28. Special Tests
Patrick's Test (Faber or Figure-
Four Test)
ท่าเตรียม : supine และ flexion, abduction,
and external rotation ของ hip (คล้ายเลข4)
วิธีตรวจ : foot of the test leg is on top of
the knee of the opposite leg
: examiner then slowly lowers the knee
of the test leg toward the
examining table
29. Special Tests
Patrick's Test (Faber or Figure-Four Test)
(Cont.)
• Negative : leg's knee falling to the table or at least being
parallel with the opposite leg.
• Positive : leg's knee remaining above the opposite
straight leg.
– hip joint ,ilio-psoas spasm, or the sacroiliac joint
30. Special Tests
Trendelenburg's Sign
ประเมิน : Assess stability of the hip and ability of the hip
abductors to stabilize the pelvis on the femur
วิธีตรวจ : stand on one lower limb
• Negative :
• Positive : pelvis on the opposite side (nonstance side) drops
when the patient stands on the affected leg
– weak gluteus medius
– an unstable hip on the affected or stance side
31. Special Tests
Anterior Labral Tear Test
ท่าเตรียม : supine position ,Take hip full flexion, lateral
rotation, abduction
วิธีตรวจ : extends hip, medial rotation, adduction
• Positive : pain, reproduction patient’s symptom
32. Special Tests
Posterior Labral Tear Test
ท่าเตรียม : Supine position, Take hip full flexion, adduction,
medial rotation
วิธีตรวจ : extends hip, abduction and lateral rotation
• Positive : pain, reproduction patient’s symptom
33. Special Tests
Craig's Test
ประเมิน : femoral anteversion or forward torsion of the
femoral neck
: degree of the femoral neck with the with the femoral
condyle(normal 8o – 15o)
ท่าเตรียม : patient lies prone with the knee flexed to 90°
วิธีตรวจ : palpates the posterior aspect of the greater
trochanter of the femur passively rotated medially and
laterally
common clinical finding of excessive anteversion is excessive
medial hip rotation (more than 60°) and decreased lateral
rotation
retroversion = plane of the femoral neck rotates backward
in relation to the coronal condylar plane or the acetabulum
itself may be retroverted
34. Special Tests
Torque Test
ประเมิน : Supine position
ท่าเตรียม : supine close to the edge of the
examining table with the femur of the test
leg extended over the edge of the table
วิธีตรวจ : one hand to medially rotate the femur to
the end of range and the other hand to apply a
slow posterolateral pressure along the line of the
neck of the femur for 20 seconds to stress the
capsular ligaments and test the stability of the hip
joint
35. Special Tests
Stinchfield Test
วิธีตรวจ : supine and flex hip with knee straight to
30° of hip flexion against resistance
• Positive : Hip or groin pain hip pathology
: Posterior hip pain or back pain lumbar or
sacroiliac pathology
36. Special Tests
Nelaton's Line
• Imaginary line drawn from the ischial tuberosity of
the pelvis to theASIS of the pelvis on the same side
• Positive : greater trochanter of the femur is
palpated well above the line
– dislocated hip
– coxa vara
37. Special Tests
Bryant's Triangle
• imaginary perpendicular Iine : ASIS of t pelvis
examining table (A)
• Second imaginary line : ASIS of t pelvis tip of
greater trochanter (B)
• Third imaginary line : B A
• Positive :
– two sides are compared = Difference
• coxa vara
• Congeni dislocation of the hip
A
B
C
38. Special Tests
Rotational Deformities
ท่าเตรียม : supine with the lower limbs straight
วิธีตรวจ : examiner looks at the patellae
• Patellae face in ; medial rotation of femur or
tibia.
• Patellae face up, out, away ; lateral rotation of
femur or tibia
39. Pediatric Tests
Ortolani's Sign
ประเมิน : congenital dislocation of the hip
Negative : highly suggestive that the problem (i.e.,
congenital dislocation of the hip)
Positive : does not necessarily rule out the problem
40. Pediatric Tests
Barlow’s
ประเมิน : developmental dysplasia of hip
: used for infants up to 6 month
• Positive : hip dislocation
41. Pediatric Tests
Galeazzi Sign (Allis or Galeazzi Test)
ประเมิน : unilateral congenital dislocation of the
hip
unilateral development dysplasia of the hip
3 to 18 months of age
วิธีตรวจ : supine ,knees flexed ,hips flexed to 90°.
