Lower Extremity Disorders Research Articles

SYSTEMATIC REVIEW OF SURGICAL INDICATIONS FOR TIBIAL DEROTATIONAL OSTEOTOMY

Background: Tibial torsion is a lower extremity disorder of children and adolescents that may be idiopathic in nature. While spontaneous correction of the torsion occurs in the majority of patients during childhood, a small percentage of cases will persist into adulthood and can be associated with significant functional compromise due to patellofemoral instability, osteoarthritis, and anterior knee pain. Furthermore, late detection of tibial torsion may lead to compromise of other therapeutic efforts to alleviate symptoms. Idiopathic tibial torsion is best corrected by a tibial derotational osteotomy. However, determining which patients may benefit most from surgical correction is not well-understood, given the wide range of accepted values for normal tibial torsion depending on various measurement techniques. This review seeks to establish surgical indications for the procedure in a pediatric population with no underlying neurological, muscular, or osseous abnormalities. Methods: Systematic literature searches of 10 major databases and grey literature resources were conducted (Medline and Embase (via OVID), Cochrane Library, SPORTDiscus, Web of Science, Scopus, ClinicalTrials.gov, WHO ICTRP, and Global Index). Studies were screened by two independent reviewers based on previously established inclusion and exclusion criteria. Articles that focused on non-idiopathic torsion, such as torsion associated with neuromuscular causes, or that did not involve derotational osteotomy were excluded. Included studies were assessed for bias by two independent reviewers using GRADE and the Newcastle Ottawa Scale. Results: 911 articles were retrieved through the searches, 16 of which were ultimately included in the study. Due to the rarity of the condition, most authors studied a mixed population of skeletally mature and immature patients, except for one study. The most common surgical indications described were functional gait or cosmetic disability (70%), followed by patellofemoral instability and anterior knee pain (30%). Only a few articles cited numerical limits of abnormal torsion, and these depended on the method of measurement. Thigh-foot angle (TFA) was most often used (external torsion > 30°, internal torsion > 15°, and TFA > 2 or 3 standard deviations from the mean for the patient’s age). A bimalleolar axis with <20° external rotation was deemed excessively internally rotated. No numerical data was provided for defining abnormal foot-progression angle. Almost all authors recommended waiting until a patient was greater than 8 years old to allow for spontaneous correction of tibial torsion. Only two studies utilized computed tomography for pre- and post-operative assessment, given the cost of advanced imaging, and two other authors measured with gait analysis the effect of derotational tibial osteotomies on knee moments and ankle power. Conclusion/Significance: The diversity of measurement techniques and different anatomic references axes for describing tibial torsion has translated into a heterogenous set of surgical indications for tibial derotational osteotomies. At this time, the literature suggests that most correction procedures are decided by a patient’s functional and/or cosmetic disability. Further research is warranted to define clear standards and numerical values of tibial torsion that would benefit from surgical correction.

Postural Disorders of the Lower Extremities in Children of the Younger School Age

Postural Disorders of the Lower Extremities in Children of the Younger School Age

Pattern of muscle contraction in different postures among Malaysia pineapple plantation workers

Lower extremity disorders is associated with prolonged and awkward postures such as kneeling, squatting and stooping. Current study aims to examine the risk factors of awkward postures among pineapple plantation workers in Malaysia by using Ovako Working Posture Analysis System (OWAS). The postural analysis output from OWAS is then compared and validated by using Surface Electromyography (sEMG). There are 103 pineapple plantation workers participated in this study with an average working experience of 1 to 3 years. Based on OWAS findings, it shows for an overall distribution, planting, manual weeding and harvesting are the tasks fell under Action Category (AC) 3 which indicating distinctly harmful and (AC) 4 which indicating extremely harmful. The readings of muscle activity during selected postures show that erector spinae and multifidus muscle are actively contracted during kneeling, squatting and stooping posture. The results from this study signify that long exposure to these postures can increase the likelihood of having WMSDs such as back pain and lower limb injuries among pineapple plantation workers. This study suggests that ergonomic intervention such as mechanization of tools and equipments should be implemented in order to eliminate or reduce poor postures. In case of incapability for any mechanization, adequate and effective training should be provided for the workers as they can apply the knowledge through their job.

