Lab Flashcards
Assessment: Trendelenburg’s Sign
Integrity of gluteus medius or unstable hip
Position: Trendelenburg’s Sign
Pt: Standing on one limb, affected sign
PT: Standing behind pt.
Method: Trendelenburg’s Sign
Observe alignment of the contralateral limb with the pelvis
Positive Test: Trendelenburg’s Sign
Pelvis on opposite side drops when the pt. stands on the affected limb
Biomechanics: Trendelenburg’s Sign
Gluteus medius (prime mover) and other hip abductors stabilize the pelvis on the femur
Assessment: Caudal Glide (Hip)
Joint mobility
Position: Caudal Glide (Hip)
Pt: Supin with hip in 30 flexion, 30 ABD, slight ER
PT: Walk-stance at end of table, facing pt., cradle limb in malleoli
Method: Caudal Glide (Hip)
Lean back, apply caudal mobilizing force on LE, gentle, gradual increase amplitude and depth if no pain.
Assess quality of movement and compare bilaterally
Assessment: Inferior Glide (Hip)
Joint mobility
Position: Inferior Glide (Hip)
Pt: Supine, hip and knee flexed to 90 supported by PT shld
PT: Support LE, wrap ulnar borders around proximal thigh
Method: Inferior Glide (Hip)
Apply caudal mobilizing force on proximal femur, gentle, gradual increase amplitude and depth if no pain.
Assess quality of movement and compare bilaterally
Biomechanics: Inferior Glide (Hip)
Increases hip joint space and loosens adhesions in the anterior direction
Assessment: Posterior Glide (Hip)
Flexion and IR
Position: Posterior Glide (Hip)
Pt: Supine with hip in resting position (i.e. 30 flex, 30 ABD, sligh ER)
PT: Mobilizing hand on anterior proximal femur
Method: Posterior Glide (Hip)
Mobilizing force straight down
Posterior glide is necessary for flexion and IR
Assessment: Anterior Glide (Hip)
Extension and ER
Position: Anterior Glide (Hip)
Pt: Side lying, pillow between knees, hip comfortably flexed
PT: Walk-stance perpendicular to side of exam table, palm against posterior lateral trochanter, other hand stabilizes pelvis
Method: Anterior Glide (Hip)
Apply anterior force parallel to joint surfaces, gentle, gradual increase amplitude and depth if no pain.
Assess quality of movement and compare bilaterally
Biomechanics: Anterior Glide (Hip)
Femoral head glides anteriorly during extension and ER
Assessment: Lateral Glide (Hip)
Lateral mobility
Position: Lateral Glide (Hip)
Pt: supine, leg extended, can have hip flexed to 90
PT: Stabilize lateral aspect of distal femur and medial aspect of proximal femur
Method: Lateral Glide (Hip)
Proximal hand applies a lateral force
Assessment: Hamstring Length (SLR)
Length of hamstrings
Position: Hamstring Length (SLR)
Pt: Supine, back neutral, knee extended, hip extended
Method: Hamstring Length (SLR)
PT passively brings leg up into increasing hip flexion
Positive Test: Hamstring Length (SLR)
< 80 of hip flexion indicates tightness in CT of posterior thigh
Assessment: Hip Flexor Length (Thomas Test)
Length of hip flexors
Position: Hip Flexor Length (Thomas Test)
Pt: sitting at EOB with distal legs supported by table (text); Laying with hips at EOB, legs dangling (picture)
PT: Lower pt. to supine while pt. holds knees to chest, Then hold pts. posterior leg with hand and palpate ASIS and PSIS with other hand. Pt will holds contralateral knee to chest
Method: Hip Flexor Length (Thomas Test)
Step 1: Lower leg to table while monitoring lower back
Step 2: If leg does not lower with knee flexed, reattempt with knee straight
Step 3: If leg does not lower with knee straightened, reattempt with knee flexed and abd hip,
Normal response: Hip Flexor Length (Thomas Test)
Leg lowers to table with knee flexed
Positive Test: Hip Flexor Length (Thomas Test)
Does not lower with knee straight = tight iliopsoas
Lowers with knee straight = tight rectus femoris
Lowers with knee flexed and hip abd = tight tensor fascia latae
Biomechanics: Hip Flexor Length (Thomas Test)
Hip flexors under examination are: iliopsoas, rectus femoris, and TFL
Hip should be able to reach neutral with spine flat if all hip flexors normal length
To bias rectus femoris = knee straight
To bias TFL = hip ABD
Assessment: IT band (Modified Ober test)
Length of iliotibial band
Position: IT band (Modified Ober test)
Pt: Side lying with leg on table having knee and hip flexed
PT: Behind pt., stabilize pelvis, and use other hand to support under leg with hand around knee cap
Method: IT band (Modified Ober test)
Bring leg into extension, ER (to prevent IR), then drop leg into adduction
Positive Test: IT band (Modified Ober test)
Leg drops less than 10 degrees from horizontal
Biomechanics: IT band (Modified Ober test)
A tight IT band/TFL will cause hip abduction and IR of the femur
Q: What are the 4 tests for hip muscular length?
