Hip Special Tests Magee Orthopedic Assessment PDF

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Hip Special Tests Magee Orthopedic Assessment...

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TESTS Patrick’s Test (Faber or FigureFour Test) 

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Sometimes referred to as as “Jansen’s test”

FlexionAdduction Test 

Used in older children and young adults  Quadrant or Scouring Test Trendelenburg’s Sign !

Structure/Condition Being Tested If (+), the following may be affected: a. b.

Hip joint Iliopsoas spasm c. Sacroiliac joint

Patient Position Supine; Faber is the beginning position of the hip.

Stabilization

Maneuver

None mentioned

PT places pt’s test leg so so that that the the foot foot is is on o (According to top of the knee o picture, PT holds opposite leg. PT then the knee of test slowly lowers the knee leg and the of test leg down toward opposite ASIS.) table.

The test compresses the femoral neck against acetabulum; pinches adductor longus, pectineus, ilipsoas, Sartorius or tensor fascia lata.

Supine

None mentioned

PT flexes pt’s hip to 90 with knee flexed. PT then adducts the flexed leg.

-Stability of the hip and ability of hip adductors to stabilize pelvis on femur -Weak gluteus medius Intra-articular pathology which may include: a. Labral tear b. Synovitis c. Arthritis d. Occult femoral neck fractures e. Iliopsoas tendinitis/bur sitis f. Prosthetic failure or loosening Tests: a Anterior

Standing

None

The pt is asked to stand on one lowe limb.

Supine

None mentioned

Pt actively elevates the straight leg to 20-30 while PT applies gentle resistance.

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Stinchfield Resisted Hip flexion Test

Anterior Labral Tear Test

Supine

PT takes hip into fu flexion lateral rotation

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TESTS TESTS

TESTS 1. Bryant’s Triangle

Structure/Condition Being Tested

Structure/Condition Being Tested To determine the upward displacement of the trochanter in fracture of the neck of the femur

Patient Position

Patient Position Supine

Stabilization

Maneuver

Stabilization

Maneuver PT drops an imaginary perpendicular line from ASIS to table.

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2. Rotational Deformities

Rotation of femur or tibia

Supine with lower limbs straight

Examiner looks at the patellae

Fick Angle – normal feet angle 5 5°° - 10° 10° out for better balance

PEDIATRIC PEDIATRIC TESTS TESTS FOR FOR HIP HIP PATHOLOGY PATHOLOGY TESTS 1. Ortolani’s Sign

Structure/Condition Being Tested - To determine whether an infant has a CDH

Patient Position Supine

*Valid only for first few weeks after birth and only for dislocated and lax hips, not dislocations

Stabilization

Maneuver

-PT’s thumbs against the insides of the knees and thighs; fingers are placed along the outsides of the thighs to buttocks

- Examiner flexes the hip and grasps the legs. -With gentle traction, thighs are abducted and pressure is applied against the greater trochanters *Should not be repeated too often because it could lead to damage of articular cartilage of femoral head

2. Barlow’s Test

- Modification of Ortolani’s Test - To determine DDH (developmental dysplasia of the hip)

For infants p to 6

Supine with legs facing the examiner; hips flexed to 90° 90°; knees are fully flexed

One hand: evaluate hip Other hand: steadies the opposite femur and pelvis PT’s hand placed

Each evaluated individually

hip

is

Part 1. Hip is taken into abduction while PT’s middle finger applies forward press re behind

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the head of femur 3. Galeazzi Sign (Allis or Galleazi Test) Test)

- good for assessing unilateral CDH or DDH

Supine with knees flexed and hips flexed to 90 90°° 

- used in children from 3-18 months

4. Telescoping Sign (Piston or Dupuytren’s Test)

- evident in children with dislocated hip

Supine

PT flexes knee and hip to 90 90°; °; femur is pushed down onto the table; femur and leg are then lifted up and away from the table

5. Abduction Test (Hart’s Sign)

Congenital dislocation of hip or developmental dysplasia (Evident when one leg does not abduct as far as the other when changing the child’s diaper)