Prevalence and Compatibility of Chronic Venous Disorders of Lower Extremities, Restless Legs Syndrome,Anxiety and Depressive Conditions Among Employees of Enterprises in the Moscow Region

Prevalence and Compatibility of Chronic Venous Disorders of Lower Extremities, Restless Legs Syndrome,Anxiety and Depressive Conditions Among Employees of Enterprises in the Moscow Region

Intra- and Inter-Rater Reliability of Ultrasound in Plantar Fascia Thickness Measurement

Background: Plantar fascia is a thick connective tissue on the plantar side of the foot, which provides the normal shape of the longitudinal arch. Plantar fasciitis is an inflammation on the medial tuberosity of calcaneus on the inferior side that may cause heel pain. Imaging plays an important role in the diagnosis of heel pain. Ultrasonography has been recognized as an effective imaging tool for assessing plantar fascia thickness, monitoring the effect of different interventions and guiding therapeutic interventions in patients with plantar fasciitis. Operator dependency is a major limitation for the common use of ultrasound. Objectives: The purpose of the present study was to evaluate intra and inter-rater reliability of ultrasound in measurements of the thickness of plantar fascia in different points of plantar fascia. Patients and Methods: Twelve healthy (without any lower extremity disorder) young (above 18) volunteers were recruited. Both heels were scanned in the sagittal plane by two raters. Subjects lied prone. Thickness of the plantar fascia was measured at the insertion point of the calcaneus, 5 and 10 mm from insertion of the calcaneus. For statistical analysis, intraclass correlation coefficients (ICC), 95% confidence intervals (CI), and linear mixed model ANOVA effects were run. Results: Our results showed that both intra and inter-rater reliability of plantar fascia thickness, measured by ultrasound, have high reproducibility (ICC > 0.821, ICC > 0.849). The linear mixed model suggested that neither rater nor time had a significant effect on the rater’s measurements. Conclusion: The results of the present study indicate that both intra and inter-rater of measuring plantar fascia thickness at three points using ultrasound seemed to be high.

WHO disability assessment schedule 2.0 is related to upper and lower extremity disease-specific quality of life.

We evaluated whether two disease-specific quality of life instruments (Disabilities of the Arm, Shoulder and Hand, DASH and Western Ontario & McMaster Universities Osteoarthritis Index, WOMAC) reflect a patient's perception of general disability using the WHO Disability Assessment Schedule 2.0 (WHODAS 2.0) and determined whether disability components are explained by upper and lower extremity HRQOL. We recruited 421 participants, 50years or older without stroke, cancer, or history of surgery for musculoskeletal disease, who participated in the NAMGARAM Cohort. Upper extremity HRQOL was determined with the DASH score and lower extremity HRQOL with the WOMAC; as a measure of disability, we obtained WHODAS 2.0 component. Multiple regression modeling was used to assess the relative contributions made by upper and lower extremity HRQOL to disability. When adjusted for covariates, the DASH total score was correlated with getting around (β = 0.217, p < 0.001) and social participation (β = 0.226, p < 0.001), and the WOMAC total score was correlated with getting around (β = 0.363, p < 0.001), life activation (β = 0.363, p < 0.001), and social participation (β = 0.301, p < 0.001). QOL significantly correlated with upper extremity disorders (β = 0.081, p = 0.018) or lower extremity disorders (β = 0.095 p = 0.004). We found that in a community-based population, perceived activity limitation and social participation were associated with upper and lower extremity HRQOL. Since the WHODAS 2.0 does not target a specific disease (as opposed to DASH and WOMAC), it can be used to compare disabilities caused by different diseases.

