Hip and Knee Special Tests

Question 1

Ely’s test

Answer 1

For rectus femoris contracture

• Pt prone, therapist passively flexes knee
• Positive: spontaneous hip flexion occurs simultaneously with knee flexion

Question 2

Ober’s test

Answer 2

For ITB/ TFL contracture

• Pt sidelying, lower leg flexed at hip and knee
• Therapist moves top leg into hip ext and ABD, attempts to slowly lower that leg
• Positive: inability of test leg to adduct

Question 3

Piriformis test

Answer 3

For piriformis tightness/ compression on sciatic nerve

• Pt sidelying, test leg up, hip flexed 60 degrees
• Therapist stabilizes pelvis and applies adducted force on the knee
• Positive: pain or tightness

Question 4

Thomas test

Answer 4

For hip flexion contracture

• Supine, legs fully extended.
• Pt brings one knee to chest
• Therapist observes position of contralateral hip
• Positive: Straight leg rising from table

Question 5

Tripod Sign

Answer 5

Basically slump test, but just for hamstring length not neural mobility
Positive: hamstring tightness or extension of trunk in order to limit effect of tight hamstrings

Question 6

90-90 straight leg test

Answer 6

• Pt puts both hip/knees at 90/90
• Instructed to alternately extend each knee while maintaining hips at 90
• Positive: Knee can’t straight past 20 degrees of flexion - indicates hamstring tightness

Question 7

Barlow’s test

Answer 7

Indicates hip dislocation being reduced (infants)
- Pt supine, hips flexed 90 degrees, knees flexed
- Move test leg into ADD while applying forward pressure posterior to great trochanter
(test legs one at a time)

Question 8

Ortolani’s Test

Answer 8

For hip dislocation
- Pt supine, hips flexed 90 degrees, knees flexed
- Therapist grasps legs so thumbs are along patient’s medial thighs, fingers on lateral thighs toward buttocks
- Therapist adducts pt’s hips, gentle pressure applied to greater trochanters until resistance is felts at about 30 degrees.
(test both legs at once)

Question 9

Anterior labral tear test (hip)

Answer 9

• Hip in full flexion, ER, ABD
• Therapist moves hip into ext, IR, ADD
• Positive: pain and/or click
• May also indicate iliopsoas tendinitis or anterior-superior impingement

Question 10

Craig’s Test

Answer 10

For femoral anteversion

• Prone, knee flexed 90 degrees
• Palpate greater trochanter, IR/ER leg until treater trochanter is parallel with table
• Degree of anteversion corresponds to angle formed by lower leg with the perpendicular axis of the table.

Normal anteversion: 15 degrees

Question 11

Patrick’s Test (FABER test)

Answer 11

For Iliopsoas, SI, or hip joint abnormalities

• Supine, start with test leg flexed, abducted, ER onto opposite leg
• Therapist slowly lowers test leg through abduction toward the table (press knee down)
• Positive: Failure of test leg to abduct below the level of the opposite leg

Question 12

Quadrant scouring test

Answer 12

For pathologies like OA, avscular necrosis, osteochondral defect

• Supine
• Passively flex and adduct hip, knee in maximal flexion
• Apply compressive force through shaft of the femur, continue passively moving hip
• Positive: grinding, catching, crepitation

Question 13

Trendelenberg Test

Answer 13

For Glut med weakness

• Pt stands on one leg for 10 seconds
• Positive: drop of pelvis

Question 14

Anterior and posterior drawer tests (knee)

Answer 14

Knee flexed 90 degrees

Hip flexed 45 degrees

Question 15

Lachman Test

Answer 15

Knee flexed 20-30 degrees

Question 16

Lateral pivot shift test

Answer 16

• Hip flexed and ABD 30 degrees, slight IR
• IR tibia, apply valgus force to knee while knee is slowly flexed
• Positive: palpable shift or clunk between 20 and 40 degrees of flexion due to reduction of tibia on femur

Question 17

Posterior sag sign

Answer 17

• Knee flexed 90 degrees

- Hip flexed 45 degrees

Question 18

Slocum test

Answer 18

• Knee flexed 90, hip flexed 45
• Rotate pt’s foot 30 degrees IR
• Grasp proximal tibia with two hands, thumbs on tibial plateau, administer anterior directed force to tibia
• Positive: movement of tibia is primarily on the lateral side
• Indicates anterolateral instability
  Can test anteromedial instability by ER foot 15 degrees

Question 19

Valgus/ varus stress test

Answer 19

Knee flexed 20-30 degrees: MCL/ LCL

Knee straight: capsule + MCL/ LCL

Question 20

Apley’s compression test

Answer 20

For mensicus lesion

• Prone, knee flexed 90
• IR/ER tibia while applying compressive force through tibia
• Positive: Pain or clicking

Question 21

Bounce home test

Answer 21

For meniscus lesion

• Supine, Maximally flex knee
• Passively extend knee
• Positive: Incomplete extension or rubbery end feel.

Question 22

McMurray Test

Answer 22

For posterior meniscus lesion

• Start with knee fully flexed
• Passively extend knee while medially rotating tibia
• Then extend knee while externally rotating tibia
• Positive: click or crepitation

Question 23

Thessaly Test

Answer 23

For meniscus tear

• Stand on one leg with 5 degrees knee flexion
• Pt rotates femur on tibia laterally and medially 3 times.
• Repeat with 20 degrees knee flexion
• Positive: Joint line discomfort or catching/ locking

Question 24

Brush test

Answer 24

For Knee Effusion

• Supine
• Place one hand below joint line, stroke proximally with palm and fingers as far as the suprapatellar pouch
• Then stroke down lateral knee
• Positive: Wave of fluid seen just below medial distal border of patella

Question 25

Patellar tap test

Answer 25

For knee effusion

• Supine, knee in position of discomfort
• Apply slight tap over patella
• Positive: Patella appears to be floating

Question 26

Clarke’s sign

Answer 26

For Patellofemoral Dysfunction

• Supine, knees extended
• Apply pressure distally over superior pole of patella
• Patient contracts quad
• Positive: failure to complete contraction without pain

Question 27

Hughston’s Plica Test

Answer 27

• Supine
• Therapist flexes knee and IR tibia while other hand moves patella medially to palpate medial femoral condyle
• Positive: popping sound over medial plica while knee is passively flexed and extended

Question 28

Noble compression test

Answer 28

For ITB Friction syndrome

• Supine, hip slightly flexed, knee flexed 90
• Thumb over lateral epicondyle of femur
• Maintain pressure while pt extends knee
• Positive: Pain over lateral epicondyle at approximately 30 degrees flexion

Question 29

Patellar apprehension test

Answer 29

For patellar sublux/ dislocation

• Supine, knees extended
• Place both thumbs on medial border of patella, apply force laterally
• Positive: Apprehension or attempt to contract quads