The Log Roll Test: Difference between revisions

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=== Purpose: ===
=== Purpose: ===
The Log Roll Test (or Passive Rotation Test) is a special test used to assess the integrity of the hip joint to look for potential hip pathology such as labral tears, ligament laxity, or impingement<ref name=":0">OrthoFixar. ''Log roll test''. (cited 3 May 2023). Available from: https://orthofixar.com/special-test/log-roll-test/ (accessed 8 March 2024).</ref>.
The log roll test (or passive supine rotation test) is a special test used to assess the integrity of the hip joint. The test is used to screen for intra-articular hip pathologies including labral tears, ligamentous laxity, and impingement.<ref name=":7" /><ref name=":8" /><ref name=":0" /><ref name=":1" />


=== Clinically Relevant Anatomy: ===
=== Clinically Relevant Anatomy: ===
The hip is a ball and socket joint formed by the head of the femur and the acetabulum of the pelvic bone. The main function of the hip is to support the weight of the upper body during static erect posture and dynamic activities including ambulation, running, stair climbing, etc<ref name=":0" />.
The hip is a ball and socket joint formed by the articulation of the head of the femur with the acetabulum of the pelvis. The main function of the hip is to support the weight of the upper body during sitting and standing, at rest and in motion.<ref name=":2">Dutton M. Hip Joint Complex. In: Dutton, M editor. Dutton's orthopedic examination, evaluation, and intervention. 6th edition. New York: McGraw Hill Education, 2023.</ref>


The femoral head is the area of the femur that contacts the acetabulum of the pelvic bone.
The femoral head is the area of the femur that contacts the acetabulum of the pelvic bone. Within the hip joint, the femoral head is connected to the acetabulum via the ligamentum teres, which surrounds the foveal artery; the foveal artery contributes significantly to the blood supply of the femoral head during childhood but its contributions are less significant in adulthood. Injuries to the ligamentum teres and foveal artery can result in osteonecrosis of the femoral head.<ref name=":5">Gold M, Munjal A, Varacallo M. Anatomy, Bony Pelvis and Lower Limb, Hip Joint. In: StatPearls [Internet]. Treasure Island: StatPearls Publishing, 2023. Available from https://www.ncbi.nlm.nih.gov/books/NBK470555/</ref> 


The acetabulum is the area of the pelvic bone where the ilium, ischium, and pubis fuse together. This area allows for the proximal transmission of weight from axial skeleton to the lower extremities. The articular surface of the acetabulum is covered by a thickened layer of hyaline cartilage.
The capsular ligaments of the hip include the iliofemoral ligament (Y-ligament), the pubofemoral ligament, and the ischiofemoral ligament. All of these ligaments limit/prevent extension of the hip. The iliofemoral ligament is the strongest ligament in the body, and it limits extension and external rotation of the hip. The pubofemoral ligament limits abduction, extension, and external rotation of the hip. Finally, the ischiofemoral ligament is the weakest of the three ligaments, and it limits extension and internal rotation of the hip.<ref name=":5" /><ref>Martin HD, Savage A, Braly BA, Palmer IJ, Beall DP, Kelly B. The function of the hip capsular ligaments: a quantitative report. Arthroscopy 2008;24:188-195</ref><ref name=":7" />


The labrum of the hip has three surfaces: the internal articular surface, the external articular surface, and the basal surface. The internal articular surface is adjacent to the joint and is avascular, causing decreased rate of healing in the event of injury. The external articular surface contacts the joint capsule and is vascularized. The basal surface is attached to the acetabular bone and ligaments. The overall function of the labrum is to provide joint stability, absorb shock, lubricate the joint, and distribute pressure. Since the labrum of the hip is cartilage, it allows for more support to the joint by holding the bones in their proper places and provides cushioning to the joint <ref>PennMedicine. Labral Tear. Available from: [[/www.pennmedicine.org/for-patients-and-visitors/patient-information/conditions-treated-a-to-z/labral-tears#:~:text%3DThe%20labrum%20is%20a%20rim%2Cprovides%20cushioning%20to%20the%20joint|https://www.pennmedicine.org/for-patients-and-visitors/patient-information/conditions-treated-a-to-z/labral-tears#:~:text=The%20labrum%20is%20a%20rim,provides%20cushioning%20to%20the%20joint]]. (accessed 21 March 2024).</ref>.
The acetabulum is the area of the pelvic bone where the ilium, ischium, and pubis converge. The articulation of the head of the femur with the acetabulum is the site where the weight of the axial skeleton is conveyed to the lower extremities.<ref name=":2" />  


