Hip

Question 1

Hip AROM

Answer 1

Flexion = 110 - 120 
Extension = 10 - 15 
Abduction = 30-50 
Adduction = 30 
External Rotation = 40-60
Internal Rotation = 30-40

Question 2

Hip PROM

Answer 2

Flexion = Tissue Stretch 
Extension = Tissue Stretch 
Abduction = Tissue Stretch 
Adduction = Tissue Stretch 
External Rotation = Tissue Stretch 
Internal Rotation = Tissue Stretch

Question 3

Hip Capsular Pattern

Answer 3

Flexion, abduction, internal rotation

Question 4

Sign of the Buttock

Answer 4

• Purpose:
– To assess whether the patient’s symptoms are related to lumbar or hamstring pathology or to a pathology around the buttocks region

• Procedure:
– The patient is supine
– The practitioner stands adjacent to the patient’s affected leg
– A straight leg raise test is performed
– The practitioner observes for limitation, restriction, and/or pain
– If there is limitation on straight leg raising the examiner flexes the patients knee to see whether further
hip flexion can be achieved

• Indication of Positive:
– If further hip flexion does not occur with the knee flexed there is a likely lesion at or around the buttock
or hip not the hamstring or sciatic nerve
– Examples of potential lesions: ischial bursitis, hamstring tendinopathy, neoplasm, abscess, hip joint
pathology

• Notes:
– A patient with a positive Sign of the buttock may demonstrate a non-capsular pattern of
the hip

Question 5

Thomas Test

Answer 5

• Purpose:
– To assess for hip flexor contracture

• Procedure:
– The patient lies supine
– The practitioner stands to the side of the patient
– Part 1: The examiner checks the patient for excessive lordosis (usually associated with tight hip flexors).
– Part 2: The patient is asked to bring their knee to their chest and hold it in that position with their arms
– The examiner observes for two things a) whether the lumbar lordosis flattens out as expected with hip
flexion and B) whether or not the opposite leg remains on the table

• Indication of a Positive Test:
– If the contralateral hip flexes without knee extension the iliopsoas on that side is tight/contracted
– If contralateral knee extends and/or the hip flexes the rectus femoris is tight
– If hip abducts, tensor fascia lata is tight/contracted
– If the patient actively pushes the leg into the table while in the test position this may increase the lumbar
lordosis which is also indicates a positive test

Question 6

Ely’s Test

Answer 6

• Purpose:
– To assess for contractures of the Rectus femoris m.

• Procedure:
– The patient is prone on the examination table
– The practitioner stands adjacent to the patient’s affected side
– The examiner passively flexes the patients knee
– The practitioner observes for changes in hip and pelvic positioning
– Both sides are tested individually for comparison starting with the unaffected side first

• Indication of a Positive Test:
– If the patient’s hip flexes on the side of passive knee flexion then a tight Rectus femoris m. is
indicated

• Note:
– This test position may also tension the femoral n.

Question 7

Ober’s Test

Answer 7

• Purpose:
– To assess the tensor fascia lata (iliotibial band) for tightness

• Procedure:
– The patient is side-lying on the examination table with the involved side facing up with lower leg flexed at hip &
knee
– The examiner stands behind the patient with one hand under the test limb and the other hand stabilizing the
patient’s pelvis
– The examiner abducts the upper thigh as far as possible, and slightly extends hip just enough so that tensor fascia
lata/iliotibial band sits over greatertrochanter
– The practitioner then lowers the patient’s leg towards the examination table while maintaining the pelvic
stabilization with the opposite hand

• Indication of a Positive Test:
– With a normal length TFL/ITB the foot of the test leg should be able touch the table without pelvic tilting
– If the thigh remains abducted, the test is positive indicating a tight TFL/ITB complex

• Notes:
– The test can be performed with the knee of the test leg flexed. In this scenario less tension is placed on
the TFL/ITB but tension may be produced in the femoral nerve
– The examiner may test the length of the gluteal muscles by moving the test leg into varying degrees of
hip flexion and internal rotation

Question 8

Single Leg Stance Test

Answer 8

Gluteal tendinopathy

Procedure:

• Patient stands close to the wall (touches wall), affected leg furthest from the wall
• Patient raises unaffected leg (knee is flexed to 90 deg.)
• Hold for 30 secs.