:
• Positive : one knee is higher than the other
42. Pediatric Tests
Telescoping Sign (Piston or Dupuytren's Test).
ประเมิน : child with a dislocated hip
ท่าเตรียม: supine position
วิธีตรวจ : flexes the knee and hip to 90° , The
femur is push down and lift up
• Negative : normal hip, little movement occcurs
with this action
• Positive : excessive movement is called
telescoping, or pistoning
43. Pediatric Tests
Abduction Test (Harts' Sign)
ประเมิน : congenital dislocation, developmental dysplasia
ท่าเตรียม : supine with the hips and knees flexed to 90°
วิธีตรวจ : passively abducts both legs, noting any
asymmetry or limitation of movement
• If one hip is dislocated, that shows asymmetry of fat folds in
the gluteal and upper leg area
44. The Weber-Barstow maneuver
for leg length asymmetry
• Patient lifts hips off bed then comparing
height of medial malleolus with the legs
extended (Leg length discrepancy)
46. Sign of the Buttock
• Passively straight leg raised. If there is
limitation, the examiner flexes the patient's
knee to see whether further hip flexion can
be obtained.
• If hip flexion does not increase, the lesion
is in the buttock or the hip, not the sciatic
nerve or hamstring muscles.
47. Thomas Test
(A) Negative
test
(B) Positive test
• Test : assess a hip flexion contracture of
the hip
• positive test. : the patient's straight leg
rises off the table and a muscle stretch
end feel will be felt .
48. Rectus Femoris Contracture Test
(Kendall Test)
• The movement leg is brought to the chest
• Negative test : (A). The test leg remains
bent over the end of the
examining table
• Positive test : (B) The test leg have knee
extends
49. Ely's Test
(Tight Rectus Femoris)
• The patient lies prone, passively flexes
the patient's knee.
• Positive test : On flexion of the knee, the
patient's hip on the same side
spontaneously flexes, indicating that the
rectus femoris muscle is tight on that
50. Ober's Test
• Test : assess the tensor fasciae latae
(iliotibial band) for contracture
• Lying position with the lower leg flexed at
the hip and knee for stability. Passively
abducts and extends upper leg with knee
straight or flexed to 90°.
• positive test : if a contracture is present, the
51. Noble Compression Test
• Determind : iliotibial band friction
syndrome
• Positive test : severe pain over the lateral
femoral condyle
52. Piriformis Test
The patient is in the side lying
position
flexes the test hip to 60° with the
knee flexed. The examiner
stabilizes the hip with one hand
and applies a downward pressure
to the knee
• Test : piriformis syndrome
• Positive : If the piriformis muscle is tight,
pain is elicited in the muscle. If the
piriformis muscle is pinching the sciatic
nerve, pain results in the buttock
54. 1) 90-90 Straight Leg Raising Test
• Normal flexibility in the hamstrings : knee
extensior should be within 20° of full
extension
• Positive : if the hamstrings are tight, the
end feel will be muscle stretch
55. 1) 90-90 Straight Leg Raising Test
• modify to test the length of gluteus
Flex hip
flex knee
maximus.
• If the thigh flexes 110° to 120° before the
ASIS moves up, gluteus maximus length
is normal.
• If the ASIS moves up before the thigh
56. 2) Hamstrings Contracture Test
Pt sit with one knee flexed
against the chest to
stabilize the pelvis and the
other knee extended.
then flex the trunk and
touch the toes of the
extended lower limb with
the fingers. Repeated on
the other side.
• Normally, the patient should be able to at
least touch the toes while keeping the
knee extended.
• If he is unable to do so, it is an indication
of tight hamstrings on the straight leg.
57. 3) Tripod Sign
patient is seated with both knees
flexed to 90° over the table
The examiner then passively
extends one knee.
If the hamstring muscles on that
side are tight, the patient
extends the trunk to relieve the
tension in the hamstring
The leg is returned to its starting
position, and the other leg is tested
and compared with the first side.
• Passively extends one knee. If the
hamstring muscles on that side are tight,
the patient extends the trunk to relieve the
tension in the hamstring.
58. Phelps' Test
• The examiner passively abducts both of
the patient's legs as far as possible. The
knees are then flexed to 90° and the
examiner tries to abduct the hips further.