The prevalence of occupational musculoskeletal disorders in Iran: A meta-analysis study.

Prevention of Work-Related Musculoskeletal Disorders (WRMSDs) is crucial as they jeopardize the well-being of the workforce in workplaces and are prevalent in developed and developing countries. This study aimed to determine the prevalence of WRMSDs among Iranian workers. A systematic review and meta-analysis of WRMSDs in Iran was performed by searching relevant keywords in authentic databases and search engines such as SID, Google Scholar, Medlib and PubMed. Twenty-seven published articles in the field of WRMSDs from 2001 to 2010 were searched. Meta-analysis and random effects approach were used to analyze data. Heterogeneity investigation of articles was done using I2 index. The total sample size was 6,090 workers with a mean of 225 samples per study. The upper and lower back had the highest prevalence rate of self-reported WRMSDs with 38.1% (95% CI: 29.9-46.4), and 50% (95% CI: 42.5-57.5), respectively. Also, knee had the highest prevalence among lower extremity disorders with 42.1% prevalence rate (95% CI:35.1-49.1). A high prevalence of WRMSDs in upper and lower limbs was reported in Iran. Trainings with regard to occupational ergonomics and industrial hygiene programs were recommended for minimizing the work-related risks of musculoskeletal disorders.

Utility of the Overhead Squat and Forward Arm Squat in Screening for Limited Ankle Dorsiflexion.

Rabin, A and Kozol, Z. Utility of the overhead squat and forward arm squat in screening for limited ankle dorsiflexion. J Strength Cond Res 31(5): 1251-1258, 2017-Limited ankle dorsiflexion (DF) range of motion (ROM) has been implicated in several lower extremity disorders. Effective screening for DF ROM may, therefore, help to identify "at risk" individuals. The primary purpose of this study was to determine the utility of 2 screening tests in detecting limited ankle DF ROM. Fifty-three healthy participants underwent an overhead squat (OS) test and a forward arm squat (FAS) test, as well as bilateral testing of weight-bearing and non-weight-bearing ankle DF ROM. Participants whose DF ROM fell below 1 SD from the sample average were considered to have limited DF ROM. The sensitivity, specificity, positive, and negative likelihood ratio (LR) of the OS and FAS in detecting individuals with limited DF ROM was calculated. The sensitivity of the OS was 1.00 regardless of the mode or the side of testing, whereas specificity ranged from 0.34 to 0.36. The positive LR of the OS ranged from 1.52 to 1.56, whereas negative LR was 0.00. The sensitivity of the FAS ranged from 0.56 to 0.70, whereas specificity ranged from 0.84 to 0.88. The positive and negative LR of the FAS ranged from 3.49 to 6.02, and 0.34 to 0.53, respectively. Our findings suggest that the OS and FAS may be used as complementing tests in screening for ankle DF limitation. Because of its excellent sensitivity, the OS should be performed first, and if negative, may confidently rule out limited DF ROM. However, given a positive OS, testing should proceed with the FAS, to more confidently rule in limited DF ROM.

Effect of the Leg Volume Change on the Performance of an Active Compression Brace Based on Shape Memory Alloys

In this paper, the effect of calf deformation on the performance of an active compression brace (ACB) due to external pressure is investigated experimentally and analytically. The ACB, actuated by shape memory alloy wires, was designed and prototyped for potentially being used in future clinical studies to prevent or mitigate symptoms of lower extremity disorders. In this work, an analytical model is presented to simulate the ACB when wrapped around a calf assumed to be either incompressible or compressible. Furthermore, a physical calf model synced with a controllable syringe pump with a LabVIEW code was used to perform cyclic tests to evaluate the performance of the ACB experimentally in both cases of having a simplified incompressible calf or, more realistically, a compressible calf. The collected experimental data was compared with simulation results obtained from the analytical model. The experimental results showed a significant drop in the actuation pressure produced by the ACB on a deformable calf model compared to an incompressible calf model. The analytical model that was developed accurately predicted such a behavior. In fact, for an initial wrapping pressure of 10 mmHg the maximum deviations between the experimental and analytical results were 1.66 and 0.54 mmHg respectively for the cases of an incompressible and compressible calf. Similarly, for the initial wrapping pressure of 15 mmHg the maximum deviations were found to be 0.52 and 0.73 mmHg respectively. A two-dimensional finite element (FE) model of the leg was also developed to investigate the effect of the applied external pressure on the internal tissue. FE analyses were conducted using different geometrical parameters of the leg including calf, tibia and fibula sizes.

