HIP SPECIAL TESTS

TESTS FOR HIP PATHOLOGY

 Patrick’s (Faber or Figure-4) Test

 Trendelenburg’s Sign
 Anterior Labral Tear Test
o Px: supine
o Examiner – takes hip into full flexion, lateral rotation, and full abduction (starting position)
 Extends hip + medial rotation and adduction
o Positive: Pain or Reproduction of Px’s symptoms with or without a click
 Posterior Labral Tear Test
o Px: supine
o Examiner – takes hip into full flexion, medial rotation, and full adduction (starting position)
 Extends hip + lateral rotation and abduction
o Positive: Pain or Reproduction of Px’s symptoms with or without a click
 Craig’s Test
o Measures femoral anteversion (forward torsion of femoral neck)
o Anteversion – angle (femoral neck and femoral condyle)
 Degree of forward projection of the femoral neck from coronal plane of shaf
 Decreases during growing period
 Birth: 30°; Adult: 8°- 15°
 Increased anteversion squinting patellae and toeing-in
 Excessive: common in girls as in boys
 Excessive Anteversion = Excessive Medial Hip Rotation (>60°) and decreased lateral
rotation
o Retroversion – plane of femoral neck rotates backward
 Acetabulum may be retroverted
o Px: prone; knee flexed to 90°
o Examiner – palpates posterior aspect of greater trochanter
 Hip passively rotated medially and laterally until greater troch is paraller with examining
table or reaches its most lateral position
o Ryder method – based on angle of the lower leg with the vertical
 Torque Test
o Px: supine; femur of test leg extended over the edge of table
o Test leg is extended until pelvis (i.e., ASIS) begins to move
o Examiner – one hand: medially rotate femur to the end range
 Other hand: apply slow posterolateral pressure along the line of the neck of femur for
20s – stress the capsular ligaments and test the stability of hip joint

 Stinchfield Test
o Px: supine; knee straight to 30° of hip flexion against resistance
o Positive: hip or groin pain or back pain
 Indication: Lumbar or SI pathology,
o Stresses hip, SI, Lumbar Spine
 Nelaton’s Line
o Ischial Tuberosity to ASIS
o Greater Trochanter above the line
 Indication: Dislocated Hip or Coxa Vara
o Two sides – compare
 Bryant’s Triangle
 o Px: supine
o 1ST Imaginary line: ASIS to Table (Perpendicular line)
o 2ND Imaginary line: Tip of Greater Troch and first line (Right angle)
o Differences: Indications – Congenital Dislocated hip, Coxa Vara
 Rotational Deformities
o Occur anywhere between the hip and foot
o Hereditary – many
o Px: supine; LE straight while examiner looks at patellae
o Patellae face in (squinting table) – Medial rotation of femur or the tibia
o Patellae face out, away and up (“Frog-eyes” or Grasshopper Eyes) – Lateral Rotation
o Tibia affected – feet face in (pigeon toes) for medial rotation
o Tibia affected – feet face out (>10°) for excessive lateral rotation of tibia
o Fick Angle – 5°-10°

PEDIATRIC TESTS FOR HIP PATHOLOGY

 Ortolani’s Sign
o For Congenital Dislocation of Hip
o Infant: supine
o Examiner: flexes hip & grasps legs (thumb – against the insides of knees and thighs; fingers –
along outsides of thighs to buttocks)
 (Gentle Traction) – Abduct thighs, Pressure applied against greater trochanters
o Resistance to abduction and lateral rotation – felt at ≈ 30° to 40°.
o Positive: click, clunk, jerk; hip has reduced; increased abduction of hip is obtained
 Sof click – may occur without dislocation; caused by iliofemoral ligament
o Repeat rotation of hip to palpate location of click
o Normal abduction: 70° to 90° (femoral head slipped over acetabular ridge into acetabulum)
o Valid only:
 First few weeks afer birth
 Dislocated and lax hips (not for dislocations that are difficult to reduce)
o Can damage the articular cartilage of femoral head
 Barlow’s Test
o Modification of Ortolani’s Sign
o For development dysplasia of the hip
o Infant: supine; legs facing the examiner
 Hips are flexed to 90°, knees fully flexed
o Examiner: Other hand – steadies the femur and pelvis (opposite side)
 Middle finger – over greater trochanter
 Thumb – adjacent to the inner side of the knee and thigh opposite to greater troch
 Abduct hip, Middle finger applies forward pressure behind greater troch
o Positive: Femoral head slips forward the acetabulum with click, clunk, or jerk
 Indication: Hip was dislocated
o For infants up to 6months
o Articular damage to femoral head
 Galeazzi Sign (Allis or Galeazzi Test)
o Assesses unilateral congenital dislocation of hip or unilateral developmental dysplasis of hip
o Children (3 to 18 months)
o Child: supine; knees flexed; hip flexed to 90°
o Positive: one knee is higher
 Telescoping Sign (Piston’s or Dupuytren’s Test)
o Evident in child with dislocated hip
 o Child: supine
o Examiner: flexes knee and hip to 90°
 Femur pushed down onto examining table
 Femur and leg are then lifed up and away from the table
o Positive: lot of relative movement (excessive movement – telescoping or pistoning)
 Abduction Test (Hart’s Sign)
o CDH – not diagnosed early or (+) developmental dysplasia of hup
o Parent’s note: (Changing diapers) – one leg does not abduct as far as the other one
o Child: supine; hips and knees flexed to 90°
o Examiner: passively abduct both legs (note asymmetry and limitation of movement)
o If one hip is dislocated:
 Demonstrates asymmetry of fat folds in gluteal and upper leg area because of “riding
up” of femur on the affected side.