Supine

•

 Patients hip and knees flexed to 90 deg •  Examiner passively abducts both legs

TEST FOR LEG LENGTH TESTS WeberBarstow maneuver

Structure/Condition being tested Leg length discrepancy

Patient Position Position Supine

Stabilization Stabilization

Maneuver  Patient hips and knees flexed •  examiner stands at pt’s feet and palpates distal aspect of medial malleoli with his/her thumbs •  pt. then lifts pelvis from examining table and returns to

•

Diffe that

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TEST TEST FOR FOR MUSCLE MUSCLE TIGHTNESS TIGHTNESS OR OR PATHOLOGY PATHOLOGY Structure/Condition Patient TESTS TESTS being tested tested Position Position Sign of the Ischial Bursitis, Supine Buttock Neoplasm, abscess in the buttock, hip pathology

Thomas Test

Hip flexion contracture (Most common contracture of hip)

Supine

Rectus Femoris Contracture Test (Kendall Test Method 1)

Name is indicative of condition being tested

Supine

Stabilization Stabilization

Examiner checks for excessive lordosis, usually present with tight hip flexors

Maneuver •

 pt. performs a straight leg raising test. •  If there is limitation of SLR, examiner flexes pt’s knee to see whether further hip flexion can be obtained

 If in bu sc ha • T lim

 Examiner flexes one of the patient’s hips, bringing knee to chest to flatten out lumbar spine and stabilize pelvis •  Pt. holds the flexed hip against the chest

 If hi on on o fla •  If = pt’s table = mu felt •  If do m lo a • W an in m si in on • If an is co • If tig ca st w

•

 In starting position, pt knees are bent over the edge of examining table • Pt then flexes one knee to chest and holds it • Angle of knee that is still hanging at the edge of the table should be at 90deg when opposite knee is flexed to chest • Examiner may attempt to passively flex the dangling knee to •

•

•

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Ely’s Test (Tight Rectus Femoris, Method 2)

Ober’s Test

Tensor Fascia Latae AKA ITB

Prone

Examiner passively flexes pt’s knee

On fl done ipsila there Rect

Side-lying

 Pt’s lower leg is flexed at hip and knee for stability • Examiner passively abducts and extends pt’s upper leg with knee

•

•

straight or flexed at 90deg.

 E le ab po co *Whe exten

ITB trochp • If ar sh pa ne • T gr ex co bu

Structure/Condition Being Tested ITB Friction Syndrome

Patient Position Supine

Adduction Contracture Test

Adductor Muscles Contracture

Supine

PT attempts to balance balanc the lower limb with the pelvis by shifting the pelvis up on the affected side or down on the unaffected side

Abduction Contracture Test

Abductor Muscles Contracture

Supine

PT attempts to balance balanc the lower limb with the pelvis by shifting the

TESTS Noble Compression Test

Stabilization One Hand: Thumb applying pressure 1-2cm proximal to the lateral femoral epicondyle

Maneuver Patient slowly extends knee up to 30° flexion while PT maintains pressure

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Piriformis Test

Piriformis Syndrome

90-90 SLR

Hamstrings Contracture

90-90 SLR

Gluteus

(Gluteus Maximus Length)

Tightness

90-90 SLR ( Gluts Max Strength)

Sidelying

Supine

Maximus

Gluteus Maximus Weakness

Supine

One hand: On the hip Other hand: Apply downward pressure to the knee Patient grasps behind the knees with both hands to stabilize hips at 90°flexion. One hand: ASIS on the same side

Prone

Other hand: Knee of same side One hand: Hip Other hand: Posterior thight, applying anterior force

TESTS 1. Hamstrings Contracture Test (Method 2)

2. Tripod Sign (Hamstrings Contracture, Method 3)

Patient Structure/Condition Position Being Tested Muscle tightness or Sitting pathology

Muscle tightness or pathology

3. Bent-Knee Stretch Test for Proximal Hamstrings

Muscle tightness or pathology

4. “Taking Off the Shoe” (TOST)

Muscle tightness or pathology

Sitting (Pt’s both knees are flexed to o 90  over the edge of the examining table) Supine

Standing (affected hip

Pt flexes test hip to 60°, knee flexed. The PT applies downward pressure to the knee

(1)Both hips are flexed to 90 with knees bent (2) Pt actively extends knee PT flexes the hip with knee flexed

From straight hip and 90° knee flexion, the patient is asked to extend the hip keeping the knee flexed. An anterior force is applied by the PT to the posterior thigh

