Lec 4 (Lab) - Hip Screen, Special Tests, MLT Lab Flashcards
For upcoming practical make sure you can explain why you’re doing what you’re doing
“What is the purpose of this special test”
Make sure you can perform the special test and interpret its results
Which special test do you need to be able to differeinitate anterior hip pain from lower quadrent pain?
RESISTED straight Leg raise
Explain how to perform a resisted straight leg raise test? (litteraly get on the ground and desribe outloud where therapist is / is pushing)
How far should their leg be off the table when pt is pushing down?
What is a positive test?
What is a negative test?
pt on table
Arms supporting behind pt
pt raises leg ~12 inches from the table (actively)
pt resists therapist apply downward pressure at DISTAL thigh
PT on ipsilateral side that they are pressing
Two types of posititve tests
1) lower quadrent pain = peritoneal inflame, appendicits (RIGHT SIDE) or inflammation of iliopsoas (make sure on that one)
2) Under lower quadrent pain or anterior hip: labral test with reproduction of comparable pain or CLICKING /CATCHING in anterior hip
Negative = No pain on anterior hip or lower quadrent
NOTE: make sure to test opposite side first and make sure it doesnt not produce pain (I think do this for most tests)
What does the Patellar-Pubic Percussion Test (PPPT) test for?
Femoral neck fracture
What test would we do for a femoral shaft fracture? What about a femoral neck fracture
Fulcrum test
Patellar Pubic Percussion Test
How is the Patellar-Pubic Percussion Test (PPPT) performed?
* Where is therapist
* Position of pt
* landmarks?
* Positive vs negative
pt in supine on table (LE extended)
pt ipsilatearl side LE
Place bell of stethoscope over pubic tubercle (ipsilaterl) of LE testing
* Note - ask pt to find belly button and go down to groin area. Then ask them to move to the side you’re on to that last boney land mark (should be on pubic tubercle)
* PT listends as they tap patella (can use finger or reflex hammer)
Posititve: if sound is diminished (not crisp because those sound waves won’t travel as easily) OR if they are experiencing pain - NOTE: this indiciates a potential femoral NECK fracture
Negative: No pain and both sides sound the same (crisp)
NOTE: DO CONTRALATERAL LEG FIRST TO FIND THEIR NORM
is great for testing for those stress fractures
Fulcrum test
* What is a positive test
* How do you perform it
Performed w/ pt sitting with knees bent over table edge and feet dangling
Test is used to see if there is a fracture in the femoral
PT places forearm under the ipsilateral leg with the hand on the opposite anterior thigh as a stabilizing force
PT utilizes free hand to apply a downward force over the distal femur, just superior (proximal) to the patella
Positive test = sharp pain or apprehension (fear) when fulcrum is applied
What does Craig’s Test look at?
Femoral antiversion or retroversion
How is the Craig’s Test performed?
* What does this test assess?
* What are the normative vaules / vaules for conditions?
* What is the goni posistion?
pt in prone w/ knee flexed to 90 degrees
PT: palpates for greater trochanter by moving pt passively through IR/ER UNTIL IT STICKS OUT THE MOST
Then the leg angle is measured measured
Test looks at excessive femoral antiversion and retroversion
Set goni parallel to the follor w/ the other end up the tibia. The angle you measure should be correct.
Limited external rotation = antiverison
Limited internal rotation = retroversion
Increased femoral antiversion is defined by what? (like the how many degrees on a craigs test)
What motion does it limit. Why?
What is it?
**>15 degrees of ER = antiversion
Antiversion causes less external rotation - because its essentially sitting the femoral shaft in to much internal rotation so when we externally rotate its essentially blocked by the anterior aspect of the acetabular rim
It is the femur being in to much internal rotation
What is the value for retoversion according to Craig’s test?
<10 degeres ER
What is the norm range for Craig’s test?
10-15 degrees ER
How is the Log Roll Test Performed?
* What does it assess?
* What is posititve / negative?
* What does a posititve test indicate
pt in supine
Therapist standing on testing limb side. One hand distal femur (lower thigh) other hand just distal to tibia (ankle) superior to the latearl malleulus
PT **passively **rotates the femur medially to end range and lets the leg fall passively into lateral rotation (may also take it actively)
* He said pt intereally and externally rotates leg entirely passively
NOTE: Check both sides
Posititve test: if motion is resitrcited (which is why we check bilatearl) or painful.
* If posititve we have some intra articular pathology
* We are thinking labral tear if painful and a click is present
* If excessively lax a iliofemoral ligament issue may be going on (lax)
Negative test: if equal bilateral and no pain
NOTE: This test is good because only rotation of the femoral head in the acetabulum occurs and the capsule is stretched w/ minimal muscular involvement - and its passive so we don’t even have muscualr involvement
TEST QUESTION: PT is highly irritable and has hip OA? Why or why not would we use the Scour Test
We would not use it because its letting crushing the head of the femur into the acetabulum
How is the Hip Scour Test performed?
* What are is a positive test?
* What is a negative test?
PT: Cusp suprapatellar region (try to avoid direct contact over patella) w/ elbows relaced along med/lat thigh
TEST: Flex / Add hip, apply manual pressure into joint and scour from that flexion / abduction point into an arc (2 to 10 then 10 to 2) while maintaing the same pressure
Positive = intra-articular pathology if repduction of clicking / catching, apperhension, or their compaireable pain
Negative = no catching / clicking / pain pr apperhension
NOTE: if we expect some kind of intra articular issue we should start w/ the log test because it is much less rough and less likely to hurt the pt
NOTE: helps us find anything intra articular because you’re closing down that femoral hd in the acetabulum –> OA / FAI / Etc
Explain how to perform an Anterior Labral Tear Test
* What is a positive / negative test
* What things could it possible indicate are wrong?
