Hip lab MSK LQ

Femoral retroversion presentation

Decreased internal rotation, increased external rotation, and a toe-out standing posture.

Femoral anteversion presentation

Increased internal rotation, decreased external rotation, and a toe-in standing posture.

Craig's test purpose

Prone measurement of the angle of femoral anteversion or retroversion.

Craig's test normal range

8 to 15 degrees of internal rotation.

Craig's test interpretation

->15 degrees indicates anteversion;

-<8 degrees indicates retroversion.

Craig's test

patient prone with knee flexed to 90° palpate greater trochanter and slowly move hip through internal/external rotation.

when greater trochanter feels most lateral stop, and measure the angle of leg relative to a line perpendicular with table surface

Normal angle = 8°-15° hip internal rotation

< 8° = retroverted hip; > 15° = anteverted hip

Hip Intra-articular Hip Pathologies:

-Femoroacetabular Impingement Syndrome (FAIS)

-Microinstability

-Hip OA

FABER test components

Flexion, Abduction, and External Rotation.

FABER test pain localization

-Anterior hip/groin indicates hip joint

-PSIS indicates sacroiliac joint.

-Low back: Lumbar spine

- Lateral hip pain may indicate gluteal tendon or trochanteric bursa involvement

Scour test

Flex hip to 90º→hip adduction and apply pressure→move hip through arc of motion while maintaining axial load through the femur

(+) test = reproduction of clicking or popping, if it hurts, then distraction should make it better

Scour test positive signs

-Anterior groin pain indicates hip pathology

-crepitus indicates intra-articular disruption.

FADIR test purpose

Tests for Femoroacetabular Impingement Syndrome (FAIS) or labral tears.

FADIR

flexion, adduction, internal rotation

Posterior impingement test movement

Sweeps hip from FADIR position into abduction, external rotation, and extension.

+ Posterior impingement test

pain= + test for posterior labral tear of the hip

log roll test

-Patient supine with hip in neutral position

-Patient's leg passively rolled into full internal and external rotation

-Positive = increased external rotation indicating iliofemoral ligament laxity

-Positive = clicking, suggestive of labral tear

Log Roll test positive findings

-Groin pain indicates microinstability

-increased ER indicates anterior capsuloligamentous laxity.

HEER test purpose

Tests for anterior microinstability or anterior labral tears.

HEER test maneuver

The patient holds the contralateral extremity in flexion while the examiner rotates the test hip laterally+extension

HEER test findinga

Hyperextension External Rotation (HEER) Test

Suspicion of hip dysplasia or Instability

A sense of apprehension from the patient or reproduction of the patient's symptoms of anterior hip or groin pain

HEER test assesses

anterior microinstability of the hip joint or possible anterior labral tear

Adductor squeeze test

The patient lies on their back with hips bent to 45°, knees at 90°, and feet flat on the table. The examiner places a fist between the patient's knees.

The patient squeezes inward, contracting both adductor muscles.

Adductor squeeze test positive

Pain reproduction during bilateral adductor contraction against examiner's fist.

Gluteal de-rotation test

-Position the hip in 90/90 position +full passive ER

-Instruct the patient to resist your attempt to further externally rotate the hip by performing an isometric internal rotation

-Then assess AROM+PROM IR

Gluteal de-rotation test positive

-Pain at the lateral hip suggests Greater Trochanteric Pain Syndrome (GTPS).

-If passive rotation range into hip IR is >1.5× greater than active and pain occurs in the groin with passive medial rotation, this suggests hip OA.

Gluteal de-rotation test OA indicator

Passive IR range >1.5x active range with groin pain.

trendelenburg test

Have the patient stand on one leg for 6–30 seconds

Trendelenburg sign positive

Pelvis drops >2 cm on the lifted side, indicating gluteus medius weakness.

normal trendelenburg

 Pelvis rises slightly on the lifted side.

Trendeleburg progression

corkscrew” test

corkscrew” test

(rotating left and right while squatting).

poor hip stability signs during corkscrew test

Medial hip rotation

Knee valgus

Foot pronation

SLS Pain provocation test

The patient stands on one leg while the examiner provides light support.