The capsular ligaments of the hip include the iliofemoral ligament (Y-ligament), the pubofemoral ligament, and the ischiofemoral ligament. All of these ligaments limit/prevent extension of the hip. The iliofemoral ligament is the strongest ligament in the body and prevents hyperextension. The pubofemoral ligament prevents abduction and extension of the hip. Finally, the ischiofemoral ligament is the weakest of the three ligaments and prevents excess extension.
Attached to the acetabulum is the labrum of the hip, which is comprised of fibrocartilage and dense connective tissue. <ref name=":10" />The labrum of the hip has three surfaces: the internal articular surface, the external articular surface, and the basal surface.<ref name=":2" /> The internal articular surface is adjacent to the joint and is avascular, causing decreased rate of healing in the event of injury. The external articular surface contacts the joint capsule and is vascularized.<ref name=":10">Petersen W, Petersen F, Tillmann B. Structure and vascularization of the acetabular labrum with regard to the pathogenesis and healing of labral lesions. Arch Orthop Trauma Surg. 2003 Jul;123(6):283-8. doi: 10.1007/s00402-003-0527-7.</ref> The basal surface is attached to the acetabular bone and ligaments. The labrum serves to provide joint stability, absorb shock, lubricate the joint, and distribute pressure.<ref>Ferguson SJ, Bryant JT, Ganz R. The influence of the acetabular labrum on hip joint cartilage consolidation: a poroelastic finite element model. J Biomech. 2000;33(8):953–60.</ref>
 
=== Summary of Potential Pathologies at the Hip: ===
The ligamentum teres (ligament of the head of the femur) is located intra-capsular. It provides blood flow to the femoral head via the foveal artery. Injuries to this can result in osteonecrosis of the femoral head.  


The nerves surrounding the hip include the femoral, obturator, and superior gluteal nerves.
* <u>Labral tears:</u> Common mechanisms of injury for labral tears include but are not limited to, femoracetabular impingement, trauma, ligamentous laxity, and abnormal bone structure.<ref>Su T, Chen GX, Yang L. Diagnosis and treatment of labral tear. Chin Med J. 2019;132(2): 211–219</ref> Labral tears may present as hip or groin pain that becomes aggravated upon sitting or standing for prolonged periods of time. Clicking or locking sensations at the hip also indicate a possible labral tear.<ref name=":2" />


=== Summary of Potential Pathologies at the Hip: ===
* <u>Iliofemoral ligament laxity:</u> Ligamentous laxity may include chronic groin pain, tendinitis, or vertical displacement of the femoroacetabular joint.<ref>Philippon MJ, Bolia I, Locks R, Briggs K. Microinstability of the hip: a previously unrecognized pathology. Muscles Ligaments Tendons J. 2016;6(3):354–360. <nowiki>https://doi.org/10.11138/mltj/2016.6.3.354</nowiki>
-labral tears- A labral tear of the hip is the second most common injury of the hip, with the first being impingement which will be discussed below. Labral tears can be caused due to trauma, impingement, laxity, deformities of the hip, and many other reasons.<ref>Su T, Chen GX, Yang L. Diagnosis and treatment of labral tear. Chinese Medical Journal [Internet]. 2019 Jan [cited 2019 Nov 29];132(2):211–9. Available from: <nowiki>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6365273/</nowiki>
</ref> If labral function is compromised, it may lead to increased stress on the structures comprising the anterior joint capsule, resulting in iliofemoral ligament laxity<ref name=":3">Martin RL, Sekiya JK. The interrater reliability of 4 clinical tests used to assess individuals with musculoskeletal hip pain. J Orthop Sports Phys Ther. 2008;38(2):71–77. <nowiki>https://doi.org/10.2519/jospt.2008.2677</nowiki></ref>


