Hip and Lumbar Special Tests

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Thomas Test

Pt: Supine + knees bent at end of table

Clinician: standing at side (non-testing limb)

hand1: under lordotic curve
hand2: behind opposite knee
then passive hip flx

(+) test: observe the opposite side

knee Ext = rectus femoris tightness
thigh lift off = hip flexor tightness

<p>Pt: Supine + knees bent at end of table</p><p>Clinician: standing at side (non-testing limb)</p><ul><li><p>hand1: under lordotic curve</p></li><li><p>hand2: behind opposite knee</p></li><li><p>then passive hip flx</p></li></ul><p>(+) test: observe the opposite side</p><ul><li><p>knee Ext = rectus femoris tightness</p></li><li><p>thigh lift off = hip flexor tightness</p></li></ul><p></p>

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Ely’s Test

Pt: prone

Clinician: standing at side (testing limb)

hand1: anterior distal tibia
then passive knee flx

(+) test: ipsilateral hip flx

Implication: rectus femoris tightness

<p>Pt: prone</p><p>Clinician: standing at side (testing limb)</p><ul><li><p>hand1: anterior distal tibia</p></li><li><p>then passive knee flx</p></li></ul><p>(+) test: ipsilateral hip flx</p><p>Implication: rectus femoris tightness</p><p></p>

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90-90 straight leg raise test

Pt: supine w/ knee & hips flexed at 90

grasps behind the knees to stabilize hip

Clinician: standing at side

Then active knee extension

(+) test: p! w/ knee extension <20 degrees

Implication: hamstring pathology

<p>Pt: supine w/ knee & hips flexed at 90 </p><ul><li><p>grasps behind the knees to stabilize hip</p></li></ul><p>Clinician: standing at side</p><ul><li><p>Then active knee extension</p></li></ul><p>(+) test: p! w/ knee extension <20 degrees</p><p>Implication: hamstring pathology</p><p></p>

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Piriformis Test

Pt: side-lying on non-testing + hip 90 & knee 90 flex

Clinician: standing in front

hand1: stabilizing hip
hand2: lateral aspect of knee
then downward pressure on knee

(+) test: p! in lower butt & hamstring &/or sciatica

Implication: piriformis syndrome

<p>Pt: side-lying on non-testing + hip 90 & knee 90 flex</p><p>Clinician: standing in front</p><ul><li><p>hand1: stabilizing hip</p></li><li><p>hand2: lateral aspect of knee</p></li><li><p>then downward pressure on knee</p></li></ul><p>(+) test: p! in lower butt & hamstring &/or sciatica</p><p>Implication: piriformis syndrome</p><p></p>

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Trendelenburg’s Test

Pt: standing

Clinician: standing behind

Then, single-leg stance (opposite side)

(+) test: hip drops of the non-weight bearing

Implication: gluteus medius weakness

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Patrick’s (FABER) Test

“Flx Abd ER”

Pt: supine + figure 4 of the testing foot

Clinician: standing beside

hand1: on opposite ASIS
hand2: on medial aspect of flexed knee
then downward overpressure on knee

(+) test: P! in SI joint or hip

Implication: labral tear or SI joint sprain

<p>“Flx Abd ER”</p><p>Pt: supine + figure 4 of the testing foot</p><p>Clinician: standing beside</p><ul><li><p>hand1: on opposite ASIS</p></li><li><p>hand2: on medial aspect of flexed knee</p></li><li><p>then downward overpressure on knee</p></li></ul><p>(+) test: P! in SI joint or hip</p><p>Implication: labral tear or SI joint sprain</p><p></p>

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Hip Scouring Test

Pt: supine

Clinician: standing beside + passive hip & knee full flx

hand1: on knee
hand2: on anterior aspect of distal tibia
then downward + hip IR & ER in multiple ankles of flx