• If abduction increase the test is
considered positive for contracture of the
59. Tightness of Hip Rotators
Pt lie supine with the hip
and knee flexed to 90
•Tightness of the lateral rotators :
medial rotate hip by rotating the leg
outward.
•If the lateral rotators are tight :
medial rotation will be less than 30° to
40° and the end feel will be muscle
stretch rather than tissue (capsular) stretch.
60. Lateral Step Down Manoeuver
(Pelvis Drop Test)
• Stand up straight
on the step one
foot. slowly lowers
the nonweight -
bearing leg to the
floor.
(A) Negative test -
normal
(B) Positive test -
pelvis drop
61. Fulcrum Test of the Hip
• Assess for possible
stress fracture of
the femoral shaft
• Places arm under
femur and carefully
applies a downward
force at the knee.
• The fulcrum arm is
move from distal to
proximal along the
thigh as gentle
pressure. If a stress
64. Referred pain around the
hip.
•Right side
demonstrates
referral to the hip.
•Left side shows
referral from hip
True hip pain is usually referred to the groin,
but it may also be referred to the ankle,
knee, lumbar spine, and sacroiliac joints
Similarly, the knee, sacroiliac joints, and
lumbar spine may refer pain to the hip
67. Sciatic Nerve (L4 through
S3)
• Injured in the pelvis
or upper femur area
(e.g., posterior hip
dislocation)
• Hamstrings and all
muscles below the
knee can be affected.
• Result : high
steppage gait with
an inability to stand
on the heel or toes
• compressed by the
68. Superior Gluteal Nerve (L4
through S1)
• Weakness of Gluteus medius, Gluteus
minimus, Tensor fasciae latae
• Hip : medial rotated, and weakness of the
hip abductors resulting in a
Trendelenburg's gait.
69. Femoral Nerve (L2 through
L4)
• compressed during childbirth, ant.
dislocation of femur or traumatic surgery.
• Not able to : flex the thigh on the trunk or
extend the knee.
• Reflex : lost deep tendon knee reflex
• Sensory loss : medial side of thigh (ant.
70. Obturator Nerve (L2
through L4)
• Caused by pelvic or
hip surgery,
pregnancy(obstetric
palsy), fractures or
tumors
• Controls primarily
the adductors, hip
adduction is
affected, as are knee
flexion and hip
lateral rotation
• Sensory deficit is
small ; medial part
71. Joint Play Movements
• Patient in the supine position.
• The examiner should attempt to compare
the amounts of available movement on
the two sides.
72. 1. Caudal Glide of the
femur
(long leg traction or long-axis
extension
The examiner places both han
around the patient's leg, slightly above the ankle.
Thexaminer
then leans back, applying a long-axis extension
(traction) to the entire lower limb. Part of th
movement occurs in the knee. If one suspects som
pathology in the knee or the knee is stiff, both han
should be placed around the thigh just proximal to th
knee, and traction force should again be applied ( e
Fig. 11-54A). The first method enables the examine
to apply a greater force. During the movement, an
telescoping or excessive movement occurring in th
hip should be
73. 2. Compression
The examiner places the patient’s knee in the
resting position and then applies a
compressive
force to the hip through the longitudinal of
the femur by pushing through the femoral
condyle
74. 3. Lateral Distraction
hand ; placing a wide strap around the leg as high
up in the groin as possible.
The strap is then wrapped around the examiner's
buttock
The examiner leans back, using the buttocks to
apply the distraction force to the hip.
The proximal palpate the hip or greater trochanter
movement, distal hand prevents abduction of the
leg, and, hence, torque to the hip
75. 4. Quadrant (Scouring)
Tests
The examiner flex and adducts the patient's hip so that
the hip faces the patient's opposite shoulder and
resistance to the movement is felt.