‌</ref>Signs of a labral tear include hip or groin pain that is aggravated by sitting or standing for prolonged periods. An individual experiencing a labral tear may also report symptoms of locking, clicking, or catching of the hip.<ref>Hip Joint Complex | Dutton’s Orthopaedic Examination, Evaluation, and Intervention, 5e | AccessPhysiotherapy | McGraw-Hill Medical [Internet]. accessphysiotherapy.mhmedical.com. Available from: <nowiki>https://accessphysiotherapy.mhmedical.com/content.aspx?bookid=2707&sectionid=224681946</nowiki>
* <u>Femoroacetabular impingement (FAI):</u> Femoroacetabular impingement is the result of bony abnormalities of either the acetabulum (pincer-type) or the proximal femur (cam-type) or a combination of the two. Severe structural changes may lead to labral tearing.<ref>Ejnisman L, Ricioli Júnior W, Queiroz MC, Vicente JR, Croci AT, Polesello GC. Femoroacetabular impingement and acetabular labral tears - part 1: pathophysiology and biomechanics. Rev Bras Ortop. 2020;''55''(5):518–22. <nowiki>https://doi.org/10.1055/s-0040-1702964</nowiki></ref>


‌</ref>  
* <u>Cam impingement:</u>  Excess growth of the femoral head and/or neck can cause abnormal contact between the femur and acetabulum resulting in cam impingement. Cam impingement is provoked by the combined movements of hip flexion, adduction, and internal rotation and can cause progressive erosion of the articular cartilage. This condition is not always symptomatic. This condition tends to affect primarily younger, active males.<ref>Ganz R, Parvizi J, Beck M, Leunig M, Notzli H, Siebenrock KA. Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res. 2003;417:112-20. doi: 10.1097/01.blo.0000096804.78689.c2</ref><ref>Byrd JW, Jones KS. Arthroscopic femoroplasty in the management of cam-type femoroacetabular impingement. Clin Orthop Relat Res. 2009;467(3):739-46. doi: 10.1007/s11999-008-0659-8. </ref><ref name=":2" />


-ligament laxity-
* <u>Pincer impingement:</u>  Pincer impingement occurs when the rim of the acetabulum provides excessive coverage of the femoral head and neck.<ref>Philippon MJ, Stubbs AJ, Schenker ML, Maxwell RB, Ganz R, Leunig M. Arthroscopic management of femoroacetabular impingement: osteoplasty technique and literature review. Am J Sports Med. 2007 Sep;35(9):1571-80. doi: 10.1177/0363546507300258</ref> When the femoral head contacts the altered socket, excess movement is allowed. The impingement can cause adverse effects such as osteoarthritis if left untreated. The demographic most susceptible to pincer impingement are middle-aged female athletes.<ref name=":2" />


-Femoral Acetabular impingement (FAI)- is one of the most common pathologies of the hip with there being multiple types.  FAI pathology can lead to the subsequent damage of the labral that may lead to tearing. Two common types of are Cam impingement and Pincer impingement.
=== Technique: ===


Cam impingement is caused by abnormalities of the femur due to overgrowth of the femoral neck. This abnormality leads to incorrect contact of the femur and the acetabulum mainly specifically during combined movements of hip flexion, adduction and internal rotation. Often many times individuals with Cam impingement don't realize they have the condition due to it being fairly asymptomatic their lives.
# The patient assumes a supine position.
# Standing beside the patient, the clinician uses his/her more cephalic hand to grasp the patient's distal anterior femur and his/her more caudal hand to grasp the distal anterior tibia.
# The clinician passively moves the patient’s femur through the available range of internal rotation, noting the end feel.
# The clinician passively moves the patient's femur through the available range of external rotation, noting the end feel.
# The clinician repeats the test on the contralateral side and compares results.<ref name=":1">Magee DJ. Orthopedic physical assessment. 6th edition. St. Louis: Elsevier Saunders, 2014.</ref>
[[File:Export 1712436778749.mp4|center|<ref name=":9">Moffett S, Nichols B, Clark A, Wragg J. Arkansas Colleges of Health Education. 2024.</ref>The Log Roll Test]]
<ref name=":9" />