ВАРИАНТЫ КЛИНИЧЕСКОЙ АНАТОМИИ АРТЕРИЙ ВЕРХНИХ КОНЕЧНОСТЕЙ

Upper extremity arterial disorders are less common than lower extremity disorders. Occlusion and critical stenoses of the arteries lead to the development of ischemia, during which anatomical features of the upper limbs structure play an important role. A large number of anastomoses and a well developed collateral circulation often lead to compensation of blood circulation. During the conducting an open treatment the vascular surgeons meet a non-standard anatomy that presents technical obstacles to the performance. The current article reviews the anatomical variations in upper limbs and formed among them anastomoses which any surgeon may encounter. Having analysed the experiences of colleagues led to the conclusion that the non-classical origin and location of upper limb arteries are a frequent phenomenon that can significantly affect to the medical strategy and change the condition of ischemia of the upper extremities. These data must be taken into consideration in angiographic studies, selection of access during surgical interventions and medical manipulations. Therefore, it is important to conduct a careful examination of each patient to the surgical treatment in order to identify individual characteristics and avoid mistakes.

小児の股関節・下肢装具の適応と実際

小児の股関節・下肢装具の適応と実際

Virtual Reality to Assess and Treat Lower Extremity Disorders in Post-stroke Patients

This article is part of the Focus Theme of Methods of Information in Medicine on "Methodologies, Models and Algorithms for Patients Rehabilitation". To identify support of a virtual reality system in the kinematic assessment and physiotherapy approach to gait disorders in individuals with stroke. We adapt Virtual Reality Rehabilitation System (VRRS), software widely used in the functional recovery of the upper limb, for its use on the lower limb of hemiplegic patients. Clinical scales have been used to relate them with the kinematic assessment provided by the system. A description of the use of reinforced feedback provided by the system on the recovery of deficits in several real cases in the field of physiotherapy is performed. Specific examples of functional tasks have been detailed, to be considered in creating intelligent health technologies to improve post-stroke gait. Both participants improved scores on the clinical scales, the kinematic parameters in leg stance on plegic lower extremity and walking speed > Minimally Clinically Important Difference (MCID). The use of the VRRS software attached to a motion tracking capture system showed their practical utility and safety in enriching physiotherapeutic assessment and treatment in post-stroke gait disorders.

Patient activity after TKA depends on patient-specific parameters.

