scholarly journals Less hip range of motion is associated with a greater alpha angle in people with longstanding hip and groin pain

2021 ◽  
Author(s):  
August Estberger ◽  
Anders Pålsson ◽  
Ioannis Kostogiannis ◽  
Eva Ageberg
Keyword(s):  
Range Of Motion ◽  
Internal Rotation ◽  
Sensitivity And Specificity ◽  
Groin Pain ◽  
External Rotation ◽  
Alpha Angle ◽  
Good Sensitivity ◽  
Level Of Evidence ◽  
Hip Range Of Motion ◽  
Hip Flexion

Abstract Purpose A higher alpha angle has been proposed to correlate with lower hip range of motion, but the association in people with longstanding hip and groin pain is currently unclear. The aims were to: (1) assess the association between range of motion and alpha angle in patients with longstanding hip and groin pain; (2) examine if a cut-off value in range of motion variables could identify patients with an alpha angle above or below 60°. Methods Seventy-two participants were consecutively recruited from an orthopaedic department after referral for hip- and groin-related pain. Passive hip range of motion was measured in flexion, internal rotation with 90° hip flexion, internal rotation in neutral hip position, external rotation with 90° hip flexion, and abduction. The alpha angle was calculated from a frog-leg lateral radiograph. Linear regression examined the association between range of motion and alpha angle, and an ROC-curve analysis was performed to identify the sensitivity and specificity of range of motion cut-offs. Results Lower range of motion in internal rotation in flexion, external rotation, and abduction were associated with higher alpha angle. Internal rotation of 27° or less displayed good sensitivity (81%) and specificity (85%) to detect an alpha angle above 60°, while a cut-off of 41° in external rotation and 27° in abduction showed a sensitivity of 72% and specificity of 50% and 60%, respectively. Conclusion Less internal rotation in flexion, external rotation, and abduction are associated with a greater alpha angle in a cohort of people with longstanding hip and groin pain. A cut-off of 27° in internal rotation has good sensitivity and specificity to identify people with an alpha angle above or below 60° and have the potential to be used in the clinical setting to identify patients that require further imaging, or that are unlikely to have cam morphology. Level of evidence II.

scholarly journals Reliability of hip range of motion measurement among experienced arthroscopic hip preservation surgeons

2019 ◽  
Vol 7 (1) ◽  
pp. 77-84 ◽  
Author(s):  
Joshua D Harris ◽  
Richard C Mather ◽  
Shane J Nho ◽  
John P Salvo ◽  
Allston J Stubbs ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Pelvic Tilt ◽  
External Rotation ◽  
Level Of Evidence ◽  
Motion Measurement ◽  
Hip Range Of Motion ◽  
Asymptomatic Volunteers ◽  
Hip Flexion ◽  
Hip Internal Rotation ◽  
Intra Class Correlation Coefficient

Abstract The aim of this study was to determine (i) the reliability of hip range of motion measurement among experienced arthroscopic hip preservation surgeons and (ii) the magnitude of hip flexion change with posterior pelvic tilt. Five experienced arthroscopic hip preservation surgeons (5–18 years of hip surgery experience) performed passive hip range of motion (internal and external rotation), flexion (contralateral hip extended) and flexion with posterior pelvic tilt (contralateral hip maximally flexed) on five young healthy asymptomatic volunteers (three males, two females; 34.4 ± 10.7 years of age). Motion was measured via digital photography and goniometry. Inter-observer reliability was calculated via two-way mixed, single measures, intra-class correlation coefficient. Paired t-test was utilized to compare hip flexion (with contralateral hip extended) to hip flexion with posterior pelvic tilt (with contralateral hip in forced flexion). The reliabilities of measurements of hip flexion with posterior pelvic tilt and external rotation were excellent, that of hip flexion was fair, and that of hip internal rotation was poor. The magnitude of hip flexion increase with posterior pelvic tilt was 17.0° ± 3.0° (P < 0.001). The reliability of hip range of motion measurement by five experienced arthroscopic hip preservation surgeons was excellent for measures of hip flexion with posterior pelvic tilt and external rotation. Contralateral maximal hip flexion significantly increased ipsilateral hip flexion (approximately 17°). Level of Evidence: Diagnostic, level III (without consistently applied reference standard)

scholarly journals The immediate effect of ipsilateral and contralateral sacroiliac joint manipulation on the hip range of motion and kicking velocity in soccer players

