Tests for hip | Knee Joint mobilization & impingement

Special Tests for Hip Joint:

Following are the special tests performed for orthopedic hip joint pain, mobilization, impingement in physiotherapy:
1. Thomas test
2. Ober’s test
3. Ely test
4. 90-90 Hamstring test
5. Piriformis test
6. Patrick/FABER (flex, abduction, external rot) test
7. Standing flexion test
8. Standing flexion test
9. Long sitting test
10. Trendelenberg’s sign
11. Leg length test

Tests for hip joint
Tests for hip joint

Piriformis test for hip:


Identifies tightness of the piriformis muscle (piriformis syndrome).
Aim of the test:
Identifies tightness of the piriformis muscle (piriformis syndrome).
Patient position:
Patient is supine and foot of tested leg is placed lateral to the opposite limb’s knee. Testing hip is adducted. Observe the position of testing knee relative to the opposite knee.
Positive sign:
Positive if testing knee is unable pass over resting knee and/ or reproduction of pain in buttock and/ or along sciatic nerve distribution.

Thomas test:


Identifies tightness of hip flexors.
Aim of the test:
Identifies tightness of hip flexors.
Patient position:
Patient is supine and one hip and knee are maximally flexed to chest and held there. Opposite limb is kept straight on table.
Positive sign:
Positive if straight limb’s hip flexes and/ or unable to remain flat on the table. If knee is straight indicates tightness of rectus femoris.

Ober’s test:


Identifies tightness of tensor fascia latae and/ or iliotibial band.

Ely test:


Identify tightness of rectus femoris.
Aim of the test:
Identify tightness of rectus femoris.
Patient position:
Observe the hip of testing limb.
Positive sign:
Positive if hip of the testing limb flexes.

90-90 Hamstring test:


Identifies tightness of hamstring.
Aim of the test:
Identifies tightness of hamstring.
Patient position:
Patient supine and hip and knee of testing limb is supported in 90 degree flexion. Passively extend knee of testing limb.

Patrick/FABER (flex, abd, external rot) test:


Identify dysfunction of hip and sacroiliac joints such as mobility restriction.
Aim of the test:
Identify dysfunction of hip and sacroiliac joints such as mobility restriction.
Patient position:
Patient lies supine. Passively flex, abduct, and externally rotate tested leg so that foot is resting above the opposite knee. Slowly testing leg down towards the table surface.
Positive sign:
Positive test when involved knee is unable to assume relaxed position and/ or reproduction of painful symptoms.

Standing flexion test for hip:


Identify dysfunction of sacroiliac joint.
Aim of the test:
Identify dysfunction of sacroiliac joint.
Patient position:
Patient stands with his feet apart, therapist stands behind him with his thumbs placing on PSIS, asked the patient to flex forward as much as he can, therapist observe both PSIS normally both equally move.

Trendelenberg’s sign:


Identifies weakness of gluteus Medius or unstable hip.
Aim of the test:
Identifies weakness of gluteus Medius or unstable hip.
Patient position:
Patient standing and asked to stand on one leg (flex the opposite knee). Observe the pelvis on the stance leg.
Positive sign:
Positive when contra-lateral pelvis drops

Leg length test:


Identifies true leg length discrepancy.
Patient position:
Patient supine and pelvis is balanced aligned with lower limbs and trunk.
Positive sign:
A True discrepancy is caused by an anatomical difference in bone lengths (either tibia or femur).

Special Tests for Knee Joint Effusion, Ligaments & Pain in Physiotherapy:

1. Lachman stress test:


Aim of the test:
Indicates integrity of anterior/posterior cruciate ligament (ACL/ PCL). 
Patient position:
Stabilize femur and passively try to glide tibia anterior (posterior). 

2. Anterior (posterior) drawer test:


Aim of the test:
Indicates integrity of anterior (posterior) cruciate ligament. 
Patient position:
Patient supine and testing hip flexed to 45 degree and knee flexed to 90 degree. 
Positive sign:
Positive finding is excessive anterior (posterior) glide.

3. McMurray test:

Aim of the test:
Identifies meniscal tears. 
Patient position:
Patient supine with testing knee is in maximal flexion. Passively internally rotate and extend the knee. This tests lateral meniscus. Test the medial meniscus with the same procedure except rotate the tibia into lateral rotation. 

4. Apley test:

Aim of the test:
Helps to differentiate between meniscal tears and ligamentous lesions. 
Patient position:
Patient prone with testing knee flexed to 90 degrees. Passively distract the knee joint then slowly rotate tibia internally and externally. 
Positive sign:
Pain or decreased motion during compression indicates a meniscal dysfunction. 

5. Clarke’s sign:

Aim of the test:
Indicates Patellofemoral dysfunction.
Patient position:
Push posterior on superior pole of patella then ask patient to perform active contraction of the quadriceps muscle.
Positive sign:
Pain is produced in knee as a result of the test.

6. Patellar tap test (Ballotable patella):


Aim of the test:
Indicates infrapatellar effusion. 
Patient position:
 Apply a soft tap over the central patella. 
Positive sign:
Positive finding is perception of the patella floating (dancing patella sign). 

7. Patellar apprehension test:

Aim of the test:
indicate past history of patella dislocation. 

People May Also Search For:

How do I check my knee?
Inspect your knee for swelling, pain, tenderness, warmth and visible bruising. 
Check to see how far you can move your lower leg in different directions.

What tests are done for hip pain?
Medical imaging, including X-rays and magnetic resonance imaging (MRI), is crucial in diagnosing hip pain. An X-ray can reveal an excess of bone on the femoral head or neck and the acetabular rim. An MRI can reveal fraying or tears of the cartilage and labrum.

What are the first signs of needing a hip replacement?
Pain during activity. 
Delayed hip pain. 
Pain that interrupts sleep
Bone on bone arthritis
Stiffness in your hip joint
Lifestyle limitations

Does walking help hip pain?
If you’re in too much pain to even think about activity, rest and ice your hip or hips until you feel better. Then attempt stretching and strengthening. 


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