SLS Pain provocation test normal

the ability to lift and hold the pelvis on the non-stance side for at least 30 seconds.

SLS Pain provocation test abnormal

Contralateral pelvis drops below horizontal or hip moves into early adduction.

Active piriformis test

1) Pt is side-lying w/hip flexed to 45 degrees and knee flexed 90 degrees

2) Examiner positions superior leg into hip abduction and external rotation. Examiner stabilization superior iliac crest.

3) Patient will resist the examiners force of hip adduction and internal rotation. (do bilaterally)

Active piriformis test +

Resisted active abduction and external rotation reproduces lateral ischial pain and neurological symptoms

Seated piriformis test

Knee extended, flexed hip passively adducted and internally rotated to reproduce pain.

Sidelying ischiofemoral impingement test

Passive hip extension, adduction, and external rotation reproduces pain.

Long stride test: Trailing leg pain

Indicates Ischiofemoral Impingement (IFI) compressing the quadratus femoris.

Long stride test: Heel strike pain

Indicates Proximal Hamstring Tendinopathy (PHT) from rapid eccentric loading.

Long stride test: Pain relieved when stride is shortened

Either condition, but IFI more likely

Long stride test: Pain worsens with faster walking or running

PHT more likely

True vs. Functional leg length discrepancy

True is structural/anatomic bone shortening; Functional is positional/compensatory.

functional leg length can result from

Unilateral foot pronation

Pelvic obliquity

Scoliosis or spinal asymmetry

Hip contractures, muscle imbalance, or spasm

True leg length measurement landmarks

From the distal ASIS to the medial malleolus.

To differentiate which part for a leg length discrepancy

-Iliac crest to GT: for Coxa vara or valga

-GT to knee: for femoral shaft length

-Knee to medial malleolus for tibial shaft length

Weber-Barstow maneuver

The patient is asked to lift the pelvis off the table and then return to the starting position to help equalize pelvic alignment. The examiner then passively extends both legs and compares the levels of the medial malleoli by observing the thumb positions.

Weber-Barstow maneuver reasoning

Visual assessment of leg-length asymmetry using medial malleoli levels after bridging.

Patellar Pubic percussion test positive

A dull or diminished sound on the affected side, indicating bone fracture.

Fulcrum test purpose

Detects femoral stress fractures using progressive downward knee pressure.

-Very sensitive

Prone knee bending test (Nachlas)

-Pain in the lumbar region, buttock, or posterior thigh suggests possible L2-L3 nerve root irritation.

-Pain in the anterior thigh indicates either tight quadriceps or femoral nerve stretching.

-If the rectus femoris is tight, bringing the heel fully to the buttock may cause anterior pelvic torsion, potentially leading to secondary sacroiliac or lumbar discomfort.

Sign of the buttock test positive

Hip flexion remains limited even after bending the knee during SLR.

Ober test positive

Leg remains abducted and fails to drop below horizontal, indicating ITB/TFL tightness.

Variations of obers

-Knee flexed: Ober's original version. Flexion increases femoral nerve tension and reduces ITB stretch.

-Knee extended: Provides greater ITB tension and better isolates ITB contracture.

-Neurological symptoms (pain, paresthesia) during testing may suggest femoral nerve irritation.

Thomas test positive

The opposite thigh rises off the table, indicating hip flexor contracture.

Lateral Rotator Tightness:

-Ask the patient to medially rotate the hip (the foot moves outward).

-Normal range: approximately 30-40° of medial rotation.

-Positive finding: Limited medial rotation (<30-40°) with a muscle stretch end feel, indicating tight lateral rotators (e.g., piriformis, obturator internus, gemelli).

Medial Rotator Tightness:

-Ask the patient to laterally rotate the hip (the foot moves inward).

-Normal range: approximately 40-60° of lateral rotation.

-Positive finding: Limited lateral rotation (<40-60°) with a muscle stretch end feel, suggesting tight medial rotators (e.g., tensor fasciae latae, gluteus minimus).

