Hip Rotation Evaluation in Children

Aka: Hip Rotation Evaluation in Children

1. See Also
   1. Hip Exam
   2. Hip Range of Motion
   3. Pediatric Limp
   4. Pediatric Limp Causes
2. Indications
   1. Evaluation of Intoeing
   2. Evaluation for Medial Femoral Torsion
3. Technique: Measure rotation of hip
   1. Test both hips at the same time
      1. Prevents false positives due to Pelvis rotation
   2. Child lies supine or prone
      1. Hips extended
      2. Knees flexed (dangling over table edge if supine)
   3. Push ankles away from midline toward table
      1. Normal medial hip rotation angle <70 degrees
   4. Push ankles across midline toward other side of table
      1. Normal lateral hip rotation angle >20 degrees
      2. Clearly abnormal if less than -10 degrees
4. Interpretation: Normal hip rotation angles (vary by age)
   1. Medial rotation (estimate normal as <70 degrees)
      1. Age 1: 25 to 63 degrees (mean 43 degrees)
      2. Age 3: 27 to 65 degrees (mean 48 degrees)
      3. Age 5: 30 to 67 degrees (mean 50 degrees)
      4. Age 7: 31 to 68 degrees (mean 51 degrees)
      5. Age 9: 33 to 68 degrees (mean 51 degrees)
   2. Lateral rotation (estimate normal as >20 degrees)
      1. Age 1: 40 to 85 degrees (mean 65 degrees)
      2. Age 3: 39 to 77 degrees (mean 58 degrees)
      3. Age 5: 30 to 70 degrees (mean 50 degrees)
      4. Age 7: 28 to 65 degrees (mean 48 degrees)
      5. Age 9: 26 to 63 degrees (mean 41 degrees)
5. Interpretation: Signs of Femoral Anteversion
   1. Most of arc of rotation of hip is inward
   2. Excessive medial hip rotation >70 degrees
   3. Limited lateral hip rotation <20 degrees
      1. Clearly abnormal if less than -10 degrees
6. Other findings on Hip Range of Motion
   1. Painful asymmetry is a red flag for pathology
   2. Also test for Congenital Hip Dysplasia
7. References
   1. Schmale (2003) AAFP Board Review, Seattle