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Abstract
Accurate measurement of hip motion is important in initial diagnosis, assessing progression over time, evaluating treatment outcomes, and rating impairments of this joint. In the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, range-of-motion (ROM) measurements are still a factor because the physical examination and other adjustment tables are used to select the grade and final rating. Further, ROM deficits may be used to derive a stand-alone rating when other tables refer the rater to motion impairment or if no diagnosis-based section is applicable for impairment rating. Hip motions generally are measured using a large goniometer, although an electronic inclinometer also may be used. Examiners must conduct tests in accordance with measurement instructions in the AMA Guides. From the standpoint of impairment rating, hip extension, at least beyond neutral, is irrelevant; if a patient does not have a flexion contracture of at least 10°, there is no extension impairment. Examiners should compare both extremities; active or voluntary motion is performed by the active contraction of the governing muscles and should be evaluated first. During this and other measurements, patients may have a tendency to extend or guard, thus producing an erroneously inflated measurement. Examiners must ensure that such behaviors do not occur and should record only the correct measurement.
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1.
Green WB, Heckman JD. The Clinical Measurement of Joint Motion. Rosemont, IL: American Academy of Orthopaedic Surgeons; 1994.
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2.
Hollinshead WH. Anatomy for Surgeons: The Back and Limbs. Vol. 3. 3rd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 1982:646-655.
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3.
Cave EF, Roberts SM. A method for measuring and recording joint function. J. Bone Joint Surg. 1936;18:455-465.
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4.
Magee DJ. Orthopedic Physical Assessment. 3rd ed. Philadelphia, PA: W. B. Saunders; 1997:463-464.
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