(+) test: P! in reproduced symptoms

Implication: labral tear or osteochondral defects, OA

<p>Pt: supine</p><p>Clinician: standing beside + passive hip & knee full flx</p><ul><li><p>hand1: on knee</p></li><li><p>hand2: on anterior aspect of distal tibia</p></li><li><p>then downward + hip IR & ER in multiple ankles of flx</p></li></ul><p>(+) test: P! in reproduced symptoms</p><p>Implication: labral tear or osteochondral defects, OA</p><p></p>

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Babinski Test

Procedure: scrape a firm pointed object along lateral inferior border of the foot

(+) test: great toe extension and splaying other toes

Indication: upper motor neuron pathology

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Straight Leg Raise Test

Pt: Supine

Clinician: standing at side

hand1: resting on distal thigh
hand2: support posterior ankle
then passive hip flx to point of tightness or pain
slowly return to point of comfort (hip ext)
lastly, forced ankle DF/neck flx

(+) test: reproduction of Sx before 70 degrees on either side

Implication:

same side: sciatic nerve irritation/ disc herniation
opposite side: disc herniation

<p>Pt: Supine</p><p>Clinician: standing at side</p><ul><li><p>hand1: resting on distal thigh</p></li><li><p>hand2: support posterior ankle</p></li><li><p>then passive hip flx to point of tightness or pain</p></li><li><p>slowly return to point of comfort (hip ext)</p></li><li><p>lastly, forced ankle DF/neck flx</p></li></ul><p>(+) test: reproduction of Sx before 70 degrees on either side</p><p>Implication: </p><ul><li><p>same side: sciatic nerve irritation/ disc herniation</p></li><li><p>opposite side: disc herniation</p></li></ul><p></p>

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Quadrant Test

Pt: standing w/ feet shoulder width apart

Clinician: standing behind & grasping shoulders

Then, active spinal Ext + Lat Flx + Rot to affected side

examiner overpressure through shoulder

(+) test: reproduced symptoms

Implication:

radiating p! = NRI
local p! = facet jt pathology
p! at PSIS = SI dysfunction

<p>Pt: standing w/ feet shoulder width apart</p><p>Clinician: standing behind & grasping shoulders</p><p>Then, active spinal Ext + Lat Flx + Rot to affected side</p><ul><li><p>examiner overpressure through shoulder</p></li></ul><p>(+) test: reproduced symptoms</p><p>Implication:</p><ul><li><p>radiating p! = NRI</p></li><li><p>local p! = facet jt pathology</p></li><li><p>p! at PSIS = SI dysfunction</p></li></ul><p></p>

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Slump Test

Pt: seated w/ lower leg off the table

Clinician: standing lateral

Then, slump + overpressure w/ neck flx + overpressure w/ knee ext + ankle DF

(+) test: reproduced symptoms at any point in test

Implication: disc herniation, NRI

<p>Pt: seated w/ lower leg off the table</p><p>Clinician: standing lateral</p><p>Then, slump + overpressure w/ neck flx + overpressure w/ knee ext + ankle DF</p><p>(+) test: reproduced symptoms at any point in test</p><p>Implication: disc herniation, NRI</p>

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Bowstring Test

Pt: Supine

Clinician: standing lateral

hand1: supporting heel
hand2: anterior distal thigh

Then, SLR to point of tightness or pain

passive knee flx to point of comfort
lastly, pressure popliteal fossa

(+) test: reproduced symptoms at any point in test

Implication: sciatic nerve irritation

<p>Pt: Supine</p><p>Clinician: standing lateral </p><ul><li><p>hand1: supporting heel</p></li><li><p>hand2: anterior distal thigh</p></li></ul><p>Then, SLR to point of tightness or pain</p><ul><li><p>passive knee flx to point of comfort</p></li><li><p>lastly, pressure popliteal fossa</p></li></ul><p>(+) test: reproduced symptoms at any point in test</p><p>Implication: sciatic nerve irritation</p><p></p>