Hip examination/testing

Question 1

Gastrocnemius muscle length testing

Answer 1

• assess ankle DF with the knee straight & with the knee bent
• positive: less DF with the knee extended than when knee bent

Question 2

Rectus femoris muscle length testing

Answer 2

• pt prone, stabilize pelvis, passively flex knee on test side
• positive: unable to obtain at least 120 knee flexion

Question 3

Ely’s test

Answer 3

• patient prone & the examiner passively flexes the knee on the test side
• positive: patient’s ipsilateral hip flexes & pelvis anteriorly tilts

Question 4

90/90 test for hamstrings

Answer 4

• patient is supine with hip flexed to 90 deg. & knee flexed to 90. passively extend the knee.
• positive: not </= 20 deg. of full extension. (be sure to note difference between muscle tightness & nerve symptoms)

Question 5

Straight Leg Raise

Answer 5

• patient supine with legs straight. monitor opposite ASIS. lift patient’s leg with knee extended, flexing it at the hip until motion detected at opposite ASIS. Angle of hip flexion from table is measured
• positive: < 80 deg. from horizontal

Question 6

Ober Test

Answer 6

• patient side-lying with examined leg up & in neutral rotation. stabilize pelvis. examiner flexes patient’s knee to 90 & abducts & extends the hip until the hip is in line with the trunk. examiner allows gravity to adduct hip as much as possible, without allowing medial rotation
• positive: unable to adduct toward table
• min. tightness: leg past horizontal but not completely adducted to table
• mod tightness: leg adducted to horizontal
• max tightness: cannot reach horizontal to table

Question 7

Thomas test

Answer 7

-tool for hip flexor, TFL/ITB, rectus femoris tightness

Question 8

Hip extensors muscle length testing

Answer 8

• passively flex hip with knee bent. assess end feel

- positive: < 120 deg. hip flexion

Question 9

Resting position for resisted motion testing?

Answer 9

-30 hip flexion, 30 hip abduction, & slight lateral rotation

Question 10

Closed packed position

Answer 10

-max extension, IR, slight abduction

Question 11

Open packed position

Answer 11

-30 deg flexion, 30 deg abduction, slight ER

Question 12

Capsular pattern

Answer 12

-flexion = abduction = IR, slight loss extension, little to no loss ER

Question 13

Hip disorder that the Trendelenburg tests for

Answer 13

-lateral hip tendon pathology

Question 14

Sensitivity/Specificity for Trendelenburg test

Answer 14

• sensitivity .23

- specificity .94

Question 15

Protocol for Trendelenburg test

Answer 15

• standing, patient raises one foot 10 cm off ground while examiner looks for change in level of pelvis
• positive: pelvis drops on unsupported side or trunk shifts to stance side

Question 16

Trochanteric Bursitis Test

Answer 16

• diagnostic tool for trochanteric bursa inflammation/irritation
• pt sidelying with affected side up. stabilize pelvis with one hand, while extending hip & flexing the knee with the other hand. adduct the hip, then move from ext to flex.
• positive: reproduction of symptoms

Question 17

Side-lying Abduction

Answer 17

• assess muscle imbalances & movement impairments
• pt in sidelying with affected side up & knee extended. have pt abduct hip. observe their movement pattern. if leg moves into hip flexion or int rot., suspect hip flexor/TFL dominance.
• Place the leg into an abducted, extended, ext rotated position. Ask them to actively hold the leg in that position. if the leg int rotates or flexes again, suspect hip flexor/TFL dominance

Question 18

FABER test is a diagnostic tool for what hip pathology? Statistics associated with FABER?

Answer 18

• diagnostic tool for hip OA
• Sensitivity .57
• Specificity .71

Question 19

Protocol for FABER test

Answer 19

• pt supine. Examiner flexes, abducts, & ext rotates involved hip so lateral ankle is placed just proximal to opposite knee. While stabilizing ASIS, involved leg is lowered toward table to end-range. Slight overpressure is added.
• Positive: reproduces pt.’s symptoms (ant pain implies soft tissue shortening or articular pathology; post pain implies SI joint pathology)

Question 20

FAIR or FADIR is a diagnostic tool for what? Statistical data for FAIR/FADIR?

Answer 20

• diagnostic tool for impingement
• for hip pain the statistics are as follows:
• sensitivity .78
• specificity .10

Question 21

FAIR/FADIR test protocol

Answer 21

• Pt supine. Examiner flexes, adducts & int rotates the involved hip to end range
• Positive: reproduces pt’s symptoms

Question 22

Scour Test statistics? This test is used as a diagnostic tool for what hip pathology?

Answer 22

• used as a diagnostic tool for hip OA
• sensitivity .62
• specificity .75

Question 23

Scour test protocol

Answer 23

• Pt supine. Examiner passively flexes symptomatic hip to 90 & then applies axial load to femur while moving the knee towards the opposite shoulder (adduction). Keeping an axial load, move the hip to a position of abduction & flexion.
• Positive: reproduces pt’s symptoms, resistance in the arc of motion

Question 24

Craig’s Test assesses what hip pathology/disorder?

Answer 24

-assesses femoral anteversion/retroversion

Question 25

Craig’s Test protocol

Answer 25

-Pt prone w/ knee flexed to 90. Stand on side of table facing pt., hold pt’s ankle with one hand while palpating the greater trochanter with the other hand. Move hip from int. to ext. rot. When the trochanter reaches it’s most lateral position, measure the angle between the lower leg & the vertical.

