Hip Joint Orthopedic Tests

Iliac Crest, ASIS, & AIIS

Greater Trochanter

Hip Joint

Tensor Fasciae Latae Muscle

Femoral Triangle

Congenital Hip Dysplasia Congenital hip dysplasia is a condition in which the femoral head is displaced out of the acetabular cavity. Often bilateral. Girls affected more often than boys. The acetabular cavity is shallow or more vertical than normal.

Congenital Hip Dysplasia Clinical Signs and Symptoms Decreased hip flexibility Limited hip abduction Painless limp Hip pain Shortened extremity

Allis Test Procedure: Infant supine, flex the knees, Feet should approximate one another on the table. Positive Test: A difference in the height of the knees is a positive test. Short knee on the affected side – posterior displacement of the femoral head or a short tibia. Longe knee on the affected side – anterior displacement of the femoral head or increase in tibia length.

Allis Test

Ortalani’s Click Test Procedure: Infant supine. Grasp both thighs with thumbs on the lesser trochanters. Flex and abduct the thighs b/l. Positive Test: Palpable or audible click is a positive sign. The click signifies displacement of the femoral head in or out of the acetabular cavity.

Ortalani’s Click Test

Hip Fractures Hip fractures occur most frequently in the elderly population. Most common types are intertrochanteric and intracapsular. Intertrochanteric and femoral head fractures typically do NOT disrupt the blood supply. Intracapsular fractures disrupt the blood supply to the femoral head and can lead to avascular necrosis.

Hip Fractures Clinical Signs and Symptoms Hip pain Shortened extremity Externally rotated extremity Referred pain to medial thigh

Anvil Test Procedure: Patient supine. Tap the inferior calcaneous with your fist. Positive Test: Local pain in the hip joint may indicate a femoral head fracture or joint pathology. Pain in the thigh or leg secondary to trauma may indicate a femoral, tibial, or fibula fracture. Pain local to the calcaneous may indicate a calcaneal fracture.

Anvil Test

Hip Contracture A hip joint contracture is a condition of soft tissue stiffness that restricts joint motion. This can be caused by immobility due to spasticity, paralysis, ossification, bone trauma, or joint trauma. A frequently moved joint is unlikely to develop a contracture deformity. The joint capsule, ligaments, or muscle tendon units can be involved.

Hip Contracture Clinical Signs and Symptoms Stiff hip joint Limited hip range of motion Inability to position joint in the neutral position Hip joint pain on range of motion

Thomas Test Procedure: Supine patient. Approximate each knee to the chest one at a time. Palpate quadriceps on the unflexed leg. Positive Test: No tightness – suspect restriction at the hip joint structure or joint capsule. If tightness is palpated on the side of the involuntary flexed knee – hip flexure contraction is suspected.

Thomas Test

Ely’s Test Procedure: Patient prone. Grasp ankle and passively flex the knee to the buttock. Positive Test: If the patient has a tight rectus femoris or hip flexion contracture, the hip on the same side will flex, raising the buttock off the table.

Ely’s Test

General Hip Joint Lesions Common problems associated with the hip joint include the following: Osteoarthritis, sprains, fractures, dislocations, bursitis, tendinitis, synovitis, and avascular necrosis of the femoral head. The following tests determine whether a general lesion of the hip is present. Further diagnostic imaging can determine the exact pathology.

General Hip Joint Lesions Clinical Signs and Symptoms Hip pain Shortened extremity Externally rotated extremity Referred pain to medial thigh

Patrick Test (Faber) Procedure: Patient supine. Flex leg and place foot flat on table. Grasp femur and press it into the acetabular cavity. Cross leg to opposite knee. Stabilize ASIS opposite and press down on knee of side tested. Positive Test: Pain in the hip – inflammatory process in the hip joint Pain secondary to trauma – may indicate fracture Pain may indicate avascular necrosis of femoral head Faber – Flexion, abduction, & external rotation

Patrick Test (Faber)

Trendelenburg Test Procedure: Patient standing. Grasp waist. Thumbs on PSIS b/l. Instruct patient to flex one leg at a time. Positive Test: If the patient cannot stand on one leg because of pain If the opposite pelvis falls or fails to rise This tests the integrity of the hip joint opposite the side of hip flexion

Trendelenburg Test

Laguerre’s Test Procedure: Patient supine. Flex the hip and knee to 90degrees. Rotate the thigh outward and the knee medially. Press down on the knee with one hand and pull up on the ankle with the other. Positive Test: This test externally forces the head of the femur into the acetabular cavity. May indicate an inflammatory process in the joint such as osteoarthritis. Pain secondary to trauma – suspect fracture of the acetabular cavity or rim.

Laguerre’s Test