2015 ◽  
Author(s):  
◽  
Zia ul Mustafa Rehman
Keyword(s):  
Range Of Motion ◽  
Internal Rotation ◽  
Sacroiliac Joint ◽  
Ordinal Data ◽  
External Rotation ◽  
Intervention Group ◽  
Soccer Players ◽  
Hip Range Of Motion ◽  
Flexion Extension ◽  
The Right

Background There is a close biomechanical relationship that exists between the sacroiliac and hip joints. It is essential to have optimum hip range of motion originating from the pelvis in both the kicking and support limbs as both limbs play a role in achieving a high speed kicking velocity. Due to the strenuous activity of soccer players, both hip ranges of motion may be decreased, thus predisposing the player to injuries. This may also affect the kicking velocity. The effects of sacroiliac joint manipulation on hip range of motion and kicking velocity were investigated. Objectives The objective of this study was to determine the effect of ipsilateral sacroiliac joint manipulation versus contralateral sacroiliac joint manipulation on bilateral hip range of motion and kicking velocity. Methods There were three groups of twenty soccer players. The ipsilateral sacroiliac joint manipulation group, the contralateral sacroiliac joint manipulation group, and the sham laser intervention group. The case history, physical, regional, lumbar and hip exams were done in the Chiropractic Day Clinic. The hip ranges of motion were measured pre- and post- Chiropractic manipulation in all three groups on both limbs in the Fred Crookes Sports Centre (Durban University of Technology). Hip ranges of motion were measured by the Saunders (The Saunders Group, Chaska, MN) digital inclinometer. The kicking velocity of all players were measured pre- and post- manipulation by a speed sport radar gun (Bushnell Speedster Speed Gun; Bushnell Inc, Lenexa, KS). This was a purposive, investigational study trial where the data was reduced and analysed with the help of a statistician, using the statistical software SPSS version 20.0.The statistical aspect of the research encompassed the following: descriptive statistics used Fischer values, Eta tests, frequency, cross-tabulation tables and various types of graphs (bar charts, scatter graphs etc.); Inferential statistics used Pearson’s and/or Spearman’s correlations at a significance level of 0.05; testing of hypotheses used chi-square tests for nominal data and ordinal data at a level of significance of 0.05. Results The ipsilateral group showed statistically significant results for the right hip in flexion, extension, internal rotation and external rotation, as well as for extension, internal rotation and external rotation in the left hip. The contralateral group showed statistically significant results for the right hip in extension, internal rotation and external rotation, as well as for extension and internal rotation in the left hip. There was a statistically significant improvement in the kicking velocity of the ipsilateral and contralateral group after treatment. There was a strong association between the perception changes to the actual kicking velocity in the soccer players. There was a correlation between the change in hip range of motion and change in kicking velocity, however statistically it was not significant. Conclusion The manipulation of ipsilateral or contralateral sacroiliac joint has an effect on the right and left hip range of motion

scholarly journals Factors Affecting the Outcomes of Arthroscopic Capsular Release for Idiopathic Adhesive Capsulitis

2019 ◽  
Vol 7 (9) ◽  
pp. 232596711986762 ◽  
Author(s):  
Syed M. Rizvi ◽  
Ahmed J. Harisha ◽  
Patrick H. Lam ◽  
George A.C. Murrell
Keyword(s):  
Range Of Motion ◽  
Internal Rotation ◽  
External Rotation ◽  
Adhesive Capsulitis ◽  
Linear Regression Analysis ◽  
Frozen Shoulder ◽  
Level Of Evidence ◽  
Duration Of Symptoms ◽  
Capsular Release ◽  
Arthroscopic Capsular Release

