HIP IMPINGEMENT

                                                           Hip Impingement



Tests for Impingement Anteroposterior Impingement Test.--

 This test is a test for hip dysplasia (e.g., acetabular retroversion), slipped capital femoral epiphysis, and femoroacetabular impingement.


The patient lies supine with the hip flexed to 90".
The examiner then medially rotates and adducts the hip which leads to impingement of femoral neck against the acetabular rim
 Forced medial rotation can lead to a labral lesion, chondral lesion, or both. Pain is a positive sign. The hip is similarly tested in different degrees of flexion (45 to 120") with pain increasing with increased flexion.

Posterior Inferior Impingement Test.--

 This test is a test for global acetabular over coverage (.. coxa pro funda, coxa protrusio), global femoral neck offset





abnormalities, and posterior acetabular cartilage damage.



The test is also positive in people who place the hip in extremes of ROM (e.g., ballet dancers, martial artists,  hockey goal tenders, mountain climbers, yoga practice ners, long striding runners).

 The patient lies supine with the legs hanging free over the edge of the bed to ensure maximum hip extension.
 The examiner then laterally rotates the hip quickly . Deep seated groin or buttock pain is an indication of posteroinferior impingement.

 The dynamic internal (medial) rotation impinge ment (DIRI) test rotation impingement test (DEXRIT) tions of the previous two tests that are commonly used in arthroscopy of the hip." In both cases, the patient is in supine lying.

 The examiner takes the test hip into 90° of flexion. For the DIRI test, the hip is passively moved through a wide arc of adduction and medial rotation while for DEXRIT,

 the hip is passively moved through a wide arc of abduction and lateral rotation. Pain is a and the dynamic external (lateral) are modifica positive test.