- SLR (hamstring)
- Thomas (hip flexor)
- Modified Ober (IT band)
- Hip IR/ER
Q: What are the 6 hip special tests?
- Scour
- Femoral-acetabular impingement test
- FABER
- Piriformis
- Craig’s
- Ely’s
Assessment: Scour Test (flexion and adduction)
Pathology in the articulating surface of the hip joint as with OA, Labral tear, Bursitis
Position: Scour Test
Pt: Supine, hip flexed 90 with knee bent and hip adducted
PT: Standing, facing pt., grasp knee with both hands
Method: Scour Test
Apply an axial load while moving the patient from adduction to abduction
Positive Test: Scour Test
Grinding or snapping
Location should indicate cause
Assessment: FABER
ROM of hip and pain
Position: FABER
Pt: Supine with foot resting on top of the knee of the opposite leg (Hip flexion, ABD, ER)
PT: Standing on side of table one hand on ASIS of contralateral hip and other handon bent knee
Method: FABER
Apply pressure to ABD the hip on the test side and pressure to stabilize the hip on the contralateral hip
Positive Test: FABER
Knee does not lower to the level of the opposite hip
Assessment: Piriformis Test
Piriformis involvement
Position: Piriformis Test
Pt: Sidelying with test hip flexed 60 and knee flexed
PT: Facing pt., one hand stablizing the hip, the other on knee
Method: Piriformis Test
Apply downward force on the knee
Positive Test: Piriformis Test
Sciatica pain or tightness of piriformis
Movement of the hip under PT hand
Assessment: Craig’s Test
Measure of femoral anteversion
Position: Craig’s Test
Pt: Prone, knee flexed to 90
PT: Standing on side, holding ankle and palpating greater trochanter
Method: Craig’s Test
Passively IR/ER the hip until the greater trochanter is in its most lateral position (parallel to table), then measure angle between lower leg and vertical
Normal Test: Craig’s Test
8-15 degree angle
Biomechanics: Craig’s Test
Excessive anteversion = IR, toe in
Excessive retroversion = ER, toe out
Assessment: Ely’s Test
Length of rectus femoris
Position: Ely’s Test
Pt: Prone, legs together
PT: Standing on the side, hand on ankle and on pelvis (posterior or anterior)
Method: Ely’s Test
Passively flex knee, stabilizes pelvis
Positive Test: Ely’s Test
Anterior pelvic til or limited knee flexion = tight rectus femoris
Functional Test: Lift foot onto 20 cm step/return (hip flexion>ext)
- 5-6 reps
- 3-4 reps
- 1-2 reps
- 0 reps
- Functional
- Functional Fair
- Functional Poor
- Nonfunctional
Functional Test: Sit in chair and stand (hip ext>flexion)
- 5-6 reps
- 3-4 reps
- 1-2 reps
- 0 reps
- Functional
- Functional Fair
- Functional Poor
- Nonfunctional
Functional Test: Standing, lift leg to balance keeping pelvis straight (hip ABD)
- Hold 1-1.5 min
- Hold 30-59 sec
- Hold 1-29 sec
- Cannot Hold
- Functional
- Functional Fair
- Functional Poor
- Nonfunctional
Functional Test: Walk sideways 6m (Hip ADD/ABD)
- 6-8m one way
- 3-6m one way
- 1-3m one way
- 0m
- Functional
- Functional Fair
- Functional Poor
- Nonfunctional
Functional Test: Tested leg off floor, IR nonWB hip OR ER nonWB hip
- 10-12 reps
- 5-9 reps
- 1-4 reps
- 0 reps
- Functional
- Functional Fair
- Functional Poor
- Nonfunctional
Q: In standing which should be higher, PSIS or ASIS and by how much?
PSIS
men = 5 degrees higher
women = 10-15 degrees higher
Assessment: Bending Forward
- Hip Compensation
- Knee flexion/hyperextension
Normal: Bending Forward
Hip flex to 90 followed by back bend
Positive Test: Bending Foward
Hip flex < 90 followed by back bend = tight hamstrings and hip flexors
Q: What is the purpose of passive hip movement in single leg stance?
Loading joint to see if symptoms are reproduced with certain movements
Stretching: UE: Supine or Sidelying: Shoulder Flexion/Elevation (3)
- Scapula is stabilized: 120 degrees of shoulder flexion/elevation
- Humerus externally rotated
OR
- Stabilize pelvis for full flexion/elevation
Stretching: UE: Supine or Sidelying: Shoulder ER (4)
- Abduction or elevation plane
- 90 elbow flexion; initially 30 or 45 of elevation
- Stabilize shoulder with one hand and elbow forearm with another hand
- Externally rotate the shoulder
Stretching: UE: Supine or Sidelying: Shoulder Horz ABD (4)
- Pec. major stretching
- Pt in the edge of the table
- Begin with shoulder in 60 to 90 degrees of abduction/pt’s elbow flexed.
- Stabilize anterior shoulder and grab the distal humerus
Stretching: UE: Supine or Sidelying: Elbow extension (2)
- Watch for shoulder and elbow compensations
- Stabilize shoulder/humerus with one hand/ apply the extension force on the forearm, use towel to support the humerus.