Pincer impingement is caused by abnormality of the acetabulum due to the rim of the acetabulum being significantly increased more than normal.  
'''Note:''' The log roll test should move the articular surface of the femoral head along the acetabulum without stressing any of the surrounding extra-articular structures.<ref name=":6">Byrd JW. Evaluation of the hip: history and physical examination. N Am J Sports Phys Ther. 2007;2(4):231-40. PMID: 21509142; PMCID: PMC2953301.</ref>


=== Technique: ===
<u>Positive Test Results</u>:  
To perform the log roll test, first have the patient assume a supine position. Grasping the patient's distal anterior femur with one hand and distal anterior tibia with the other hand, move the patient’s femur through the available range of internal rotation. Next, move the patient's femur through the available range of external rotation<ref name=":1">Magee DJ., Orthopedic Physical Assessment, 6th edition, St. Louis: Elsevier Saunders, 2014.</ref>. This will move the articular surface of the femoral head along the acetabulum. This test should not stress any of the surrounding extra-articular structures<ref>Byrd J.W. Evaluation of the hip: History and physical examination. North American Journal Of Sports Physical Therapy. 2007; 2:237.</ref>.


<u>Positive Test Results</u>: The log roll test is positive if there is pain, ligamentous or capsular laxity, clicking, or popping noted during the test. The presence of pain is indicative of an intra-articular pathology. The presence of a ligamentous or capsular laxity is demonstrated by noticeable hyper-mobility or increased range of motion through hip internal rotation and external rotation. The presence of clicking and popping refers to an acetabular labral tear<ref name=":0" />. If the rotational mobility component of this test is restricted or painful this would indicate hip pathology<ref name=":1" />.
* The test is positive for intra-articular pathology if the patient reports pain during the test, especially pain localized in the anterior groin.<ref name=":2" /><ref name=":0">Wong SE, Cogan CJ, Zhang AL. Physical examination of the hip: assessment of femoroacetabular impingement, labral pathology, and microinstability. Curr Rev Musculoskelet Med. 2022;15(2):38-52. doi: [[/www.physio-pedia.com//doi.org/10.1007/s12178-022-09745-8|10.1007/s12178-022-09745-8]].</ref><ref>Wichman D, Rasio JP, Looney A, Nho SJ. Physical examination of the hip. Sports Health. 2021;13(2):149-53. doi: [[/www.physio-pedia.com//doi.org/10.1177/1941738120953418|10.1177/1941738120953418]].</ref>
* Noticeable joint hyper-mobility or increased external rotation range of motion of the hip indicates iliofemoral ligament laxity or capsular laxity.<ref name=":7">Martin RL, Enseki KR, Draovitch P, Trapuzzano T, Philippon MJ. Acetabular labral tears of the hip: examination and diagnostic challenges. JOSPT. 2006;36(7):503-13. [[/doi.org/10.2519/jospt.2006.2135|https://doi.org/10.2519/jospt.2006.2135]]</ref><ref name=":8">Reiman MP, Thorborg K. Clinical examination and physical assessment of hip joint-related pain in athletes. Int J Sports Phys Ther. 2014;9(6):737-55. PMID: 25383243; PMCID: PMC4223284.</ref>
* Clicking or popping during the test suggests the presence of an acetabular labral tear.<ref name=":7" /><ref name=":8" />