This is the FADIER test
pt is in supine
put them in hip flexion into IR (looks like ER) into ADduction
* the goal is essentially to close down on that anterior aspect of the leg / ground
Positive test: Reprodiction of compareable pain (with or without a click) or apperhension
* Note things that possible problems = anteriorsuperior impingement tendin / anterior labral tear (click) / iliopsoas tendin tendinopathy
Negative = no repduction of pain
NOTE: You are looking for pain with or without a click
Explain how to do a Patrick’s test
* Postive (3)
* Negative
AKA a FABER test or figure 4 test
pt in supine
therapist places the patients ipsilateral foot over the contralateral leg just superior to the patella
PT will stabilze over contralateral ASIS
PT will slowly lower the knee towards the examination table while stabilizing the contralateral ASIS
Positive =
* If pain is reproduced latearlly could be a potential lateral FAI (C- shape latearl thigh)
* If it brings on deep groin pain it could be iliopsoas or psoas tendinopathy or FAI
* If it brings on posterior pain were thinking sacro iliac joint is involved (most likely best one if this is the pain it produces)
Negative: if the pts leg falls to table or parallel and no symptoms
Explain the FAIR test
* How to perform
* What is the point in it?
* Possitive vs negative
Flexion, Adduction Internal rotation
Used to assist in detecting for compression of the sciatic nerve by the piriformis (piriformis syndrome)
* so it is looking at the reproduction of sciatica type symptoms
pt is in supine w/ the involved extremity supported by the clinican
Holding the pts knee, the clinician brings the involved extremity into a position of hip flexion, adduction and internal rotation (note, this is out)
Posititve = pain is elicited posteriorly, following along the sciatic n distribution (down the back of the leg)
* not superior on the back (especially if they point to the psis it won’t be that area)
* NOTE: pain can be numbness / tingling / dull achy pain
Negative = no symptoms
W/ a trendelnburg sign - if I am right single leg stance and my left hip drops. Is this a positive trendelenburg on the left or right? Why (what muscle is weak)
Right (opposite the dropped side)
Weak glute med on right (I think it should be pulling the right glute med back down into neutral) - clarify this
Left hip drops becuase of right weakness
Explain how to do the Modified Thomas Test
* How to do it
* what is normal
* What is abnormal
* What does this test test for
pt sits on the edge of the table
pt lies back w/ both knees against their chest
Once supine, patient asked to flatten their back against their table and the test limb is loweered over the edge of the bed toward the floor (while other leg is still held toward chest)
* Note: when starting this test the knee is bent when lowering the effected side to the table
* However, when testing for rec fem you want to keep the knee straight to keep this muscle taut
Normal: thigh should be parallel to the bed, in neutral rotation, and neither AB/Adducted
Abnormal:
* iliopsoas involved: thigh is raised compared to the table
* if the thigh is raised then we would have them staright their leg. If they starighten their leg out and it drops - we can assume the rec fem was to blame (we essentailly had it taight or stretched out as far as it could go when the knee was bent - unbending the knee put it on slac) and if this putting it on slac causes the knee to drop - than its posititve for rec fem
* If bending the knee does nothing to the position of the leg - then we can assume the tight ilipsoas is to blame (since its the only muscle to be consistently taut)
* If i change the knee and the thigh doesnt move = iliopsoas
* We an also add in tensor fascia latae involvement by maximal hip adduction of testing limv and check to see if ipsilateral pelvis rises (we didnt practie this and i doubt it will get tested) - biggest point is iliopsoas invovlement vs rec fem involvement
This test is used to asses for flexibility / involvement of iliopsoas, rectus femoris, or tensor fascia lata
Explain how to perform Ely’s test
* what is its purpose
* Postitive / negative
Looking for rec fem flexibility (makes sense - rec fem is a 2 joint m and what will be limiting the motion below) - its already pretty extended at the hip (lengthened) and we will continue to lengthen it by putting it in knee flexion (because it does knee extension / hip flexion)
pt is put in prone, and the knee is passively flexed by the clinican
NOTE: Check both sides for their norm
Posititve = were looking for anterior thigh / anterior knee pain (NOT DEEP ANTERIOR HIP)
* also posititve if they start flexing that ipsilateral hip (into the table) or if the pelvis roates anteriorly (which will go along w/ that hip flexion) - they’re trying to get out of that position of disconfert
What is the goal of the modified Ober test?
* explain how to do it
The goal is to see if the hip can lower past neutral
Take the hip into extension abduction and neutral force
* do it on both sides to figure out what neutral is
Checked bilatearlly to make sure they arent just tight everywhere
This is checking to see the flexibility of TFL (and IT band)
Posititve = if the testing leg fails to lower to the midline/neitral or excessive pelvic rotation is noted
Explain how to do a straight leg raise test
* purpose
* posititve/negative
Used to assess hamstring length (measure both sides)
stand on the side being tested and support the pts ankle while palpating the opposite ASIS
w/ the knee extended, the clincian passively lifts the pts leg into hip flexion until motion is detected at opposite ASIS
Positive = if the staight leg cannot be raised to an angle of 80 degrees while maintaing hip neutral or the leg straight
Explain the 90/90 test
* how to do it
* posititve / negative
* goal of test
Used to assess hamstring length
Oatient actively flexes the hip to 90 degrees and the therapist asks the pt to actively extend the involved knee without losing the 90 degrees of hip flexion
* hip starts at 90 degrees of hip flexion
* Knees starts at 90 degrees of knee flexion - then as pt to actively extend their knee up
Measurement of the knee extension angle is taken at the first resistance barrier
