The portion of the body lying between the hip joint and the knee refers to the thigh. Impairment refers to any loss or abnormal change related to structure or function. Impairment of the thigh refers to limitations of hip abduction and adduction, and hip rotation. Abduction is moving the thigh away from the midline. The normal range is 0 to 45° degrees. Normal range of adduction is 45° to 0 degrees. Lateral/medial rotation is pointing the foot medially, and external rotation is pointing the foot lateral or away from midline. The maximum rotation possible is 45° degrees.

Causes of thigh impairment related to abduction, adduction or rotation might include: muscle weakness; trauma; inflammation of the muscle, tendon, or bursa; neuropathy; surgery; disease; congenital; fracture; dislocation; or contractures.

In general, manifestations may include: stiffness; pain; limitations of movement; crepitation; swelling; warmth over a joint; muscle deterioration; and an audible snap or pop of the joint. The signs and symptoms will vary depending on the underlying cause.

Tests may include: x-ray; bone scan; electromyography (EMG); goniometer ; computed tomography (CT) scan; magnetic resonance imaging (MRI); and laboratory screening tests related to the underlying problem.

Treatment will vary according to the underlying cause of the impairment. These treatments may include: physical therapy; range of motion exercises; braces; surgery to restore motion through joint replacement; disc removal; tendon or ligament repair; fracture reduction; and medications.

Impairment of thigh motion is a dysfunction that may impact on stability and walking which could lead to falls and further injury.

• See VAOPGCPREC 9-2004

  • On September 17, 2004, General Counsel issued a precedent opinion concerning the rating of hip conditions under two separate diagnostic codes involving limitation of motion. Specifically, General Counsel held that separate ratings for qualifying hip movements under diagnostic codes 38 CFR 4.71a, DC 5251 (extension), 38 CFR 4.71a, DC 5252) (flexion) and 38 CFR 4.71a, DC 5253 (abduction, adduction or rotation) may be assigned for a disability of the same hip.

  • Multiple hip evaluations do not, as a matter of law, violate 38 CFR 4.14.or preclude separate evaluation of a disability of the same hip  under  DC 5251, 5252, and/or 5253.

  • Evaluation of the same manifestation under multiple diagnoses is prohibited under 38 CFR 4.14.

  • Although it is permissible to assign multiple evaluations under multiple diagnostic codes for a single hip, you must always abide by the amputation rule (38 CFR § 4.68).

  • As always, when evaluating hip function, the provisions of 38 CFR §§ 4.40, 4.45, and 4.59 must be considered.

• To properly rate disability, accurate measurement of range of motion of thigh abduction, adduction, and rotation is required and must be reported in degrees. The use of a goniometer in the measurement of range of thigh abduction, adduction, and rotation is indispensable. 38 CFR 4.46 [Accurate measurement]

• Evaluate under diagnostic codes 5256, 5257, 5260, or 5261 for the knee, or 5250-5254 for the hip, whichever results in the highest evaluation.