Test Outcome: reproduction of patients lateral hip pain of the stance leg in the greater trochanter region (2/10 NPRS)

Add static palpation of the greater trochanter (anterior, lateral or postero-superior facets) for the G.Med
and/or G.Min tendon insertions

Question 9

Patrick’s (FABER) Test

Answer 9

• Purpose:
– To assess for pathological conditions of the hip, iliopsoas spasm or sacroiliac joint dysfunction
– FABER = Flexion, ABduction, External Rotation

• Procedure:
– The patient lies supine on the examination table
– The examiner stands adjacent to the test leg or contralateral to the test leg
– The examiner places the patient’s foot so that it is on top of the patient’s other leg, just above the knee
– The examiner stabilises the patient’s pelvis by placing a hand on the contralateral ilium and then slowly
lowers the patients ipsilateral leg down towards the table

• Indication of a Positive Test:
– The knee of the test leg remains above the opposite leg, and does not fall to the level of the table
– Indicates hip joint pathology, myofascial shortness (iliopsoas), or sacroiliac joint pathology

• Notes:
– The unaffected side is always tested first
– In more elderly patients with restricted hip mobility, the ankle of the test leg may be placed on the
examination table instead of the opposite knee making the start position a little more comfortable

Question 10

Log Roll Test

Answer 10

• Purpose:
– Used to detect acetabular or femoral neck pathology

• Procedure:
– The patient lies supine on the examination table with their legs straight
– The practitioner stands adjacent to the patient’s test leg
– Keeping the patient’s leg on the table the practitioner passively and fully internally rotates then passively
and fully externally rotates the patient’s leg by ‘rolling‘ it back and forth on the examination table
– The practitioner notes the patient’s subjective response to the test procedure

• Indication of a Positive Test:
– Pain in the anterior hip or groin

• Notes:
– The unaffected side is always tested first
– The patient is asked to fully relax the test leg during the procedure

Question 11

Scouring (Quadrant) Test

Answer 11

• Purpose:
– To assess for hip pathology

• Procedure:
– Patient is supine on the examination table
– The practitioner stands adjacent to the patient’s test leg
– The practitioner passively flexes and adducts the patient’s hip towards their opposite shoulder,
any resistance to this movement is noted
– The practitioner then grasps the patient’s knee and applies axial force directed towards the couch
through the femur
– While maintaining the axial force through the femur the practitioner internally and externally
rotates the femur and notes the signs and symptoms produced
– Using the above technique, the practitioner can scour various portions of the joint by altering the
degree of hip flexion or extension and/or the degree of hip abduction and adduction

• Indication of Positive:
– Crepitus, grinding sensations or pain indicate a positive test

• Notes:
– In extremes of hip ROM the femoral head may impinge on various muscular structures (adductor longus,
pectineus, iliopsoas, TFL and sartorius)

Question 12

Anterior Labral Tear Test

Answer 12

• Purpose:
– To assess for anterior impingement syndrome, anterior labral tear, iliopsoas tendinitis

• Procedure:
– Patient lies supine on the examination table
– The practitioner stands adjacent to the test leg
– The examiner takes the patient’s hip into full flexion, external rotation and abduction
– From there the examiner moves the patient’s hip into extension while simultaneously adducting
and internal rotating the hip

• Indication of a Positive Test:
– Pain and replication of symptoms with or without a click

• Notes:
– The examiner should securely hold and stabilize the lower extremity being tested to minimize
guarding on the part of the patient

Question 13

Posterior Labral Tear Test

Answer 13

• Purpose:
– To assess for posterior inferior impingement syndrome, posterior labral tear, anterior hip instability

• Procedure:
– Patient lies supine on the examination table
– The practitioner stands adjacent to the test leg
– The examiner takes the patient’s hip into full flexion, internal rotation and adduction
– From there the examiner moves the patient’s hip into extension while simultaneously abducting and
external rotating the hip

• Indication of a Positive Test:
– Pain and replication of symptoms with or without a click

• Notes:
– The examiner should securely hold and stabilize the lower extremity being tested to minimize guarding on
the part of the patient
– As the test also assesses for anterior hip instability, the patient may become apprehensive toward the end
range of the maneuver