Background: Arthroscopic capsular release has been shown to provide excellent short- and long-term outcomes in patients with idiopathic frozen shoulder. Some surgeons delay surgery in the belief that operating in the early stages of adhesive capsulitis results in a poorer prognosis. However, it is unclear which factors, particularly the stage of the disorder, affect the surgical outcome of this procedure. Hypothesis: Patients who undergo capsular release during the early symptomatic stage of idiopathic adhesive capsulitis would have less improvement in range of motion compared with those who undergo surgery at a later stage. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 189 shoulders with idiopathic adhesive capsulitis that underwent arthroscopic capsular release were evaluated. All patients completed a L’Insalata questionnaire and had their range of motion and strength tested prior to surgery and at 1, 6, and 12 weeks and 6 months post–capsular release. Post hoc, patients were grouped by whether they had symptoms lasting <10 months (shorter symptoms group; n = 131) or ≥10 months (longer symptoms group; n = 38). Multiple linear regression analysis was performed to determine which preoperative factors were independently associated with a favorable outcome. Results: Patients in the shorter symptoms group were more restricted prior to surgery than were those in the longer symptoms group (mean ± SEM: external rotation, 17° ± 2° vs 27° ± 4° [ P = .04]; abduction, 78° ± 3° vs 92° ± 6° [ P = .04]; internal rotation, S3 ± 1 vs S1 ± 1 [ P = .03]). The shorter symptoms group had greater postoperative improvement in internal rotation (from S3 ± 1 preoperatively to T12 ± 1 vertebral levels) compared with the longer symptoms cohort (from S1 ± 1 to L2 ± 1) ( P = .02). Conclusion: Patients with a frozen shoulder and a duration of symptoms <10 months made greater improvements in internal rotation and had similar final results for flexion, abduction, and external rotation following arthroscopic capsular release when compared with patients who had a longer duration of symptoms, so there is no reason to delay surgery.

scholarly journals The Effect of Straight-Line Long-Toss Versus Ultra-Long-Toss Throwing on Passive Glenohumeral Range of Motion Recovery After Pitching

2021 ◽  
pp. 194173812098001
Author(s):  
T. David Luo ◽  
Aaron D. Sciascia ◽  
Austin V. Stone ◽  
Chukwuweike U. Gwam ◽  
Christopher A. Grimes ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Internal Rotation ◽  
National Collegiate Athletic Association ◽  
External Rotation ◽  
Level Of Evidence ◽  
Left Hand ◽  
Right Hand ◽  
Straight Line ◽  
Significant Difference ◽  
Baseball Pitchers

Background: Repetitive throwing in baseball pitchers can lead to pathologic changes in shoulder anatomy, range of motion (notably glenohumeral internal rotation deficit), and subsequent injury; however, the ideal strengthening, recovery, and maintenance protocol of the throwing shoulder in baseball remains unclear. Two strategies for throwing shoulder recovery from pitching are straight-line long-toss (SLT) throwing and ultra-long-toss (ULT) throwing, although neither is preferentially supported by empirical data. Hypothesis: ULT will be more effective in returning baseline internal rotation as compared with SLT in collegiate pitchers after a pitching session. Study Design: Cohort study. Level of Evidence: Level 3. Methods: A total of 24 National Collegiate Athletic Association Division I baseball pitchers with mean age 20.0 ± 1.1 years were randomized to either the ULT group (n = 13; 9 right-hand dominant, 4 left-hand dominant) or SLT group (n = 11; 10 right-hand dominant, 1 left-hand dominant). Measurements (dominant and nondominant, 90° abducted external rotation [ER], internal rotation [IR], and total range of motion [TROM]) were taken at 5 time points across 3 days: before and immediately after a standardized bullpen session on day 1; before and immediately after a randomized standardized ULT or SLT session on day 2; and before practice on Day 3. Results: ULT demonstrated significantly greater final ER compared with baseline (+10°; P = 0.05), but did not demonstrate significant IR changes. Similarly, SLT demonstrated significantly greater post-SLT ER (+12°; P = 0.02) and TROM (+12°; P = 0.01) compared with baseline, but no significant IR changes. Final ER measurements were similar between ULT (135° ± 14°) and SLT (138° ± 10°) ( P = 0.59). There was also no statistically significant difference in final IR between ULT (51° ± 14°) and SLT (56° ± 8°) ( P = 0.27). Conclusion: The routine use of postperformance, ULT throwing to recover from range of motion alterations, specifically IR loss, after a pitching session is not superior to standard, SLT throwing. Based on these findings, the choice of postpitching recovery throwing could be player specific based on experience and comfort. Clinical Relevance: The most effective throwing regimens for enhancing performance and reducing residual impairment are unclear, and ideal recovery and maintenance protocols are frequently debated with little supporting data. Two strategies for throwing shoulder recovery from pitching are SLT and ULT throwing. These are employed to help maintain range of motion and limit IR loss in pitchers. The routine use of ULT throwing for recovery and to limit range of motion alterations after a pitching session is not superior to SLT throwing.