Adduction contracture test

-The examiner passively abducts the test leg while monitoring pelvic motion.

-Normally, the hip can abduct 30°-50° before the ASIS begins to move.

-If the ASIS shifts before this range, it indicates tightness or contracture in the adductor muscles.

-A positive test occurs when the affected leg forms an angle less than 90° with the line joining the ASISs, or when the pelvis tilts upward on the test side (or downward on the opposite side) during abduction, preventing proper pelvic "balancing."

Abduction contracture test

-The examiner passively adducts the test leg while monitoring for pelvic movement.

-Normally, the hip can adduct about 30° before the ASIS begins to move.

-If the ASIS moves before reaching 30°, and the end feel is that of a muscle stretch, the abductors are tight.

-If a contracture is present, the affected leg forms an angle greater than 90° with the line joining the ASISs.

-When attempting to rebalance the pelvis, the ASIS shifts downward on the affected side or upward on the opposite side, making pelvic alignment difficult.

Ely's test positive

Prone knee flexion causes spontaneous hip flexion, indicating tight rectus femoris.

90/90 hamstring test normal

Active knee extension within 20 degrees of full extension.

Rectus Femoris Contracture Test

also called Modified Thomas Test

patient is positioned at the end of table w/only the butt on the table

___Patient flexes 1 knee to their chest while supine & the other knee should remain at 90 of knee flexion

___If not at 90, examiner tries to passively bring the knee to 90 while palpating the muscle

___Bilaterally performed

___Positive findings: knee does not remain at 90 &/or hip flexes

___Indications: tight rectus femoris &/or iliopsoas

The Star Excursion Balance Test (SEBT)

The test involves standing on one leg in the center of a grid with eight lines extending outward at 45° angles (like a star).

While keeping the stance leg stable, the individual uses the non-stance leg to reach as far as possible along one line, lightly touches the line with the toes, and returns to the center without losing balance.

Y balance test

•Shortened version of star excursion test

•Three directions (forms a Y)

•Anterior

•Posteromedial

•Posterolateral

SEBT simplified version directions

Anterior, posteromedial, and posterolateral.

Step down test

A 20-cm (8-inch) stool or step is placed in front of the patient. The patient is instructed to place one foot on the stool and then stand up fully so they are balanced on that single leg.

The patient then slowly lowers the opposite leg toward the floor, maintaining control throughout the movement.

normal step down test

The movement is done with the arms relaxed at the sides,

The trunk remains upright, and

There is no hip adduction or internal rotation of the weight-bearing leg.

abnormal step down test

Arm abduction for balance,

Forward trunk lean,

Hip adduction or medial rotation, or

Pelvic drop or backward rotation,

Single leg squat tets

The subject stands barefoot with the test leg centered on the vertical line.

The opposite knee is flexed to 90°, keeping it off the ground.

The subject is instructed to squat down until the horizontal tape just disappears from view beyond their toes, then return to the starting position.

coppenhagen hip exercise

Side plank with Top LE on chair and contracting adductors to lift body up

Nordic hamstring exercise

An exercise that strengthens the hamstring muscle and can reduce the likelihood of hamstring tears.

Exercises with High Gluteus Medius to Tensor Fascial Latae Muscle Recrutiment

Resisted clamshell, resisted sidestep, SL bridge with opposite hip in extension

Hip extension MET

Manually resist (sub-max isometric) hip flexion,

hold 5 sec

hip abduction MWM

1. Apply an inferior-medial glide at the greater

trochanter

2. Actively or passively abduct the hip through the pain-

free range

Hip extension MWM

1. Apply an anterior glide at the proximal femur

2. Actively or passively extend the hip through the pain-

free range

Hip flexion MWM

1. Apply an inferior glide at the proximal femur

2. Actively or passively flex the hip through the pain-free

rangeH

Hip IR/ER MWM

1. Apply a lateral distraction glide at the proximal femur

2. Actively or passively externally or internally rotate the hip through the pain-free range

Low load isometrics

4 repetitions of 45-60 seconds submaximal

traditional isometrics

10 repetitions of 6-10 seconds