Hip

Question 1

Special tests

Answer 1

** Test unaffected leg first then compare and test affected leg

1) Leg length - true
2) Leg length- apparent
3) Thomas test
4) Modified Thomas test
5) Trendelemberg
6) FABER
7) FADIR
8) FADIR-R

Question 2

1) Leg length test- true shortening

Answer 2

Patient position

Therapist position

Place tape measuring on ASIS and measure to medial malleolus repeat x3

Explanation:

Affected limb is physically shorter than the other
Caused by pathology prox/distal to Greater Trochanter
Proximal= fracture femur or loss articular surface
Distal= tibia fracture or polio

Question 3

2) Leg length- apparent shortening

Answer 3

Patient position

Therapist position

Place measuring tape on xiphoid process an measure to medial malleolus repeat x3 times

Explanation:

Limb is not acctually sorter may be a result from muscle contracture around the hip which produces a tilited pelvis or a problen with the sacroiliac joint

Question 4

3) Thomas test

Answer 4

Patient position

Therapist position

Stand on affected side ask model to flex knee towards there chest and hold it so that their thigh is nearly in contact with their trunk

🟥 opposite thigh remains in contact with plinth
🟩 opposite thigh lifts off the plinth

Explanation:

Shows a loss of extension and a fixed flexion deformity contracture hip felxors

Question 5

4) Modified Thomas test

Answer 5

Model laying on their back with their knees flexed dangling off the end of the plinth ensure that knee crease is not touching the plinth ( an inch away)

Ask patient to flex unaffected leg and hold it around their knee.

If the opposite thigh lifts up this would show lack of extension

> Therapist then passively extends knee that is dangling off the plinth affected leg and if hip drops down= RECTUS FEMORIS is shortened then rest thigh and measure knee flexion

> Therapist then passively abducts affected leg that is dangling off the plinth if the hip drops into more extension= IT BAND= tight structure

> If neither of these tests result in more extension then we can conclude that that ILIOPSOAS OR HIP JOINT CAPSULE are limiting movement

Question 6

5) Trendelemberg test

Answer 6

Patient position

Therapist position

model in standing stand behind the model

Get model to stand on unaffected leg and flex the knee of the affected leg lifting it off the floor a negative test is if the pelvis remains negative

if the model is standing on the affected leg and the pelvis drops to the side of the unaffected leg this shows a posititve test which identifies weal hip abductors (glute med min TFL)

Question 7

6) FABER

Flexion, Abduction, External Rotation

Answer 7

Passive movement test. Patient in supine lying therapist standing on affected limb side. Place the lateral malleolus of affected leg side just above the knee of the unaffected side. stabilise pelvis by placing hand on the ASIS then lower affected leg into full external rotation and abduction

Pain provocation test= OA shortening extra articular hip joint structures

Lateral hip region absence movement restriction= GLUTEAL TENDINOPATHY. This is because test places anterior porions of Glute MED + MIN under tensile load as they also internally rotate

Pain SIJ/ bum= SIJ

Question 8

7) FADIR

Flexion, Adduction, Internal Rotation

Answer 8

Passive movement test. Patient in supine lying. Therapist on affected side. Fully flexes hip of affected limb and one hand is cupping under ankle and the other palm of the hand is on the flexed knee and femur is adducted and internally rotated.

Pain= Femoral acteabular impingement or intra-arcticular hip pathology because movement approximates anterior aspect of femoral neck with acetabulum

Question 9

8) FADIR-R

Flexion, Adduction, Internal Roataion ( pulse resistance)

Answer 9

If there was lateral hip pain with minimal movement restrction= GLUETAL TENDONOPATHY = compression gluteal tendons by the overlying of IT band

Apply isometirc internal rotaion at end range