scholarly journals Evaluation of the inter and intraobserver reproducibility of the GRASP method: a goniometric method to measure the isolated glenohumeral range of motion in the shoulder joint

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Miguel Angel Ruiz Ibán ◽  
Susana Alonso Güemes ◽  
Raquel Ruiz Díaz ◽  
Cristina Victoria Asenjo Gismero ◽  
Alejandro Lorente Gomez ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Internal Rotation ◽  
Glenohumeral Joint ◽  
External Rotation ◽  
Intraclass Correlation ◽  
Correlation Coefficients ◽  
Outpatient Setting ◽  
Interobserver Reproducibility ◽  
Level Of Evidence ◽  
Intraclass Correlation Coefficients

Abstract Purpose To evaluate the intra and interobserver reproducibility of a new goniometric method for evaluating the isolated passive range of motion of the glenohumeral joint in an outpatient setting. Methods This is a prospective observational study on healthy subjects. The Glenohumeral ROM Assessment with Scapular Pinch (GRASP) method is a new method for assessing the isolated range of motion (ROM) of the glenohumeral joint (GH) by a single examiner with a clinical goniometer. It measures the isolated glenohumeral passive abduction (GH-AB), passive external rotation (GH-ER) and internal rotation (GH-IR) with the arm at 45º of abduction. These three GH ROM parameters were measured in both shoulders of 30 healthy volunteers (15 males/15 females, mean age:41.6[SD = 10.3] years). The full shoulder passive abduction, passive external rotation and internal rotation 45º of abduction were measured by the same examiners with a goniometer for comparison. One examiner made two evaluations and a second examiner made a third one. The primary outcome was the intra- and interobserver reproducibility of the measurements assessed with intraclass correlation coefficients (ICC) and the Bland–Altman plot. Results The intra-observer ICC for isolated glenohumeral ROM were: 0.84 ± 0.07 for GH-ABD, 0.63 ± 0.09 for GH-ER, and 0.61 ± 0.14 for GH-IR. The inter-observer ICC for isolated glenohumeral ROM were: 0.86 ± 0.06 for GH-ABD, 0.68 ± 0.12 for GH-ER, and 0.62 ± 0.14 for GH-IR. These results were similar to those obtained for full shoulder ROM assessment with a goniometer. Conclusion The GRASP method is reproducible for quick assessment of isolated glenohumeral ROM. Level of evidence III

Shoulder Range of Motion Deficits in Youth Throwers Presenting With Elbow Pain

2021 ◽  
pp. 194173812110363
Author(s):  
Michael Rosen ◽  
Karim Meijer ◽  
Scott Tucker ◽  
C. Luke Wilcox ◽  
Hillary A. Plummer ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Internal Rotation ◽  
External Rotation ◽  
Group Versus ◽  
Control Group ◽  
Pain Group ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
Elbow Pain ◽  
Shoulder Range Of Motion

Background: Glenohumeral internal rotation deficit (GIRD) and total arc of motion difference (TAMD) have been associated with elbow injuries in throwing athletes. Hypothesis: Youth pitchers with elbow pain will have greater GIRD and TAMD compared with youth pitchers without elbow pain. Study Design: Cross-sectional study. Level of Evidence: Level 3. Methods: Glenohumeral range of motion of 25 consecutive throwing athletes presenting with elbow pain and that of a matched control group of 18 asymptomatic throwing athletes were compared. Bilateral glenohumeral internal rotation, external rotation, and horizontal adduction at 90° were measured and GIRD and TAMD were then calculated. An analysis of variance was performed to compare range of motion between throwers with and without elbow pain. Results: The average GIRD of the elbow pain group was 32.7° compared with 14.5° in the control group ( P < 0.05). The average TAMD in the elbow pain group was 28.3° compared with 6.7° in the control group ( P < 0.05). GIRD and TAMD were present in 88% (22 of 25) and 96% (24 of 25) of the elbow pain group versus 33.3% (6 of 18) and 55.6% (10 of 18) of the control group, respectively. Conclusion: Compared with asymptomatic youth pitchers, those presenting with elbow pain have a statistically significant GIRD and TAMD. Clinical Relevance: This study suggests that a GIRD and TAMD may predispose youth pitchers to present with symptomatic elbow pain.