<u>Negative Test Results</u>: The log roll test in negative if there is no symptoms present.  
'''Note:''' The absence of a positive log roll test does not exclude the hip as a source of symptoms.<ref name=":6" /><ref name=":4">Domb BG, Brooks AG, Byrd JW. Clinical examination of the hip joint in athletes. J Sport Rehabil. 2009;18(1):3-23. doi:10.1123/jsr.18.1.3</ref>


=== Evidence: ===
=== Evidence: ===
When positive the Log Roll test the test will result rule out the presence of hip pathology.  However, the finding of a negative log roll test does not 100% exclude the hip as a source of the symptoms<ref name=":0" />. The sensitivity for the log roll test for a femoral neck stress fracture was 100% and the specificity was 33%<ref>Rahman L.A., Adie S, Naylor J.M., Mittal R, So S, Harris I.A. A systematic review of the diagnostic performance of orthopedic physical examination tests of the hip. BMC Musculoskeletal Disorders. 2013; 14:257</ref>.
The log roll test is reported to have acceptable inter-rater reliability with a kappa coefficient of .61.<ref name=":3" />


=== Related Physiopedia Pages: ===
=== Related Physiopedia Pages: ===
Line 50: Line 56:


[[Functional Anatomy of the Hip]]
[[Functional Anatomy of the Hip]]
[[Labral Tear]]
[[Hip Labral Disorders]]
[[Femoroacetabular Impingement]]


=== Reference: ===
=== Reference: ===

Latest revision as of 04:15, 8 April 2024

Welcome to Arkansas Colleges of Health Education School of Physical Therapy Musculoskeletal 1 Project. This space was created by and for the students at Arkansas Colleges of Health Education School in the United States. Please do not edit unless you are involved in this project, but please come back in the near future to check out new information!!

Purpose:[edit | edit source]

The log roll test (or passive supine rotation test) is a special test used to assess the integrity of the hip joint. The test is used to screen for intra-articular hip pathologies including labral tears, ligamentous laxity, and impingement.[1][2][3][4]

Clinically Relevant Anatomy:[edit | edit source]

The hip is a ball and socket joint formed by the articulation of the head of the femur with the acetabulum of the pelvis. The main function of the hip is to support the weight of the upper body during sitting and standing, at rest and in motion.[5]

The femoral head is the area of the femur that contacts the acetabulum of the pelvic bone. Within the hip joint, the femoral head is connected to the acetabulum via the ligamentum teres, which surrounds the foveal artery; the foveal artery contributes significantly to the blood supply of the femoral head during childhood but its contributions are less significant in adulthood. Injuries to the ligamentum teres and foveal artery can result in osteonecrosis of the femoral head.[6]

The capsular ligaments of the hip include the iliofemoral ligament (Y-ligament), the pubofemoral ligament, and the ischiofemoral ligament. All of these ligaments limit/prevent extension of the hip. The iliofemoral ligament is the strongest ligament in the body, and it limits extension and external rotation of the hip. The pubofemoral ligament limits abduction, extension, and external rotation of the hip. Finally, the ischiofemoral ligament is the weakest of the three ligaments, and it limits extension and internal rotation of the hip.[6][7][1]

The acetabulum is the area of the pelvic bone where the ilium, ischium, and pubis converge. The articulation of the head of the femur with the acetabulum is the site where the weight of the axial skeleton is conveyed to the lower extremities.[5]

Attached to the acetabulum is the labrum of the hip, which is comprised of fibrocartilage and dense connective tissue. [8]The labrum of the hip has three surfaces: the internal articular surface, the external articular surface, and the basal surface.[5] The internal articular surface is adjacent to the joint and is avascular, causing decreased rate of healing in the event of injury. The external articular surface contacts the joint capsule and is vascularized.[8] The basal surface is attached to the acetabular bone and ligaments. The labrum serves to provide joint stability, absorb shock, lubricate the joint, and distribute pressure.[9]

Summary of Potential Pathologies at the Hip:[edit | edit source]

