or merely tends to be incidental? Any ideas why ext rotation is increased when int rotation is diminished? Compensatory? Imbalances?

[physiobob]

Hi Physiobase,
Just noticed you mention that a greater degree of external rotation, coupled with a reduction in internal rotation can occur, even though the "total" ROM is still relatively preserved. Just interested if this is usually a pathological finding or merely tends to be incidental? Any ideas why ext rotation is increased when int rotation is diminished? Compensatory? Imbalances?

Indeed clinically this is usually the case. A hemi-pelvis that is 'flared' out on one side will look like the person is standing in external rotation even though that are in neutral relative to that side of the pelvis. Thus if the same person is then assessed in supine lying in assumed 'neutral' position in the sagittal plane what they are actually doing is lying in internal rotation relative to the actual hemi-pelvic position. On assessment of ROM this would make you think they have reduced internal rotation on examination and increased external rotation.

Is is very important to look at both sides as it is often a dysfunction on the contralateral side that can be causing this, especially during movements such as running.