Most patients expect an improvement of walking ability and an increase in activity levels after TKA. Unfortunately, few studies report qualitative and quantitative activity improvements after TKA. The aims of this study were (1) to evaluate quantity and quality of physical activity before and after TKA with an accelerometer, and to compare activity level with that of an age-matched control group without lower-extremity disorders. (2) Improvement in measured steps per day after TKA and the ability to meet physical activity guidelines were evaluated. (3) The influence of patient-specific and implant parameters were assessed. An accelerometer was used to measure activity in 97 patients who were assessed before TKA and 1year after TKA. The measurements included the total number of steps, moderate to vigorous activity defined as at least 100 steps per minute, and time spent lying, sitting/standing, or walking. We then calculated the proportion of patients who met the 10,000 steps per day guideline recommendation and determined factors that predicted failure to meet that goal. Thirty-nine age-matched control subjects without lower-extremity disorders were selected and underwent the same assessments using the accelerometer for comparison with patients 1year after TKA. Measured steps per day improved from a mean of 5278 (SD, 2999) preoperatively to 6473 (SD, 3654) postoperatively (effect size, 1.23; 95% CI, 1.10-1.35; p<0.001). Moderate to vigorous steps per day improved from a mean of 1150 (SD, 982) to 1935 (SD, 1728; p<0.001). Times spent in lying, sitting, or standing position or during walking did not change after TKA. For all measured parameters, activity of the patients after TKA was considerably less than that of the age-matched control subjects, who walked a mean of 13,375 (SD, 4614) steps per day (p<0.001), performed a mean of 6562 (SD, 3401) vigorous steps per day (p<0.001), and spent a mean of 2.9hours (SD, 1.1) per day walking (p<0.001). Only 16 patients (16.5%) met physical activity guidelines after TKA. BMI (p=0.017), sex (p=0.027), and comorbidities (American Society of Anesthesiologists Grade, p=0.042) were independent factors associated with steps per day after TKA. One year after TKA, patients had increased walking and moderate to vigorous steps. However, only 16.5% achieved the guideline recommendations for walking activity. BMI, sex, and comorbidities are patient factors that are associated with activity after TKA. Even with improvements in walking, activity level after TKA remains less than that seen for age-matched control subjects. Surgeons should be aware of this when counseling patients undergoing TKA. Level III, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.

An insight into the plantar pressure distribution of the foot in clinical practice: Narrative review

In clinical practice and within the scope of research studies, foot pressure distribution as measured by plantar pressure analysis is widely used to diagnose foot pathologies. Although plantar pressure data have been recognized as an important element in the assessment of patients with various foot problems, an in-depth knowledge of the plantar pressure distribution of the foot is lacking in literatures. This article presents a review of literature on plantar pressure distribution and factors that may affect plantar pressure among patients with foot pathologies and healthy population. A literature search was conducted in Science Direct and PubMed databases for articles published from January 2000 to August 2012. Medical Subject Headings (MeSH) and other keywords for search were plantar pressure, age, body weight, gender, reliability, instrument and healthy subjects. This paper reviews on the factors influencing plantar pressure distribution. Factors such as the gender, age, body weight, foot type and footwear proved to have a significant effect on plantar pressure distribution of the foot. The paper also reports on the plantar pressure distribution of the foot and the reliability of the measurement. Studies were excluded from this narrative review if they did not meet the above criteria. This review has added sufficient knowledge on plantar pressure distribution of the foot in clinical practice. Data obtained from a plantar pressure distribution can be used by the physical therapist in the evaluation and management of patients with a wide variety of foot and lower extremity disorders.

The Spanish lower extremity functional scale: A reliable, valid and responsive questionnaire to assess musculoskeletal disorders in the lower extremity