  • Labral tears: Common mechanisms of injury for labral tears include but are not limited to, femoracetabular impingement, trauma, ligamentous laxity, and abnormal bone structure.[10] Labral tears may present as hip or groin pain that becomes aggravated upon sitting or standing for prolonged periods of time. Clicking or locking sensations at the hip also indicate a possible labral tear.[5]
  • Iliofemoral ligament laxity: Ligamentous laxity may include chronic groin pain, tendinitis, or vertical displacement of the femoroacetabular joint.[11] If labral function is compromised, it may lead to increased stress on the structures comprising the anterior joint capsule, resulting in iliofemoral ligament laxity[12]
  • Femoroacetabular impingement (FAI): Femoroacetabular impingement is the result of bony abnormalities of either the acetabulum (pincer-type) or the proximal femur (cam-type) or a combination of the two. Severe structural changes may lead to labral tearing.[13]
  • Cam impingement: Excess growth of the femoral head and/or neck can cause abnormal contact between the femur and acetabulum resulting in cam impingement. Cam impingement is provoked by the combined movements of hip flexion, adduction, and internal rotation and can cause progressive erosion of the articular cartilage. This condition is not always symptomatic. This condition tends to affect primarily younger, active males.[14][15][5]
  • Pincer impingement: Pincer impingement occurs when the rim of the acetabulum provides excessive coverage of the femoral head and neck.[16] When the femoral head contacts the altered socket, excess movement is allowed. The impingement can cause adverse effects such as osteoarthritis if left untreated. The demographic most susceptible to pincer impingement are middle-aged female athletes.[5]

Technique:[edit | edit source]

  1. The patient assumes a supine position.
  2. Standing beside the patient, the clinician uses his/her more cephalic hand to grasp the patient's distal anterior femur and his/her more caudal hand to grasp the distal anterior tibia.
  3. The clinician passively moves the patient’s femur through the available range of internal rotation, noting the end feel.
  4. The clinician passively moves the patient's femur through the available range of external rotation, noting the end feel.
  5. The clinician repeats the test on the contralateral side and compares results.[4]

[17]

Note: The log roll test should move the articular surface of the femoral head along the acetabulum without stressing any of the surrounding extra-articular structures.[18]

Positive Test Results:

  • The test is positive for intra-articular pathology if the patient reports pain during the test, especially pain localized in the anterior groin.[5][3][19]
  • Noticeable joint hyper-mobility or increased external rotation range of motion of the hip indicates iliofemoral ligament laxity or capsular laxity.[1][2]
  • Clicking or popping during the test suggests the presence of an acetabular labral tear.[1][2]

Note: The absence of a positive log roll test does not exclude the hip as a source of symptoms.[18][20]

Evidence:[edit | edit source]

The log roll test is reported to have acceptable inter-rater reliability with a kappa coefficient of .61.[12]

Related Physiopedia Pages:[edit | edit source]

Hip Examination

Hip Anatomy

Functional Anatomy of the Hip

Labral Tear

Hip Labral Disorders

Femoroacetabular Impingement

Reference:[edit | edit source]

