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30° to 45° for external rotation. Adequate internal rotation is important for normal hip function, and there should be at least 10° of internal rotation at terminal hip extension. The loss of internal rotation is an important physical finding, because it is one of the first signs of internal hip pathology [29]. The loss of internal rotation at the hip joint can be related to diagnoses such as arthritis, effusion, internal derangements, slipped capital femoral epiphysis, and muscular contracture [29,32]. Pathology related to osteocartilaginous impingement (femoroacetabular impingement) or to rotational constraint from increased or decreased femoral acetabular anteversion can result in significant side-to-side measurement differences [17]. An increased internal rotation combined with a decreased external rotation may indicate excessive femoral anteversion [32]. Further ranges of motion are assessed in the supine examination, below.

Supine Examination

An important examination position to address the multifactorial presentation of complex hip pathology is the supine position (Table 6). The battery of tests, conducted with the patient in the supine position, helps to further distinguish internal from extra-articular sources of hip symptoms. There are four initial examination s of the athletic hip in the supine position.

The first examination completes the hip ranges of motion initiated in the seated position, focusing now upon flexion, adduction, and abduction. With the patient supine, abduct the affected leg by holding the ankle, and note the degree between the body's center line and the shaft of the femur. A normal abduction is 45°. To adduct, the leg must cross over the nonaffected leg. Note the degree again between the center line and femoral shaft. Normal adduction is 20° to 30°. During this evaluation, place one hand on the ASIS to assess any

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