Test: Hip Abduction (Glutei medius and minimus)

Video Link

Background/Purpose

The hip joint is one of the most flexible joints in the entire human body. The many muscles of the hip provide movement, strength, and stability to the hip joint and the bones of the hip and thigh. These muscles can be grouped based upon their location and function. The four groups are the anterior group, the posterior group, adductor group, and finally the abductor group. The abductor muscle group is located on the lateral side of the thigh and moves the thigh away from the body’s midline. These muscles include the piriformis, superior gemellus, inferior gemellus, tensor fasciae latae, sartorius, gluteus medius, and gluteus minimus muscles. Spreading the legs to do a split is an example of a movement involving the abductor muscles.

Procedure

Position of Patient: Side-lying with test leg uppermost. Start test with the limb slightly extended beyond the midline and the pelvis rotated slightly forward. Lowermost leg is flexed for stability.
Position of Clinician: Standing behind the patient. Hand used to give resistance is contoured across the lateral surface of the knee. The hand used to palpate the Gluteus medius is just proximal to the greater trochanter of the femur. (No resistance is used in a Grade 3 test). Alternatively, resistance may be applied at the ankle, which gives a longer lever arm and requires greater strength on the part of the patient to achieve a grade of 5 or 4. Clinician is reminded always to use the same lever in a given test sequence as in subsequent comparison tests. To distinguish a Grade 5 from a Grade 4 result, first apply resistance at the ankle and hen at the knee.
Test: Patient abducts hip through the complete available range of motion without flexing the hip or rotating it in either direction. Resistance is given in a straight downward direction.
Instructions to Patient: “Lift your leg up in the air. Hold it. Don’t let me push it down.”
Grading:
Grade 5 (Normal) Completes available range and holds end position against maximal resistance.
Grade 4 (Good) Completes available range and holds against heavy to moderate resistance.
Grade 3 (Fair) Completes range of motion and holds end position without resistance.
Grade 2 (Poor) – Position of Patient: Supine.
Position of Clinician: Standing on the side of the limb being tested. One hand supports and lifts the limb by holding it under the ankle to raise the limb just enough to decrease friction. This hand offers no resistance, nor should it be used to offer assistance to the movement. On some smooth surfaces such support may not be necessary. The other hand palpates the Gluteus medius just proximal to the greater trochanter of the femur.
Test: Patient abducts hip through available range.
Instructions to Patient: “Bring your leg out to the side. Keep your kneecap pointing to the ceiling.”
Grading:
Grade 2 (Poor) Completes range of motion supine with no resistance and minimal to zero friction.
Grade 1 (Trace) and Grade 0 (Zero) – Position of Patient: Supine.
Position of Clinician: Standing at the side of the limb being tested at level of thigh. One hand supports the limb under the ankle just above the malleoli. The hand should provide neither resistance nor assistance to movement. Palpate the Gluteus medius on the lateral aspect of the hip just above the greater trochanter.
Test: Patient attempts to abduct hip.
Instructions to Patient: “Try to bring your leg out to the side.”
Grading:
Grade 1 (Trace) Palpable contraction of Gluteus medius but no movement of the part.
Grade 0 (Zero) No palpable contraction.
The clinician should not be able to “break” a Grade 5 muscle and most clinicians will not be able to “break” a Grade 4 muscle. A Grade 4 often masks significant weakness because of the intrinsic great strength of these muscles. Giving resistance at the ankle rather than at the knee assists in overcoming this problem. It is difficult to impossible to palpate minimal contractile activity of muscle through clothing. When the patient is supine, the weight of the opposite limb stabilizes the pelvis. It is not necessary to use a hand to stabilize the contralateral limb.

Performed: Unilaterally

Dialog

Patient abducts hip through the complete available range of motion without flexing the hip or rotating it in either direction.

Criteria

• Range of motion 0 to 45 degrees.

Measurement

LOINC Code

0

Scale/Grading

Pass/Fail