Question 26

Craig’s test normal degrees of retroversion/anterversion & biomechanics

Answer 26

• normal: 8-15 deg. in an adult
• biomechanics: excessive anteversion presents with excessive medial rotation & decreased lateral rotation. Retroversion presents with excessive lateral rotation. Deviation from this measure may indicate anteversion/retroversion (at femoral neck). Excessive rotation can lead to knee pathology (e.g. lateral patellar tracking) and/or ankle pathology (e.g. excessive pronation)

Question 27

Patellar-Pubic-Percussion Test is a diagnostic tool for what hip pathology? Statistics associated with this test?

Answer 27

• tool for detecting hip fractures
• sensitivity .96
• specificity .86

Question 28

Patellar-Pubic-Percussion Test protocol

Answer 28

• Pt. supine. Examiner taps one patella at a time while auscultating the pubic symphysis with a stethoscope.
• Positive: diminution of the percussion noted on the affected side

Question 29

Hip Positional Problem

Answer 29

-A leg might look longer with an anterior rotation of the pelvis & shorter with a posterior rotation of the pelvis. This can be due to soft tissue & may not be architectural in nature. Mobilization may be effective to correct this.

Question 30

Structural Problem: True Leg Length Test

Answer 30

-Pt. supine. Level the pelvis by having the pt perform a “bridge” & return hips to treatment surface. Position the legs equally from midline, 4-8” apart. Measure with a tape measure from ASIS to lateral malleolus

Question 31

Hip Segmental Testing

Answer 31

• Pt. supine. With a tape measure,
• Iliac crest -> gr. trochanter (suggesting coxa vara or coxa valgus)
• Greater trochanter -> lateral knee joint line (suggesting femoral shortening)
• Medial knee joint line -> medial malleolus (suggesting tibial shortening)
• Little agreement on how much difference is clinically significant: range in literature from 1/4” to just under 1”

Question 32

Hip examination outcome measures

Answer 32

• Lower Extremity Functional Scale (LEFS)

- Western Ontario & McMaster Universities OA Index (WOMAC)

Question 33

Anatomical considerations with the acetabulum

Answer 33

• acetabulum faces laterally, anteriorly & inferiorly

- performing joint distraction, your force should be directed perpendicular to this articular orientation

Question 34

Ligamentous close packed position

Answer 34

-medial rotation, slight abduction & max extension

Question 35

Bony close packed position

Answer 35

-90 deg flexion, abduction & lateral rotation (you should not mobilize in the bony close packed position)

Question 36

Long axis distraction

Answer 36

-pt. is positioned supine, hip slightly flexed, abducted, laterally rotated - grasp at the ankle, near malleoli. If pt has knee problems or has an amputation, grasp above knee. Be sure hip muscles are as relaxed as possible to improve elasticity of the joint capsule.

Question 37

Distraction, with hip/knee in flexion

Answer 37

• position pt with shin against your chest or knee draped over shoulder. You might wish to place a small towel at pt’s groin, for modesty.
• try to maintain some adduction & medial rotation to avoid the bony close packed position

Question 38

Inferior (caudal) glide facilitates which motions?

Answer 38

1. abduction (primarily)

2. flexion (secondarily)

Question 39

Inferior (caudal) glide supine method #1

Answer 39

-virtually identical to distraction, but line of force is slightly different (i.e. more caudal)

Question 40

Inferior (caudal) glide supine method #2

Answer 40

-pt. positioned supine with hip & knee flexed up. A belt or therapist’s hands are placed at proximal thigh. Slight rotation or abduction may be adjusted for effect & comfort. Again, similar to distraction.

Question 41

Prone method for inferior (caudal) glide

Answer 41

-Pt is positioned prone with the leg held in some extension. Now, capsular stretching can be effectively performed, especially in the anterior portion. Avoid starting in a (ligamentous) close packed position

Question 42

Posterior (dorsal) glide facilitates which motions at the hip?

Answer 42

• flexion

- medial rotation

Question 43

Posterior (dorsal) glide method in supine with legs straight

Answer 43

-pt. is positioned supine, in resting position for grades I & II. Try placing a small towel under sacrum. If you place your hand near inguinal line, recommended that fingers are pointed laterally rather than medially to protect the patient’s modesty

Question 44

Posterior (dorsal) glide method in supine with hip/knee flexed

Answer 44

-This technique is similar to post glide of glenohumeral joint. Pressure is applied at the knee, directed downward & laterally. This is a more vigorous technique that you might wish to utilize if the pt’s primary problem is limited motion. A small towel should be placed under sacrum to allow hip motion

Question 45

Anterior (ventral) glide facilitates which motions at the hip?

Answer 45

• extension

- lateral rotation

Question 46

Prone (method #1) for anterior (ventral) glide

Answer 46

-to approximate the resting position of 30 deg flex, pt is prone over several pillows (2-3 rather than 1). The therapist may support the bent knee with the non-mobilizing hand: if so, the knee is not lifted - only supported

Question 47

Standing (method #2) for anterior (ventral) glide

Answer 47

-pt is standing, bent over a table. You may use a belt to stabilize the pt’s trunk, but this is not required. Have the leg non-weight bearing. This technique can be helpful if your pt can’t be positioned prone & it might permit you to add some distraction force along with the glide

Question 48

Lateral glide facilitates what motions?

Answer 48

• medial rotation
• adduction
• this technique is also very helpful in the treatment of generalized hip joint pain

Question 49

Lateral glide

Answer 49

-pt is positioned supine & line of force is almost purely lateral, without inferior force. A belt or sheet is placed on inner thigh over a folded towel (pt comfort). The belt/sheet is also wrapped around the therapist, as the hips & rear are used to mobilize the joint. Be aware of how much force you can generate on a relatively small area of the body. Once again, you are reminded to explain this technique first since the belt/sheet must be placed so high into the groin area.