Special Tests of the Hip Flashcards
What does a positive Trendelenburg test indicate?
Paralysis or weakness of gluteal muscles
Inhibition of gluteal muscles due to pain from hip joint
What is a positive Trendelenburg test?
Standing on one leg - supported by plinth - therapist stood behind
Pelvis drops downwards on unsupported side
Which muscles could be effected in Trendelenburg’s sign?
TFL, glut med and min (adduct the hip and turn it in)
What does Thomas’ test look for?
loss of extension of the hip (FFD)
What is a positive Thomas’ test?
Stand on the side of the affected hip. - Place one hand under the pt lumbar spine to assess its position.
Ask the pt to flex one hip fully towards their chest (note that your hand under the model’s lumbar spine should be compressed due to flattening of the lumbar curve).
Positive test - opposite hip and thigh rise from plinth
What is the modified Thomas Test?
Complete Thomas test - if FFD then try modified test
Passively extend hip to make contact with the plinth
If no contact with plinth then assess:
- Anterior rotation of pelvis and Lx extension
- Add knee extension
- Add abduction with flexed knee
- Add knee extension and hip abduction
Why would there be anterior rotation of the pelvis and Lx extension during Thomas Test?
Inability to stabilise lumbopelvic region
Why would adding knee extension cause contact with the plinth in Modified Thomas Test?
Shortened rectus femoris
Why would adding hip abduction cause contact with the plinth in Modified Thomas Test?
Tightness/Shortening of TFL or ITB
Why would adding knee extension and hip abduction still cause a positive Modified Thomas Test?
Shortened iliopsoas
Tightened Anterior JC
How to complete FABER test?
Flexion, abduction and external rotation (passively)
- place lateral malleolus above knee on opposite side
- stabilise pelvis on opposite side
- apply pressure into lateral rotation and abudction
What is a positive FABER test?
Pain provocation or reduced ROM
What does pain during FABER suggest?
Pain in groin = Hip joint pathology (OA)
If pain is on lateral hip with no movement restriction = gluteal tendinopathy
If pain is in the SI/buttock region = SI pathology
Why does FABER indicate gluteal tendinopathy?
Places anterior portions of Glut Min and Med under tensile loads
How to complete FADIR?
Flexion, adduction and internal rotation
- full hip flexion
- hip adduction
- Add internal rotation by turning foot out
What is a positive FADIR test?
Pain in the hip and restriction of movement
OR Pain over lateral hip
What is pain in the hip joint and decreased ROM indicating in FADIR?
Femoral-acetabular impingement
Pathology within the hip joint inself
What is the cause of pain over lateral hip during FADIR?
Gluteal tendinopathy - because tendons are compressed by overlying ITB
What is FADIR-R?
At the end of FADIR, as the patient to internally rotate hip against resistance (isometrically)
What is a positive FADIR-R and why?
Increased pain over lateral hip
Causing the already stretched and compressed gluteal tendons to contract
How to complete leg length testing?
Supine ly
Place end of the tape measure over the ASIS and press it backwards until it hooks under its inferior edge.
Measure to the inferior border of the medial malleolus
Complete 3 times and take mean score
What is true shortening in leg length testing?
Pathology proximal to the trochanter - e.g. loss of femoral head length, loss of articular cartilige
What is apparent shortening in leg length testing?
Visible appears shorter, however on measurement in supine ly there is no difference
Due to contactures around the pelvis causing tilting
