i. Hip
a. Hip assessment Hip
Assessment Landmarks Orientation (+) CHD
Nelaton’s line ASIS to Ischial
tuberosity Diagnonal Femoral head above the diagonal Bryant’s
triangle 1st: ASIS
2nd: Isc. Tuberosity ® triangle Difference measurement on femoral head Helgenreiner’s ASIS Horizontal FH moves upward and locates outward
quadrant
Perkin’s line Acetabular fossa Vertical Acetabular fossa goes up/ FH outward quadrant
Shenton’line Femoral head Curve Curve is distorted of broken curves b. Hip pathology
i. Patrick’s Test (FABERE test, Figure of 4, Jansen’s test) 1. Supine c knee is FABER (hip/ knee)
2. Push the medial knee 3. (+) inability to lower the knee
a. Midrange: Hip Joint b. End range: SI joint 4. Gives stress to the hip joint ii. Trendelenburg sign
1. Indication: G. Medius weakness 2. Standing in one leg
3. Note:dropping hip on opposite leg 4. (+) dropping hip
5. *MC cause: OA
Trendelenburg sign Trendelenburg gait (-) compensation (+) compensation, by lateral trunk
bending upon singe limb stance
iii. Quadrant Test ( Scouring)
1. Supine with hip and knee flexed 2. Examiner will give axial load 3. (+) pain
4. Indication OA of the hip
iv. Craig’s test (Ryder’s method) 1. Femoral Anteversion 2. Prone
3. Palpation (g. troch) 4. Parallel to bed 5. IR and ER of the hip 6. (+)excessive movement c. Hip muscle pathology
i. Thomas test “iliothomas”
1. Supine with 1 hip and knee flexed, knee to chest.
2. Examiner will push the flexed leg 3. Note: if the straight leg rises off the table 4. Indication: Hip flexion contracture 5. Modified:
a. 1 jointed/ 2 jointed hip flexion contracture
b. Supine with legs dangling (knee to chest of other limb) Flexion of the knee Elevation of the pelvis
1 jointed <70o (+)
2 jointed >70o (-)
ii. Staheli’s test (infants)
1. Hip flexion contracture 2. Prone with legs dangling
3. Examiner will sowly extend one leg 4. (+) pelvis rises
iii. Rectus femoris contracture test 1. (B) are passive
Kendall’s Supine Knee to chest (+) knee extension Ely’s Test Prone Heel to butt Hip flexion Rectus FemELY’s
iv. Hamstrings contracture Test 1. 3 methods
a. Method 1: 90-90 SLR (active) i. Supine
ii. Hips and knee 90o flexion iii. Let subject extend one knee iv. (+) politeal angle <120o
v. (n) extensor lag is 25o, for children extensor lag starts at 6 y/o
= 155o
vi. * most reliable test b. Method 2: Sit and reach (active)
i. Long sitting and reach toes ii. (+) unable to reach
iii. *Most unreliable test – trunk tends to lateral bend
c. Method 3: Tripod Sign (passive) i. Sitting with legs dangling
ii. Examiner should passively extend one knee iii. (+) backward trunk lean
d. Tightness
Test Ober’s Test Phelp’s Noble Compression Take of Shoe Test (TOST) Indication ITB tightness Gracilis Tightness ITB Friction
syndrome 1o & 2o Biceps femoris strain
Position Sidelying Prone Supine Standing
Examiner
Extends and abducts top leg, and let subject lower leg
Subject will abduct, examiner will flex the knee, and
Subject will actively remove shoes on the affected side by means of the opposite foot.
(+) Inability to lower
leg Increased
abduction Pain on lateral
femoral condyle ER of the hip and flexion of the knee e. Piriformis Test
i. Sidelying
ii. With hips and knee flexed iii. Examiner will push the upper leg iv. (+) pain accompanied by:
1. IR + hip extension (Freiberg’s sign) 2. ER + abduction (Sign of Pace & Nagel) v. Indication: Piriformis tightness
f. Other tests:
i. Leg Length Discrepancy 1. True
a. Structural E.g. Fracture, CHD b. Landmarks: ASIS> Medial Malleolus 2. Apparent/ Functional
a. Compensation E.g. Scoliosis, Pes planus b. Landmarks: Umbilicus> medial malleolus c. *xiphoid process can be used as well.
