The Log Roll Test: Difference between revisions

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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=":4" />.
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=":4" />.


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>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 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 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 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 limits extension and internal rotation<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>.
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 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 limits extension and internal rotation<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>.


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 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.

Revision as of 04:54, 6 April 2024

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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. The test is used to screen for hip pathologies including labral tears, ligamentous laxity, and impingement[1].

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[2].

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[3].

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 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 limits extension and internal rotation[3][4].

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 [5].

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: Common mechanisms of injury for labral tears include, but are not limited to, direct or indirect trauma, impingement from the femoral head or acetabulum, laxity of the hip ligaments, and abnormal bone structure.[6] Labral tears may present in many ways such as pain in hip or groin area due to nerves innervating the labrum being disrupted. This pain will be aggravated by sitting or standing for prolonged periods of time. Some subjective things said by the patient that could key the examiner towards a labral tear is reported symptoms of locking or clicking of the hip when walking or doing other activities that requires excessive hip movement.[2]
  • Iliofemoral ligament laxity: In general, a ligamentous laxity may present with symptoms similar to that of hip microinstability. Symptoms may include, but are not limited to, chronic groin pain, tendinitis from dynamic stabilizer overload, or pistoning of the femoracetabular joint.[7] If labral function is compromised it may also lead to increased stress on the structures comprising the anterior joint capsule and promote iliofemoral ligament laxity.[8]
  • Femoral Acetabular impingement (FAI): Femoral acetabular impingement causes changes to the structure of the acetabulum and proximal femur, and when the changes are severe enough may lead to tearing of the labrum.[9] It is important to note that there are multiple types of FAI, with the two most common being Cam impingement and Pincer impingement. These 2 impingements often affect a certain demographic, for instance a Cam impingement is more likely to affect male athletes. Female athletes have a highest risk for a 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. A good way to think of this incorrect contact is by picturing a car with a larger tire than it should have, while it allows movement it does so at the expense of the whole car. The larger tire will rub against the inner part of the car leading to things getting stuck. The same goes for an overgrowth of the femoral neck leading to acetabular impingement. This impingement specifically occurs during combined movements of hip flexion, adduction and internal rotation of the hip.[10] Often many times individuals with Cam impingement don't realize they have the condition due to it being fairly asymptomatic most of their life. It is observed that the demographic most affected by this impingement are young male athletes in sports such as basketball, baseball, soccer, and football just to name a few.[11]
  • Pincer Impingement: is caused by abnormality of the acetabulum due to the rim of the acetabulum being larger than normal. This larger than normal rim causes the socket to become larger as an adverse effect. Bigger is not necessarily better as the femoral head is still a normal size in contact with the acetabulum, which can cause excess movement between the two. Over time this type of impingement can eventually lead to what is called an impaction type injury through years of degeneration, which can lead to development of osteoarthritis or a need for a total hip replacement of the involved limb.[11] While not many studies have correlated the two it has been observed that the demographic that tends to be the most susceptible to this impingement are middle aged female athletes or those who frequently take part in sports.[11]

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.
  4. The clinician passively moves the patient's femur through the available range of external rotation[12].

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[13].

Positive Test Results:

  • Pain reported during the test is positive for an intra-articular pathology.
  • Noticeable joint hyper-mobility or increased external and internal rotation range of motion of the hip is positive for iliofemoral ligament laxity or capsular laxity.[8]
  • Clicking or popping noted result in a positive test for the presence of an acetabular labral tear[1].
  • If the rotational mobility component of this test is restricted or painful this would indicate hip pathology[12].

Note: The absence of a positive log roll test does not exclude the hip as a source of symptoms.[1]

Evidence:[edit | edit source]

When positive the log roll test the test will result rule in the presence of hip pathology. However, the finding of a negative log roll test does not exclude the hip as a source of the symptoms[1]. This is because the log roll test is highly sensitive and has the chance of producing false positive tests. The sensitivity for the log roll test for a femoral neck stress fracture was 100% and the specificity was 33%[14].

Related Physiopedia Pages:[edit | edit source]

Hip Examination

Hip Anatomy

Functional Anatomy of the Hip

Reference:[edit | edit source]

  1. ↑ 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).
  2. ↑ 2.0 2.1 Dutton M, Hip Joint Complex, In: McGraw-Hill Education. Dutton's Orthopedic Examination Evaluation and Intervention 5th edition. New York: McGraw Hill / Medical, 2019. p 824-921
  3. ↑ 3.0 3.1 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/
  4. ↑ 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
  5. ↑ 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).
  6. ↑ Su T, Chen GX, Yang L. Diagnosis and treatment of labral tear. Chin Med J. 2019;132(2): 211–219
  7. ↑ 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
  8. ↑ 8.0 8.1 Martin, R. L., & Sekiya, J. K. (2008). The interrater reliability of 4 clinical tests used to assess individuals with musculoskeletal hip pain. Journal of Orthopaedic &amp; Sports Physical Therapy, 38(2), 71–77. https://doi.org/10.2519/jospt.2008.2677
  9. ↑ Ejnisman, L., Ricioli Júnior, W., Queiroz, M. C., Vicente, J. R. N., Croci, A. T., & Polesello, G. C. (2020). Femoroacetabular Impingement and Acetabular Labral Tears - Part 1: Pathophysiology and Biomechanics. Revista brasileira de ortopedia, 55(5), 518–522. https://doi.org/10.1055/s-0040-1702964
  10. ↑ Dutton M, Hip Joint Complex, In: McGraw-Hill Education. Dutton's Orthopedic Examination Evaluation and Intervention 5th edition. New York: McGraw Hill / Medical, 2019. p 893-894
  11. ↑ 11.0 11.1 11.2 Dutton M, Hip Joint Complex, In: McGraw-Hill Education. Dutton's Orthopedic Examination Evaluation and Intervention 5th edition. New York: McGraw Hill / Medical, 2019. p 894-895
  12. ↑ 12.0 12.1 Magee DJ., Orthopedic Physical Assessment, 6th edition, St. Louis: Elsevier Saunders, 2014.
  13. ↑ Byrd J.W. Evaluation of the hip: History and physical examination. North American Journal Of Sports Physical Therapy. 2007; 2:237.
  14. ↑ Rahman LA, Adie S, Naylor JM, Mittal R, So S, Harris IA. A systematic review of the diagnostic performance of orthopedic physical examination tests of the hip. BMC Musculoskelet Disord. 2013;14:257
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