  1. ↑ 1.0 1.1 1.2 1.3 Martin RL, Enseki KR, Draovitch P, Trapuzzano T, Philippon MJ. Acetabular labral tears of the hip: examination and diagnostic challenges. JOSPT. 2006;36(7):503-13. https://doi.org/10.2519/jospt.2006.2135
  2. ↑ 2.0 2.1 2.2 Reiman MP, Thorborg K. Clinical examination and physical assessment of hip joint-related pain in athletes. Int J Sports Phys Ther. 2014;9(6):737-55. PMID: 25383243; PMCID: PMC4223284.
  3. ↑ 3.0 3.1 Wong SE, Cogan CJ, Zhang AL. Physical examination of the hip: assessment of femoroacetabular impingement, labral pathology, and microinstability. Curr Rev Musculoskelet Med. 2022;15(2):38-52. doi: 10.1007/s12178-022-09745-8.
  4. ↑ 4.0 4.1 Magee DJ. Orthopedic physical assessment. 6th edition. St. Louis: Elsevier Saunders, 2014.
  5. ↑ 5.0 5.1 5.2 5.3 5.4 5.5 5.6 Dutton M. Hip Joint Complex. In: Dutton, M editor. Dutton's orthopedic examination, evaluation, and intervention. 6th edition. New York: McGraw Hill Education, 2023.
  6. ↑ 6.0 6.1 Gold M, Munjal A, Varacallo M. Anatomy, Bony Pelvis and Lower Limb, Hip Joint. In: StatPearls [Internet]. Treasure Island: StatPearls Publishing, 2023. Available from https://www.ncbi.nlm.nih.gov/books/NBK470555/
  7. ↑ Martin HD, Savage A, Braly BA, Palmer IJ, Beall DP, Kelly B. The function of the hip capsular ligaments: a quantitative report. Arthroscopy 2008;24:188-195
  8. ↑ 8.0 8.1 Petersen W, Petersen F, Tillmann B. Structure and vascularization of the acetabular labrum with regard to the pathogenesis and healing of labral lesions. Arch Orthop Trauma Surg. 2003 Jul;123(6):283-8. doi: 10.1007/s00402-003-0527-7.
  9. ↑ Ferguson SJ, Bryant JT, Ganz R. The influence of the acetabular labrum on hip joint cartilage consolidation: a poroelastic finite element model. J Biomech. 2000;33(8):953–60.
  10. ↑ Su T, Chen GX, Yang L. Diagnosis and treatment of labral tear. Chin Med J. 2019;132(2): 211–219
  11. ↑ Philippon MJ, Bolia I, Locks R, Briggs K. Microinstability of the hip: a previously unrecognized pathology. Muscles Ligaments Tendons J. 2016;6(3):354–360. https://doi.org/10.11138/mltj/2016.6.3.354
  12. ↑ 12.0 12.1 Martin RL, Sekiya JK. The interrater reliability of 4 clinical tests used to assess individuals with musculoskeletal hip pain. J Orthop Sports Phys Ther. 2008;38(2):71–77. https://doi.org/10.2519/jospt.2008.2677
  13. ↑ Ejnisman L, Ricioli Júnior W, Queiroz MC, Vicente JR, Croci AT, Polesello GC. Femoroacetabular impingement and acetabular labral tears - part 1: pathophysiology and biomechanics. Rev Bras Ortop. 2020;55(5):518–22. https://doi.org/10.1055/s-0040-1702964
  14. ↑ Ganz R, Parvizi J, Beck M, Leunig M, Notzli H, Siebenrock KA. Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res. 2003;417:112-20. doi: 10.1097/01.blo.0000096804.78689.c2
  15. ↑ Byrd JW, Jones KS. Arthroscopic femoroplasty in the management of cam-type femoroacetabular impingement. Clin Orthop Relat Res. 2009;467(3):739-46. doi: 10.1007/s11999-008-0659-8.
  16. ↑ Philippon MJ, Stubbs AJ, Schenker ML, Maxwell RB, Ganz R, Leunig M. Arthroscopic management of femoroacetabular impingement: osteoplasty technique and literature review. Am J Sports Med. 2007 Sep;35(9):1571-80. doi: 10.1177/0363546507300258
  17. ↑ 17.0 17.1 Moffett S, Nichols B, Clark A, Wragg J. Arkansas Colleges of Health Education. 2024.
  18. ↑ 18.0 18.1 Byrd JW. Evaluation of the hip: history and physical examination. N Am J Sports Phys Ther. 2007;2(4):231-40. PMID: 21509142; PMCID: PMC2953301.
  19. ↑ Wichman D, Rasio JP, Looney A, Nho SJ. Physical examination of the hip. Sports Health. 2021;13(2):149-53. doi: 10.1177/1941738120953418.
  20. ↑ Domb BG, Brooks AG, Byrd JW. Clinical examination of the hip joint in athletes. J Sport Rehabil. 2009;18(1):3-23. doi:10.1123/jsr.18.1.3
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