Topical Glyceryl Trinitrate Application in the Treatment of Chronic Supraspinatus Tendinopathy

2005 ◽  
Vol 33 (6) ◽  
pp. 806-813 ◽  
Author(s):  
Justin A. Paoloni ◽  
Richard C. Appleyard ◽  
Janis Nelson ◽  
George A.C. Murrell
Keyword(s):  
Clinical Trial ◽  
Glyceryl Trinitrate ◽  
Range Of Motion ◽  
Internal Rotation ◽  
Outcome Measures ◽  
External Rotation ◽  
Controlled Clinical Trial ◽  
Level Of Evidence ◽  
Muscle Testing ◽  
Topical Glyceryl Trinitrate

Background Topical glyceryl trinitrate therapy has previously demonstrated short-term pain reduction in patients with supraspinatus tendinopathy. Hypothesis Topical glyceryl trinitrate improves outcome measures in patients with supraspinatus tendinopathy. Study Design Randomized controlled clinical trial; Level of evidence, 1. Methods Fifty-three patients (57 shoulders) were recruited, and the authors completed a prospective, randomized, double-blinded, placebo-controlled clinical trial of continuous topical glyceryl trinitrate treatment (1.25 mg/24-h glyceryl trinitrate). Results The glyceryl trinitrate group had significantly reduced shoulder pain with activity, at night, and at rest at week 24 (P =. 03); reduced internal rotation impingement at week 24 (P =. 02); increased range of motion in abduction and internal rotation at week 24 (P =. 04); and increased force at weeks 12 and 24 with supraspinatus muscle testing (P =. 001), external rotation (P =. 04), internal rotation (P =. 01), adduction (P =. 04), and subscapularis pushoff (P =. 01). Forty-six percent of patients on glyceryl trinitrate patches were asymptomatic with activities of daily living at 6 months compared with 24% of patients with tendon rehabilitation alone (P =. 007, χ2 analysis). Mean effect size for all outcome measures was 0.26. Discussion Topical glyceryl trinitrate treatment significantly improved pain scores, range of motion, internal rotation impingement, muscular force, and patient outcomes in patients with supraspinatus tendinopathy. Topical glyceryl trinitrate should be included as part of nonsurgical management of chronic tendinopathies.

scholarly journals Differences in Passive Shoulder Range of Motion Between Baseball Players With Neurogenic Thoracic Outlet Syndrome and Matched Healthy Controls

2021 ◽  
Vol 9 (4) ◽  
pp. 232596712110007
Author(s):  
J. Craig Garrison ◽  
Joseph P. Hannon ◽  
John E. Conway
Keyword(s):  
Range Of Motion ◽  
Internal Rotation ◽  
Thoracic Outlet Syndrome ◽  
External Rotation ◽  
Limited Information ◽  
Level Of Evidence ◽  
Baseball Players ◽  
Shoulder Range Of Motion ◽  
Neurogenic Thoracic Outlet Syndrome ◽  
Shoulder Range

Background: Neurogenic thoracic outlet syndrome (nTOS) is becoming more recognized as a diagnosis in the throwing athlete. Currently, there is limited information on the clinical presentation and development of nTOS in baseball players. Purpose: To compare passive shoulder range of motion (ROM) and anatomic humeral retrotorsion (HRT) of baseball players diagnosed with nTOS with a group of healthy, matched controls. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 53 adolescent baseball players diagnosed with nTOS (age, 17.2 ± 2.3 years; height, 180.9 ± 10.1 cm; weight, 80.0 ± 13.3 kg) were compared with 53 healthy baseball players (age, 17.2 ± 2.4 years; height, 183.9 ± 9.0 cm; weight, 83.8 ± 11.5 kg). Participants were measured for shoulder internal rotation (IR) and external rotation (ER) ROM and HRT. All measurements were taken bilaterally, and the differences (throwing to nonthrowing arm) were used to calculate mean values for glenohumeral internal rotation difference, glenohumeral external rotation difference (GERD), total rotational motion difference (TRMdiff), and anatomic humeral retrotorsion difference. Group comparisons were made between the nTOS and control players using multivariate analysis of variance, and descriptive comparisons were made with independent t tests. Results: There were no significant differences between groups in age, height, weight, or years of experience. Players in the nTOS group had significantly less throwing arm ER compared with controls (103.4° ± 10.4° vs 109.6° ± 7.5°, respectively; P = .001) and GERD (3.0° ± 9.2° vs 8.8° ± 9.2°, respectively; P = .002). TRMdiff was significantly greater in nTOS (–11.1° ± 11.1°) than in controls (–3.7° ± 9.4°) ( P < .001). Conclusion: In the current study, adolescent baseball players diagnosed with nTOS were evaluated with shoulder ROM differences when compared with a matched healthy cohort. A loss of throwing arm ER appeared to be the main factor behind shoulder ROM changes in the nTOS group.