Question 14

FADIR Test

Answer 14

• Purpose:
– To assess for femoral acetabular impingement (FAI)
– FADIR = Flexion, ADduction, Internal Rotation

• Procedure:
– Patient lies supine on the examination table
– The practitioner stands adjacent to the test leg
– The examiner takes the patient’s hip into full flexion, internal rotation and adduction
– The examiner takes note of the patient’s subjective response to the test position

• Indication of a Positive Test:
– Pain and replication of the patient’s symptoms.
– Usually anterolateral hip pain in the case of FAI

Question 15

Craig’s Test

Answer 15

• Purpose:
– To quantify the degree of femoral anteversion or forward torsion of the femoral neck

• Procedure:
– The patient lies prone with the knee of the test leg flexed to 90 degrees
– The patient’s hips and thigh are aligned with the trunk
– The examiner palpates the posterior aspect of the greater trochanter
– The hip is then passively internally and externally rotated until the trochanter contact is
parallel with the examining table or the end-point is reached
– The degree of anteversion or retroversion can be estimated based on the angle of the lower
leg with the imaginary vertical line that is perpendicular to the examination table

• Indication of Positive:
– Normal ranges in adults are within 8-15°
– Internal femorocondylar torsional deformity = femoral anteversion
– External femorocondylar torsional deformity = femoral retroversion

Question 16

Fulcrum Test

Answer 16

• Purpose:
– To assess for potential stress fracture in the femoral shaft

• Procedure:
– The patient sits with their legs hanging off the examination table
– The practitioner stands adjacent to the patient’s test leg
– The practitioner places his/her forearm/rolled towel (secondary contact) under the patient’s distal
femur
– With the primary contact, the practitioner applies P-A pressure over the anterior aspect of the
knee which levers the femur over the fulcrum point (practitioner’s secondary contact)
– The practitioner moves the secondary contact proximally, in increments, and applies pressure with
the primary contact

• Indication of a Positive Test:
– If a stress fracture is present, the patient will complain of sharp pain and will be apprehensive
when the fulcrum point is under or approaches the fracture site
– The level at which the fulcrum test is positive corresponds to the site of the stress fracture in the
femoral shaft

Question 17

Weber-Barstow Manoeuvre

Answer 17

• Purpose:
– To assess for differences in leg length and leg asymmetries

• Procedure:
– The practitioner stands at the caudal end of the examination table

– Part 1: The patient lies supine with hips and knees flexed and the feet flat on the table
– The practitioner makes sure that the feet are aligned at the heels
– The patient is then asked to actively lift their pelvis off the table and then lower it again
– With the patient keeping their hips and knees flexed the practitioner then visually inspects the length
of the tibia and femur from both the front and the side for inequality in length

– Part 2: From the knees flexed position, the practitioner passively extends the patient’s legs
– The practitioner then palpates the patient’s medial malleoli with his/her thumbs, checking for
asymmetries in length between the paired limbs

• Indication of Positive Test:
– Part 1: Leg length inequality which is derived from either the tibia or femur
– Part 2: Leg length inequality which is derived from either the tibia and/or the femur

• Note:
– Leg length discrepancy can be either structural or functional in nature or a exist as a combination of
the two

Question 18

True Leg Length Test

Answer 18

• Purpose:
– To assess for differences in leg length and leg asymmetry

• Procedure:
– The patient lies supine with the feet approximately 15-20cm apart and the legs parallel to each other
– The practitioner stands adjacent to the leg being assessed
– The practitioner measures from the caudal aspect of the ASIS to the caudal aspect of the medial malleolus or the
lateral malleolus
– The test is repeated on the opposite leg and the results are compared
• Indication of a Positive Test:
– Differences of up to 1.5 cm are considered to be within normal limits, however a difference of this magnitude or
greater may produce symptoms

• Notes:
– Great care must be taken to ensure that the legs are appropriately aligned. Each leg must be positioned in a mirror image of the opposite leg otherwise the accuracy of the measurement will be compromised. The practitioner must take into account any contracture (e.g. reduced hip abduction) that may be present in one leg and replicate that contracted position in the opposite leg before proceeding with the measurement of leg length.
– Muscle bulking, swelling, contracture, deformity and atrophy can influence the accuracy of the measurements