As slight resistance is maintained, the
patient's hip is taken into abduction while maintaining
flexion in an arc of movement. As the movement is
performed, the examiner should look for any
irregularity
in the movement (e.g., "bumps"), pain, or patient
apprehension, which may give an indication of where
the pathology is occurring in the hip
Hinweis der Redaktion
เป็นการตรวจข้อ sacro-iliac ในท่านอนหงาย โดยการวางพับขาข้างที่จะตรวจให้ส้นเท้าวางพาดบนเข่าด้านตรงข้าม ทำให้เป็นรูปเลขสี่ ( sign for four ) ผู้ตรวจใช้มือข้างหนึ่งกดลงไปที่ iliac crest ด้านตรงข้ามแล้วอีกมือหนึ่งกดลงเข่าข้างที่พับไว้ แล้วกดลงไปพร้อมๆ กันซึ่งเป็นการแบะข้อ sacro-iliac ข้างที่ตรวจออก ถ้ามีความผิดปกติเกิดขึ้นในข้อนี้ก็จะทำให้เกิดความเจ็บปวดขึ้นที่ข้อ sacro-iliac
Anteversion is measured by the angle made by the femoral neck with the femoral condyles (mean angle is 8° to 15°)
Increased anteversion leads to squinting patellae and toeing-
degree of forward projection of the femoral neck from the coronal plane of the shaft
retroversion, the plane of the femoral neck in rotates backward in relation to the coronal condylar plane or the acetabulum itself maybe retroverted.
feet face in ("pigeon toes") for medial rotation and face out more than 10° for excessive lateral rotation of the tibia while the patellae face straight ahead
lies supine, the examiner flexes one of the patient's hips, bringing the knee to the chest to flatten
out the . lumbar spine and to stabilize the pelvis. The patient holds the flexed hip against the chest. If there is no flexion contracture, the hip being tested (the straight leg) remains on the examining table.
This syndrome is chronic inflammation of the iliotibial band near its insertion, adjacent to the femoral condyle
Pt lies supine , flexed knee to 90°, hip flex. applies pressure to the lateral femoral epicondyle proximal to it.
While the pressure maintained, the patient slowly extends the knee. At
approximately 30 องศา of flexion
The patient lies supine with the ASISs level. Normally,
the examiner can easily "balance" the pelvis on the
legs. This "balancing" implies a line joining the ASIS
1 perpendicular to the two lines formed by the
traight legs
The patient is in the side lying position
flexes the test hip to 60° with the knee flexed. The examiner stabilizes the hip with one hand and applies a downward pressure to the knee
Flex hip flex knee
Pt sit with one knee flexed against the chest to stabilize the pelvis and the other knee extended.
then flex the trunk and touch the toes of the extended lower limb with the fingers. Repeated on the other side.
patient is seated with both knees flexed to 90° over the table
The examiner then passively extends one knee.
If the hamstring muscles on that side are tight, the patient
extends the trunk to relieve the tension in the hamstring
The leg is returned to its starting position, and the other leg is tested and compared with the first side.
Pt lie supine with the hip and knee flexed to 90
no reflexes around the hip that can easily evaluated.
the examiner should assess normal dermatome patterns of the nerve roots as well as the cutaneous distribution of
peripheral nerve
True hip pain is usually referred to the groin, but it may also be referred to the ankle, knee, lumbar spine, and sacroiliac joints
Similarly, the knee, sacroiliac joints, and lumbar spine may refer pain to the hip
The examiner places both han
around the patient's leg, slightly above the ankle. Thexaminer
then leans back, applying a long-axis extension
(traction) to the entire lower limb. Part of th
movement occurs in the knee. If one suspects som
pathology in the knee or the knee is stiff, both han
should be placed around the thigh just proximal to th
knee, and traction force should again be applied ( e
Fig. 11-54A). The first method enables the examine
to apply a greater force. During the movement, an
telescoping or excessive movement occurring in th
hip should be
The examiner places the patient’s knee in the resting position and then applies a compressive
force to the hip through the longitudinal of the femur by pushing through the femoral condyle
hand ; placing a wide strap around the leg as high up in the groin as possible.
The strap is then wrapped around the examiner's buttock
The examiner leans back, using the buttocks to apply the distraction force to the hip.
The proximal palpate the hip or greater trochanter movement, distal hand prevents abduction of the leg, and, hence, torque to the hip
The examiner flex and adducts the patient's hip so that the hip faces the patient's opposite shoulder and resistance to the movement is felt.
As slight resistance is maintained, the
patient's hip is taken into abduction while maintaining
flexion in an arc of movement. As the movement is
performed, the examiner should look for any irregularity
in the movement (e.g., "bumps"), pain, or patient
apprehension, which may give an indication of where
the pathology is occurring in the hip (see Fig. 1154D).
64 This motion also causes impingement