Stabilization

Maneuver

Pt’s one knee flexed against chest to stabilize pelvis and the other knee extended

Pt attempts to flex the trunk and touch the toes of the extended lower limb with the fingers PT passively extends one knee

PT flexes the hip and knee of the test leg maximally. The PT then slowly extends the knee Pt is asked to remove the shoe on the

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Tests

Structure or Condition Being Tested

Lateral Step Down Maneuver (Pelvis Drop Test)

Hip rotators (lateral)

Fulcrum Test of the Hip

Femoral shaft

Patient Position Standing

N/A

One foot on an 8 inch stool, arms on the side and erect trunk, no hip adduction or IR Sitting dangling

Structure/Condition

Stabilization

N/A

Patient

Maneuver Pt in initial position is asked to slowly lower non weight bearing leg to the floor

Arms inclin bear pelvi pelv rotat

PT’s arm under the pt’s thigh moves from distal to proximal as a gentle pressure is applied on the dorsal knee

Shar appr fulcr fract

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Navicular Drop Test -a progression of the Neutral Position of Talus (Standing)

Tests for Neutral Position of the Talus

Neutral Position of the Talus (Supine)

Tests for Neutral Position of the Talus

Neutral Position of the Talus (Prone)

–

Palpate the Talus on Dorsum

Measure Height of navicular from floor in relaxed standing, and also in the neutral talus position

One hand: th Grasp foot on 4  th and 5  Metatarsals (using thumb and index)

Passively dorsiflex foot until resistance is felt. Then while maintaining dorsiflexion, perform supination, then

Other hand: Palpate both sides of head of talus on dorsum (using thumb and index) One hand: th th Grasp 4  and 5  metatarsal heads (using index and thumb) Other hand: Palpate both sides of head of talus on dorsum (using thumb and index)

pronation. Position where the Talar head doesn’t bulge=neutral position

Neutral Talus Position

Tests for Neutral Position of the Talus

Structure/ Condition Test Being Tested Leg Heel Tests for Alignment Alignment (valgus or varus of the foot)

Forefoot Heel Alignment

Standing

Tests for Alignment (valgus or varus of the foot)

Coleman Tests for Block Test Alignment - Differentiates (valgus or varus

Supine; feet over the end of table

Prone; foot extend over table

Patient Position Prone with foot extending over the end of table

Stabilization

Passively dorsiflex foot until resistance is felt. Then while maintaining dorsiflexion, move foot back and forth through an arc of supination and pronation. Where the foot appears to “fall off”, that is the neutral position.

Maneuver

PT makes a PT places subtalar joint in calcaneal line prone neutral position. (between midline of PT looks at 2 lines. calcaneus and 1 cm distal to first mark), and tibial line (between two marks on lower third of leg in midline). PT places subtalar joint in prone neutral position. Supine with PT positions subtalar PT pronates midtarsal feet joint in supine neutral joints maximally, extending position observes relation over the between vertical axis of nd th heel and plane of 2  - 4  end of table metatarsal heads Standing If pt is found to have hindfoot varus in standing, PT places a lift

H is H is (N

F m ra F la ra T (N

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Test

Structure/Condition Being Tested

°-18° -18°); Tibial Torsion Too Many Toes Sign

Test

Excessive Toe-out position (tibial torsion is >18° >18°); Tibial Torsion

Structure/ Condition Being Tested

Patient Position

Stabilization

Prone with knee flexed to 90° 90°

No stabilization required

Standing

No stabilization required

Patient Position

Maneuver

PT views from above the angle formed by foot and thigh noting the angle the foot makes with the tibia PT stands behind pt and examines the foot from a posterior view

Stabilization

Maneuver Draws the talu forward in th ankle mortise °

Prone Anterior Anterior talofibular Drawer Test ligament Instability

Talar Tilt

Prone with feet extending over the end of table

Test for torn Supine or sidelying Calcaneofibular with foot relaxed ligament

plantar flexion One hand: Grasps the ankle

One hand: PT holds affected foot in anatomical (90° (90 °) position

PT uses othe hand to push he steadily forward

PT uses othe hand to tilt talus affected foot, sid to side in adduction an abduction