Purpose: The Lower Extremity Functional Scale (LEFS) is a widely used questionnaire to evaluate the functional impairment of a patient with a disorder of one or both lower extremities. It also can be used to monitor the patient over time and to evaluate the effectiveness of an intervention. Nevertheless there is no Spanish version of the LEFS, so the aim of this study was the translation and cross-cultural adaption of the Spanish version of the LEFS and to evaluate its psychometrics properties. Methods: The questionnaire was cross cultural adapted into Spanish. The psychometric properties tested in the Spanish version of the LEFS were: internal consistency, test–retest reliability, constructs validity, discriminative validity, responsiveness, concurrent validity and floor and ceiling effects in 132 participants seeking for treatment due to lower extremity dysfunction. Results: The Spanish version of the LEFS had high internal consistency (Cronbach’s α = 0.989), test–retest reliability (ICC = 0.998, 95% CI: 0.996–0.999) and presented a high correlation with the SF-36 (36-Item Short-Form Health Survey) especially with the physical function and pain subscales. The construct validity showed a single factor that account for 84.95% of the variance. The standard error of measurement of the Spanish version of the LEFS was 0.88 scale points (95% CI) and the minimal detectable change was 2.18 scale points (95% CI). The sample, collected from five Spanish physical therapy centers, was divided in groups (acute, sub-acute and chronic subjects). Within group changes showed a significant improvement on the LEFS score (p < 0.001) and effect sizes were large in all conditions. The LEFS allowed to distingue between acute and not acute conditions; for this criterion ROC curve was performed at baseline (area under the curve [AUC] = 0.95). There was no floor or ceiling effects. Conclusions: The Spanish version of the LEFS has been shown to be a valid and reliable tool to assess musculoskeletal dysfunction in the lower extremity that could be used with Spanish speaker population.Implications for RehabilitationCross-cultural adaptation of a self-reported questionnaire to evaluate musculoskeletal lower extremity disorders in the Spanish population.To provide Spanish clinicians and physiotherapists a useful tool to assess the lower extremity function.To provide Spanish researchers a valid tool for research on lower extremity function: patient’s improvement due to treatment, compare results obtained between populations, treatment.

Evaluation of Functional Restoration Outcomes for Chronic Disabling Occupational Lower Extremity Disorders

To compare patients with chronic low back pain (LBP) with those with chronic lower extremity (LE) disorders. Participants were 2164 consecutive patients with either LE or LBP disorders, admitted to a functional restoration program (FRP). Analyses compared demographic, psychosocial, and work-related factors and 1-year post-FRP socioeconomic outcomes. Patients with LE disorders initially reported lower symptom levels of depression, pain, and disability and were also less likely to have a substance use or opioid dependence disorder, relative to LBP patients. Both groups improved on measures of pain, disability, and depression after the FRP. Patients in both groups also displayed similarly high return-to-work and work-retention rates 1-year post-FRP. This FRP seems to be effective equally for patients with chronic LE disorders and those with LBP disorders.

Musculoskeletal anomalies in a large cohort of boys with 49, XXXXY

49, XXXXY is a rare aneuploidy and variant of Klinefelter syndrome, occurring in 1 per 80,000-100,000 live births. We present a cohort of 40 affected males, focusing on musculoskeletal problems. Subjects were participants in an annual 49er family support group meeting. Children were examined in a multidisciplinary clinic by a pediatric neurologist and geneticist, a pediatric orthopedist, a neurodevelopmentalist, and two physical therapists. The patient data were collected from this clinic from 2004 to 2012. All patients were required to have karyotypes that confirmed the presence of XXXXY. There was a high prevalence of musculoskeletal disorders, particularly hypotonia (34 patients [85%]), radioulnar synostosis (30 [75%]), pes planus (26 [65%]), asymmetric hip rotation (27 [67.5%]), and clinodactyly (24 [60%]). Other, less common lower-extremity disorders, included, 5 patients (12.5%) with unilateral club foot, 5 boys (12.5%) with pes cavus, 10 patients (25%) genu valgum and 2 children with genu varus (5%). To our knowledge, this is the first large cohort of boys with 49, XXXXY that focuses on musculoskeletal disorders. There was an increased incidence of hypotonia, clubfoot, avascular necrosis of the femoral head, radioulnar synostosis, and pes planus compared to the normative population. Boys with 49, XXXXY would benefit from multidisciplinary evaluations, particularly from pediatric orthopedists, physical therapists, neurologists, and geneticists for appropriate medical care.