g. CHD
Ortolani’s Barlows
Tested: Few weeks from birth Correction Test, The hip is already dislocated
“Correctiolani”
Supine
Inward pressure (+) relocation click
Tested: 3 months to 6 months Dislocatable
Supine
Inward + Outward pressure
*one time test (+) Reduction click
i. Gallezi’s/Alli’s – a. Hook lying
b. Note: Height on (B) knees c. (+) lower leg/ knee
d. Femoral shortening – lateral view e. Tibial shortening – anterior view ii. Telescoping Test (Piston test/ Dupuytren’s Test)
a. Hips and knees flexed 90o
b. Examiner will perform piston action( downward first and upward ) c. (+) excessive translation
d. *note: administer on (B) sides
Mc-Murray Bounce Home Apley’s (compression) Apley’s(Distraction) Supine
Supine with hip/ knee flexed 90o + IR = Lateral Meniscus + ER = Medial Meniscus (+) Pain + clicking
Supine
Hip/ knee fully flexed Slowly extend knee
*note: end feel
(+) Springy/rubbery Block
Prone with 90o knee flexed Compress and rotate Meniscal lesion ER = lateral meniscus IR= medial meniscus
Same posn Distract + rotate Ligamentous lesion
h. Ligamentous Lesions
MCL LCL
Valgus Stress Test Varus Stress test Supine/ sitting with knees extended
Examiner will give valgus force to the knee/ abduction force
Same posn
Examiner gives varus force/
Adduction force (+) pain/ apprehension/ excessive movement
i. Cruciates i. PCL
Post. Drawer Test Godfrey’s Test/ Gravity Test Posterior Sag Sign Supine with hips and knee flexed 90o
Examiner will draw the tibia backward
(+) excessive movement
Supine with hip and knee 90o Examiner will hold both flexed legs
(+) Tibia will sag backwards
Supine with hips 45o and knee 90o flexed
(+) tibia will sag backwards
ii. ACL
Anterior drawer’s Test Lachman’s Test Supine hip and knee flexed 90o
Examiner will draw the tibia anterior (+) excessive movement of tibia anterior
Supine hip and knee 20-30o flexion Examiner will draw the tibia anterior (+) excessive movement of tibia anterior
iii. Lachman’s Test modifications
Lachman modification Fulcrum
I. – Examiners Thigh
II. Stable Examiners Knee
III. Drop leg Between examiners thigh
IV. – Examiner’s thorax
V. – Bed (Eye of examiner parallel to the knee)
VI. Prone Prone
VII. Active (No touch) Forearm VIII. Maximal Quadriceps test Arm/ Hand
Lachmans displacement stages - 1: 3-6 mm
- 2: 6-9mm - 3: 10-16mm - 4: 16-20mm iv. Rotatory instability
1. AI: Opposite, PI: Same 2. Special tests
a. Slocums > Anterior b. Houghstons > Posterior v. Patella
Patellar Tap Brush Test/ Stroke Test/ Wipe Test/ Bulge Test Ballotable patella
Supine, knee extended or flexed Examiner will tap the patella
(+) Floating of patella (Dancing patella) Indication infrapatellar effusion
Spine stroke on medial side of the patella 2-3x
(+) examiner will feel fluid on the medial aspect of the knee Indication: swelling
Patellofemoral pain syndrome
Clarke’s Sign McConell’s Waldron’s
Aka patellar grind test Contract the quads & resist
the patella.
(+) pain and unable to hold contraction
Sitting position & femur in ER
Contract quads isometrically in 120o > 90o > 60o >30o > 0o of knee flexion for 10 seconds each.
* note where the pain is elicited
> let the subjects knee extend fully, and push the patella medially then perform the 2nd procedure:
(+) if there is decreased pain upon returning position
Standing Examiner Palpate
the patella and subject perform
squats (+) pain and
crepitation
j. Other tests:
i. Wilson’s Test
1. Indication: osteoarthritis dissecans 2. Sit c legs dangling
3. Actively knee extension with tibia in IR 4. (+) pain on media condyle upon rotating in IR 5. To confirm:
a. ER the tibia, if there is decreased pain b. (+) osteochondritis dissecans
ii. Patellar dislocation/ Fairbank’s apprehension test 1. MC dislocation of the patella > laterally
2. Supine, make sure quads are in a relaxed position 3. Examiner will push patella laterally
4. (+) contraction of the quads in order for the patella to be mid line ii. Ankle & Foot
Special Indication Position/ Procedure (+)
Anterior Drawer Test (ankle) ATFL Supine, 20o plantarflexion and draw talus
anteriorly Pain + excessive
movement Talar Tilt Test CFL Supine, foot in relaxed and examiner tilts ankle
abduction and adduction Pain + excessive
movement Kleiger’s Test/ External
rotation Stress Test
Deltoid Ligaments
Sit with legs dangling and examiner ER talus Pain on medial side of ankle
iii. Other Tests
Indication (+)
Squeeze test (leg) Syndesmosis Sprain Pain
Homan’s sign (Passive DF) DVT Pain
Hoppas test Calcaneal fracture Pain, (-) PF
Thompson’s (Simmonds/
Achilles rupture test) Achilles tendon rupture (-) PF
Morton’s Test (MTT heads) Morton’s neuroma, (+) pain/ paresthesia iv. Other tests for ankle and foot
a. Feiss Line
i. Foot is in relaxed position
ii. Examiner will push the first MTP/ Big toe iii. (+) Dorsiflexion of the remaining toes iv. Indication:superficial peroneal nerve lesions c. Tinel’s sign
i. Ant: Anterior tibial nerve/ superficial peroneal nerve ii. Post: Posterior tibial nerve/ tibial nerve
d. Buerger’s test
i. Patency of the blood supply of the lower ex, subjects leg is elevated 2-3 minutes ii. Examiners observes for any discoloration
iii. (+) blanching/ pale in color 1. To confirm:
a. Dependent position
i. Sitting with legs dangling ii. Examiners observes 1-2 minutes iii. (+) >2 minutes of discoloration