Hip Special Tests & Midterm Imaging

Craig Test

Normal males: 8-12 degrees

Normal females: 12-18

Put hand on greater trochanter and IR/ER femur

Tests for femoral anteversion → if lots of IR you have anteversion

Barlow's Test

Flex + Adduct Hip

Apply posterior force

(+) = dislocation / sublux

Ortolani's Test

Flex Hips/Knees + Abduct

(+) = relocation

FADDIR

just flex to 90

IR and adduct

Tests for: FAI, hip OA

FABER

Tests for: FAI, hip OA

Quadrant

NO axial load

flex/add/IR quad

flex/abd/ER quad

Tests for: FAI, Labral injury

Hip Scour Test

WITH an axial load

flex/add/IR quad

flex/abd/ER quad

Tests for: FAI, Labral injury, OA

Log Roll

Tests for: FAI, labral injury, generalized laxity

AB-HEER

positive= pain provocation of anterior pain or feeling of instability or apprehension

Tests for: microinstability

HEER

We are just looking for pain or apprehension here

Be at very edge of table, let them grasp the opposite knee

Push into more extension and ER

Tests for: microinstability

Prone Instability

Prone, flex to 90, ER the femur

Stretching anterior structures

Posterior to anterior glide of femoral head

Move butt cheek out of the way

**make sure your elbow is extended

Tests for: microinstability

Ely's Test

(+) potential tightness of the rectus femoris muscle (and length) by pelvis lifting off of the table. *** if you have lengthened or weakened abs, that can give you a false positive

Tests for: Internal Coxa Saltans

Thomas Test

positive= femur lifted 10 degrees off of the bed

Tests for: Internal Coxa Saltans, tight hip flexors/contracture

Modified Thomas Test

Iliopsoas - 1 joint muscle → if high is parallel or below the table this is good

Rectus femoris - 2 joint muscle → amount of knee flexion, if its a large angle its probably tight

TFL → IR means tightness

Sartorius → ER means tightness

Ober's Test

Abd and extend hip, if the leg does not fully adduct or drops back down to the table, it indicates tightness or restriction in the ITB and TFL. Bottom leg is bent, top leg is bent to 90, closest to pt will stabilize pelvis. *keep in ext the whole time

GOLD STANDARD

Tests for: External Coxa Saltans , IT Band Syndrome or TFL tightness/superior hip structures

Resisted Cross Body Sit-up Test

Tests for: athletic pubalgia

Straight leg Sit-up Test

Test for: athletic pubalgia

Trendeleburg Sign

Gluteus medius endurance weakness

C/L hip drop

SLR

Hamstring length

90/90

Hamstring Length

Noble's Compression Test

It involves applying pressure over the lateral epicondyle while the patient passively extends the knee from 90 degrees of flexion. A positive test is indicated by pain or snapping felt at 30 degrees of knee flexion, suggesting irritation or friction of the iliotibial band.

Tests for: IT band syndrome

Femoral N. Tension Test

The femoral nerve tension test is not specific for hip osteoarthritis (OA), but it can be used to differentiate hip pain from lumbar radiculopathy or nerve root involvement... a negative test supports hip OA

Tests for: Hip OA

SI Joint Test

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Tests for: Hip OA

Fulcrum Test

Tests for: Femur stress fx

Patellar Pubic Percussion Test

Not pain provocation, if there is a stress fracture it will decrease the conductance of vibration/sound through the bone. let the patient find their pubic bone. Middle finger on belly button and heel of hand on pubic bone

(+)= muffled sound on affected side

Tests for: femur stress fx

Piriformis Test (FAIR Test)

-Patient sidelying with top hip flexed to 60 degrees with knee flexed

-PT stabilizes hip with one hand and applies downward pressure to knee

-Positive = pain during pressure

Sign of the Buttock

take them info SLR first, if you bend the knee if its hamstring tightness you should be able to flex hip farther. Positive would be no change in hip flexion from SLR to knee bent position

(+)= NOT a good sign! a space occupying a lesion in the gluteal region like neoplastic tumor/ tumor. Positive if they CANNOT get more motion in SLR as knee at 90 and hip flexion

*non-musculoskeletal = you can't reproduce the symptoms that brought them in --> you need to refer OUT!

Modified Ober's Test

Top leg is now extended. If they have IT band syndrome at distal lateral knee you extend the leg to decrease the pain

The limb should be able to drop into parallel.

hip dysplasia on the Left photo

the L hip is worse than the R hip

very acute center edge angle

periacetabular osteotomy

used for hip dysplasia. break femur and pelvis, rotate them to provide greater joint angle

SCFE

percutaneous pinning for SCFE

crossover sign

(+) means acetabular retroversion and a PINCER

posterior acetabular rim is medial to the center of the femoral head

alpha angle

used to diagnose FAI CAM (large femoral head)

Pincer

CAM

mixed impingement

CAM + Pincer

alpha angle > 55

angle of wiberg > 35

MR arthrogram of labral tear

FAI arthroscopy

A pre op

B post op

Hip OA

L: bipolar hemiprosthesis

R: unipolar hemiprosthesis

trochanteric osteotomy

used for THA revisions

femoral stress fracture

femoral stress fracture

gardens I fx

gardens II fx

gardens III fx

gardens IV fx

intercapsular fx

intertrochanteric fx

intertrochanteric fx

Comminuted intertrochanteric fracture. There is a fracture from the greater to the lesser trochanter (blue arrow). There are separate fragments of the greater trochanter (white arrow) and lesser trochanter (red arrow). There is varus deformity (white line) of the femoral shaft.

subtrochanteric fx

subtrochanteric fx