Reliability and validity of the Taiwan Chinese version of the Lower Extremity Functional Scale

The Lower Extremity Functional Scale (LEFS) is a region-specific functional outcome measure designed for patients with lower extremity musculoskeletal dysfunction. In this study, a Taiwan Chinese version was adapted and its validity and reliability were tested. The LEFS questionnaire was adapted and tested in 159 patients with lower extremity disorders from two university hospitals. The Cronbach α-coefficient value was calculated for internal consistency. Intraclass correlation coefficient (ICC), Bland-Altman plot, and minimal detectable change (MDC) were used for evaluating the test-retest reliability and agreement in 40 patients followed up within 7 days. Construct and convergent/divergent validity were examined by principal component analysis and correlation was examined with the Medical Outcomes Study Short Form-36 (SF-36) questionnaire. The internal consistency and test-retest reliability of the adapted LEFS questionnaire were satisfactory [Cronbach α: 0.98; ICC(2,1), 0.97]. The Bland-Altman plot of the two tests showed a relatively consistent distribution, with limits of agreement in the range of -9.32 to 13.02. The MDC at 90% confidence interval was 9.6. One-factor model was confirmed by principal component analysis. Also, there was a moderate association between the LEFS and the physical component scores and several subscales of SF-36, but not with the mental component scores. The Taiwan Chinese version of the LEFS questionnaire is a valid and reliable measure of health status for patients with lower extremity disorders.

A Lower Extremity Physical Function Computerized Adaptive Testing Instrument for Orthopaedic Patients

The aim of this study was to develop a lower extremity (LE) physical function computerized adaptive testing (CAT) instrument based on Patient Reported Outcomes Measurement Information System (PROMIS) physical function items. The PROMIS physical function item bank was administered to adult outpatient orthopaedic patients. Three hundred eighty-two patients presenting with LE disorders were analyzed using item response theory modeling. A LE physical function item bank was developed by distilling relevant and psychometrically sound items from the full PROMIS physical function bank. Real data CAT simulations were conducted to examine specifications for a live CAT. The LE physical function item bank was sufficiently unidimensional and free of item bias. It demonstrated high reliability along with content and construct validity. The flexible length LE CAT was highly correlated with the full LE instrument and showed uniformly high precision across the entire measurement continuum. The average CAT length was 6 to 7 items when standard error of measurement was 0.3 or less. This LE physical function CAT is a valid, reliable and feasible physical function assessment tool for orthopaedic patients with LE problems that has the potential to reduce patient burden as well as administrative costs associated with data collection.

Clinical evaluation of hip joint rotation range of motion in adults

Data on hip joint rotation range of motion (ROM) are rare; the methods of measurement vary and reproducibility has not been evaluated, in particular in relation to the subject's position (prone or supine, seated). Hip joint rotation ROM is symmetrical, and ROM is not modified by the patient's position when data is obtained. This series included 120 adults between 20 and 60 years old (71 women, 49 men), who had no hip, spine or lower extremity disorders. External (ER) and internal (IR) rotation ROM was obtained using a photographic method by two observers. Measurements were obtained with the patient in three positions: the dorsal decubitus (supine) (P1), and ventral decubitus (prone) (P2) with the hip in extension and seated with the hip in flexion (P3). Hip rotation ROM was P1: 68.1° (ER=38.5°; IR=29.6°); P2: 77.1°(ER=41.8°; IR=35.2°); P3: 78.5° (ER=78.5°; IR=37.9°) with no significant difference among the three positions. Interobserver reproducibility was satisfactory (concordance correlation coefficient (ccc) 0.7) and was comparable in the three positions with a ccc of 0.7072 (P1), 0.7426 (P2) and 0.7332 (P3), respectively. Hip rotation ROM balance was ER predominant in 47.5%, neutral in 39.5% and IR predominant in 13%. Hip rotation ROM balance was symmetric in both hips in 73 subjects (61%). Hip rotation ROM was reduced with age (P<0.0001), and was 4.7° less in men (P=0.0078), and in overweight subjects (P<0.0006). Our values are probably lower than those in the literature because of the difference in study population. In our series, age, BMI and gender seemed to be determining factors. Hip rotation ROM balance is usually ER predominant or neutral. Hip rotation ROM can be measured in the three positions with no significant difference, with satisfactory interobserver reproducibility for each. Diagnostic prospective study: level III.