The Log Roll Test
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Purpose:[edit | edit source]
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[1].
Clinically Relevant Anatomy:[edit | edit source]
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[1].
The femoral head is the area of the femur that contacts the acetabulum of the pelvic bone.
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 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 [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.
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.
Summary of Potential Pathologies at the Hip:[edit | edit source]
-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.[3]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.[4]
-ligament laxity-
-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.
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.
Pincer impingement is caused by abnormality of the acetabulum due to the rim of the acetabulum being significantly increased more than normal.
Technique:[edit | edit source]
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[5]. 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[6].
Positive Test Results: 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[1]. If the rotational mobility component of this test is restricted or painful this would indicate hip pathology[5].
Negative Test Results: The log roll test in negative if there is no symptoms present.
Evidence:[edit | edit source]
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[1]. The sensitivity for the log roll test for a femoral neck stress fracture was 100% and the specificity was 33%[7].
Related Physiopedia Pages:[edit | edit source]
Reference:[edit | edit source]
- ↑ 1.0 1.1 1.2 1.3 OrthoFixar. Log roll test. (cited 3 May 2023). Available from: https://orthofixar.com/special-test/log-roll-test/ (accessed 8 March 2024).
- ↑ PennMedicine. Labral Tear. Available from: 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).
- ↑ 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: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6365273/
- ↑ Hip Joint Complex | Dutton’s Orthopaedic Examination, Evaluation, and Intervention, 5e | AccessPhysiotherapy | McGraw-Hill Medical [Internet]. accessphysiotherapy.mhmedical.com. Available from: https://accessphysiotherapy.mhmedical.com/content.aspx?bookid=2707§ionid=224681946
- ↑ 5.0 5.1 Magee DJ., Orthopedic Physical Assessment, 6th edition, St. Louis: Elsevier Saunders, 2014.
- ↑ Byrd J.W. Evaluation of the hip: History and physical examination. North American Journal Of Sports Physical Therapy. 2007; 2:237.
- ↑ 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