TESTS FOR LEG LENGTH

 True Leg Length

 Weber – Barstow Maneuver

o Measure leg length asymmetry

o Px:supine; hips and knees flexed
o Examiner: stands at px’s feet & palpates distal aspect of medial malleoli with thumbsz
o Px lifs pelvis from table and returns to starting position
o Examiner: passively extends px’s legs and compares position of medial malleoli using borders of
thumb
o Measure the ff:
 Iliac Crest to Greater trochanter (Coxa Vara or Coxa Valga). Neck-shaf angle - 150° to
160° at birth; 120° to 135° adult
 <120° (ADULT) – Coxa Vara
 >135° (ADULT) – Coxa Valga
 Greater trochanter to Knee joint line (lateral aspect) (Femoral Shaf Shortening)
 Knee joint line to medial side to medial malleolus (Tibial shaf shortening)

TESTS FOR MUSCLE TIGHTNESS OR PATHOLOGY

 Sign of the Buttock

 Thomas Test
 Kendall Test
 Ely’s Test
 Ober’s Test

 Noble Compression Test

o ITB Friction Syndrome – chronic inflammation of the ITB near its insertion, adjacent to femoral
condyle
o Px: supine, knee flexed to 90° accompanied by hip flexion
 o Examiner: applies pressure with thumb to the lateral femoral epicondyle or 1 to 2 cm (0.4-
0.8inch) proximal to it
o While pressure is maintained, px slowly extends knee
o Positive: ≈ 30° of flexion: px c/o severe pain over lateral femoral condyle
 Adduction Contracture Test
 Abduction Contracture Test
 Piriformis Test
o Px: side-lying; test leg uppermost
 Flexes test hip to 60° (knee flexed)
o Examiner: stabilizes hip with one hand and applies downward pressure to the knee
o Positive: pain in buttock
o Sciatica – resist lateral rotation, hip medially rotated
 Hamstrings Contracture Method 1 (90-90 SLR)
 Hamstrings Contracture Method 2
o Px: sit; one knee flexed against the chest to stabilize pelvis; other knee extended
 Attempts to flex the trunk and touch toes of the extended lower limb (test leg) with the
fingers
o Repeat to other side
o Normal: px should be able to touch the toes while keeping the knee extended
o Positive tight hamstrings – unable to do
 Tripod Sign (Hamstrings Contracture, Method 3)
o Px: sit; both knees flexed to 90° over edge of examining table
o Examiner – passively extends one knee
o If px’s hamstrings are tight – px extends trunk to relieve tension in hamstrings
o Positive: extension of spine
 Phelp’s Test
o Px: prone; knees extended
o Examiner: passively abducts both px’s legs as far as possible
o Knees are then flexed to 90°, abducts hip further
o Positive: Abduction increases
 Tightness of Hip Rotators
o Px: supine; knee flexed to 90°
o Tightness of Lateral Rotators:
 Ask px to medially rotate hip (rotating leg upward)
 If tight, medial rotation will be less than 30° to 40°; end feel will be muscle stretch

o Tightness of Medial Rotators:

 Ask px to laterally rotate hip (rotate leg inward)
 If tight, lateral rotation will be less than 40° to 60°; end feel will be muscle stretch
 Lateral Step Down Manoeuver (Pelvis Drop Test)
o 20cm (8in) infront of px
o Px is asked to place one foot on the stool and stand up straight on the stool on one foot
o Px slowly lowers the NWB leg to the floor
o Normal: Arms at side, Trunk relatively erect, No hip adduction or medial rotation
o Positive: (Weak Lateral Rotators or Unstable Hip)
 Arms abduct
 Trunk inclines forward
 WB hip adducts or medially rotates
 Pelvis flexes forward or rotates backwards

OTHER TESTS
 Fulcrum Test
o Assess for possible stress fracture of the femoral shaf
o Px: sit; knees bent over the end of the bed with feet dangling
o Examiner: places an arm under px’s thigh (fulcrum)
o Fulcrum – moved distal to proximal
o Stress Fracture present – px c/o sharp pain and expresses apprehension when fulcrum is under
the fractured site