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External Rotation Stress Test (Kleiger Test)

Syndesmosis Injury

Sitting with legs Stabilizes leg with hanging over one hand. The table other hand holds the foot in neutral (platigrade 90°) position

Point Palpation Test

Syndesmosis injury

Sitting or Supine

Cotton Test

Syndesmosis instability with diastasis (separation of the tibia and fibula)

Sitting

Dorsiflexion Maneuver

Crossed Test

Dorsiflexion

Sits on edge of table

Leg

Syndesmosis Injury

Sitting with affected leg crossed over the opposite knee

Syndesmosis Injury

Bilateral

weight

Compression o the malleoli rat than shaft of t and fibula Passive late rotation stress the foot and ank

Examiner app gradual press over anteroinferior tibiofibular ligam (anterior aspect the distal t fibular syndesmosis) using the ind in finger Stabilize distal Apply medial tibia with one lateral transla hand force with the ot hand ( inversion/eversio Stabilize patient Passively a leg with one hand forcefully dorsi the foot by hold onto the heel us the forearm dorsiflex the foot Examiner grasps the lower leg at midcalf

Gentle force to medial aspect the knee of injured leg

Patient is asked

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Heel Test

Thump

Syndesmosis injury

Sitting or Supine

normal stand position. PT app a compress force using hands surround the malleoli injured leg. Pt. Pt asked to dorsif dorsi when compress is maintained One hand to Other hand, stabilize the leg applies a f thump on the h with the fist so t the force is app to the center of heel and in with the long a on the tiba

Test Functional Leg Length

Structure/ Condition Being Tested Other Tests/ Tests for Muscle or Tendon Affectation

Patient Position Patient stands on a normal relaxed stance

Stabilization

Maneuver PT palpates t ASIS ASIS and and PSIS PSIS .. PT then positions t patient’s in subta joint neut position while weig bearing PT. maintains t position with the to straight ahead a knees straight PT repalpates t ASIS and PSIS problems

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Firgure-8 Ankle Measurement for Swelling

Test Peroneal Tendon Dislocation

Other Tests/ Tests for Muscle or Tendon Affectation

Long sitting with ankle and lower leg beyond the edge of the table; ankle in PLANTIGRADE o (90 )

for

Other Tests/ Tests for Muscle or Tendon Affectation

Prone with o flexed to 90 

knee

Swing Test for Posterior Tibiotalar Sublaxation

Other Tests/ Tests for Muscle or Tendon Affectation

Prone with o flexed to 90 

knee

N/A

base of theacro fif metatarsal, the tibialis anter tendon and th around the ank joint just distal to t tip of the med malleolus across t Achilles tendon a just distal to t lateral malleol malleo returning to t starting point. N/A Posterolateral regi of ankle is inspect for swelling. Pt ask to dorsiflex a plantarflex wo eversion again PT’s resistance. One hand: Push dorsally on t Calcaneus held in navicular a eversion and metatarsal heads ankle in dorsiflexion Other hand: Thumb contacts the plantar surface of the nd base of the 2 , 3rd, 4th metatarsals with index finger and middle finger contact planter surface of navicular.

St

t

/C

diti

PT places end tape measu midway between t tibialis anter tendon and t lateral malleolu draws tape media across instep ju distal to the navicu tuberosity, tape then pulled acro the arch of the fo just proximal to t

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Later: observe th all points a aligned

Hoffa’s Test

Calcaneal fracture

Prone, feet extended over edge of table

Prevent knee flexion

Palpate Achil tendon while plantar a dorsiflexes

Tinel’s Sign at the Ankle (Percussion Sign)

Nerve affectation

Duchenne Test

Nerve affectation

Supine *may be elicited in two places a.) Anterior Tibial Branch of Deep Peroneal Nerve b.) Posterior Tibial Nerve Supine, legs straight

Stabilize leg

a.) tap at front ankle b.) tap at poster part of med malleolus

Prevent knee flexion

Push up on he of first metatar through the so (towards dorsiflexion)

Morton’s Test

Fracture or affectation

Homan’s Sign

Deep thrombosis

nerve

venous

Supine

Supine, extended

Stabilize distal leg

knee

N/A

Grasp foot ab metatarsal head squeeze hea together Passive dorsiflexion...