scholarly journals The Bipolar Hip: Combined Acetabular and Femoral Pathomorphology Determine Hip Motion

2019 ◽  
Vol 7 (7_suppl5) ◽  
pp. 2325967119S0042
Author(s):  
Jessica Shin ◽  
Temitope F. Adeyemi ◽  
Taylor Hobson ◽  
Christopher L. Peters ◽  
Travis G. Maak
Keyword(s):  
Logistic Regression ◽  
Femoral Head ◽  
Internal Rotation ◽  
External Rotation ◽  
Alpha Angle ◽  
Acetabular Version ◽  
Femoral Version ◽  
Hip Flexion ◽  
Hip Internal Rotation ◽  
Head Neck

Objectives: Prior studies have suggested femoral version may outweigh the effect of cam impingement on hip internal rotation; however, the effects of acetabular morphology were considered. This study investigates the influences of acetabular and femoral morphology on hip range of motion (ROM) in patients with femoroacetabular impingement syndrome (FAIS). Methods: With IRB approval, a retrospective chart review and radiographic analysis was performed of patients presenting with hip pain to the clinic of a single surgeon. Patients were included in the study if their hip pain was thought to be intra-articular in origin, had full physical exam documentation (including bilateral hip evaluations and measurements of passive hip ROM), Tönnis grade ≤ 1, and had full imaging including: AP pelvis, 45⁰ Dunn lateral, and false profile radiographs and a CT scan with 3-D reconstructions of the affected hip. Patients were excluded if they had prior hip surgery, prior hip trauma or other underlying hip pathology. Femoral head/neck angle, femoral version, size and clock-face location of the maximum femoral alpha angle, mid-coronal center edge angle (CEA), mid-sagittal CEA, acetabular version at the 1, 2 and 3 o’clock positions and the McKibbin index were measured on CT scan. Univariable and multivariable logistic regression analyses were performed to determine which measurements correlated with hip ROM. Results: 200 hips from 200 patients were included in the final analysis. Mean age was 31.9 ±10 years, 145 (72%) patients were female, and mean BMI of the cohort was 25.2 ± 5. Univariable logistic regression analysis found femoral head/neck angle, mid-sagittal CEA, acetabular version at 1 and 2 o’clock, and McKibbin Index all significantly correlated with hip flexion (all q’s > 0.05 after adjusting for false discovery rate). Femoral head-neck angle, femoral version, and McKibbin index all significantly correlated with external rotation. Femoral neck version, mid-sagittal CEA, acetabular version at all three clock positions, McKibbin index, max femoral alpha angle, and alpha position all significantly correlated with internal rotation. In the multivariate logistic regression analysis mid-sagittal CEA was the only measurement correlating with flexion, femoral head/neck angle and McKibbin index were the only significant variables correlating with external rotation, and McKibbin index and maximum femoral alpha angle were the only variables correlating with internal rotation. The results of the logistic regressions are summarized in Figure 1. Conclusion: Our univariate data supported previous data that suggested femoral version significantly correlated with hip internal rotation. However, multivariate analysis including acetabular version demonstrated that combined acetabular and femoral version significantly correlated with internal and external rotation while femoral version in isolation did not. In contrast to prior studies, an increased cam deformity, as defined by max femoral alpha angle, remained a significant contributor to reduced internal rotation but did not affect hip flexion. Rather, the increased mid-sagittal CEA remained the sole significant contributor to reduced hip flexion in the multivariable analysis. These data suggest that hip ROM is affected in a bipolar fashion and careful multiplanar evaluation of the femoral and acetabular pathomorpohlogy should be conducted prior to attempting to increase hip ROM with corrective osteoplasty or osteotomy. [Figure: see text]

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