13 Orthopedic Tests for Hip and Pelvis
Trendelenburg's sign is named after Friedrich Trendelenburg who was a German surgeon. This sign is positive in individuals whose abductor muscles of the hip, i.e. gluteus medius and gluteus minimus, have become weak or paralyzed.
- Patient is told to stand on one leg.
- Trendelenburg sign is positive if upon standing on one leg, the patient's pelvis tilts on the opposite side, so as to decrease the load. The weakness is present in the muscle present on the opposite side of the stance leg.
- A positive Trendelenburg sign indicates muscular dysfunction, i.e. weakness of the gluteus minimus or medius.
- A positive Trendelenburg sign also occurs when the patient is having pain.
This orthopedic test is done to assess a dislocated hip. The patient is made to lie supine on an examination table. The knee and hip on the affected side are flexed to 90 degrees. Gentle pressure is applied in a downward motion towards the table and then lifted back up.
- The test is positive if the patient does not exhibit any movement or if there is excessive movement due to hip dislocation.
- The test is negative if there is only a little bit of movement.
Pelvic Rocking Test
Pelvis rocking test is done to find out the stability of a joint. The patient is made to lie supine on the table. The examiner places his/her hands on the patient's iliac crest with the thumbs on the anterior superior iliac spines and the palms on the iliac tubercles. Both the palms of the hands are pushed towards each other. This will stress both the anterior superior iliac spines and stresses the sacroiliac joint. The test is positive if:
- There is pain around the sacroiliac joint.
- There is decrease or increase in the motion on the affected side.
Positive Pelvis Rocking Test Indicates:
- Trauma or injury to the sacroiliac joint.
- Infection in the sacroiliac joint.
Ortolani Test or Ortolani Maneuver
Ortolani Test or Ortolani Maneuver is named after Michael Ortolani and Marino Ortolani who developed it in 1937.
Ortolani maneuver is done along with the Barlow maneuver and is done as a part of physical examination for a medical condition known as developmental dysplasia of the hip. Ortolani Test or Ortolani Maneuver helps in relocating a dislocated hip joint.
- Patient is made to lie in a supine position.
- The examiner first flexes the hips and knees to 90 degrees.
- The examiner then places his/her index fingers and applies anterior pressure on the greater trochanters while smoothly and gently abducting the patient's legs.
- Ortolani Test or Ortolani Maneuver is deemed positive when a distinctive "click" or a "clunk" can be heard and the femoral head is felt relocating anteriorly into the acetabulum.
Ober's Test is done to determine the tightness of the iliotibial band. The patient is made to lie on the table in a lateral position with the uninvolved leg placed on the bottom and their shoulder and pelvis in a straight line. If there is any lordosis of the spine, then in order to counteract the lordosis, the lower hip and knee can be placed in a flexed position. When the patient is lying on his/her side, the examiner will support the knee and flex or bend it to about 90 degrees. The hip is then extended and abducted. The examiner then releases the support on the knee. If the knee fails to adduct then it is a positive test and indicates iliotibial band syndrome.
The patient is kept in a seated position and the examiner supports him from behind by reaching around the patient's upper chest and shoulders. The patient is then told to lean forward on one side and then around to slowly bend obliquely backward by keeping the palm on the buttock and then slowly moving it down the posterior side of the thigh and leg as far as possible. This maneuver resembles those which are used in oblique cervical compression tests. If the patient feels a type of radicular pain in the thigh and leg upon this compression or if the pain exacerbates, then this test is positive. Positive sign indicates:
- Nerve root compression.
- Sprain or strain where pain is present when the patient bends forward obliquely or at any time during the movement.
- It may also indicate shortening of the contralateral paraspinal ligaments and tendons, which leads to irregular movements where there is lateral flexion.
This test is done to confirm if there is any excessive tension in the iliopsoas. Thomas' test should always be done on both the sides. The patient is made to lie in a supine position and told to hold one flexed knee against his/her abdomen with both the hands. The other leg is completely extended upon which the lumbar spine of the patient should flatten. If the limb does not extend completely, if the patient moves his chest forward or flexes his back when extending the leg, then it indicates:
- A fixed flexion contracture of the hip.
- It can also indicate a shortened iliopsoas muscle.
- Sometimes the extent of the pain produced upon forced extension of the flexed knee is used to determine the tension in the iliopsoas.
The patient placed in a prone position in Yeoman's test. The examiner uses one hand to apply firm pressure over the involved sacroiliac joint, while steadying the patient's anterior pelvis to the table. Using the other hand, the examiner flexes the patient's leg on the affected side to its maximum physiologic capacity. Along with this, the examiner hyperextends the thigh by lifting up the knee from the examining table. Patient should not feel pain upon this maneuver. If pain is felt, it is a positive Yeoman's test and indicates:
- Increased pain in the sacroiliac region indicates a lesion in the hip or ventral sacroiliac.
- Pain may also be produced due to force on the anterior sacroiliac ligaments.
The patient is placed in the supine position. The examiner holds the ankle and does the following maneuvers:
- Flexes the knee.
- Flexes the thigh.
- Abducts the thigh.
- Externally rotates the thigh.
- Extends the thigh.
Pain felt in hip during the above maneuvers, especially on external rotation and abduction, is a positive test and indicates coxa pathology or hip joint pathology.
The patient is made to lie in a prone position on the table for Nachlas' Test. The patient's knee is then flexed to a right angle. The leg on the other side is stabilized by the examiner's hand and using the other hand, the examiner puts gentle pressure on the anterior side of the ankle and slowly lifts the heel and directs it towards the ipsilateral buttock. The Nachlas test indicates the following if:
- A sharp pain is felt in the sacral region or in the ipsilateral buttock then it indicates a sacroiliac disorder.
- Pain is in the upper lumbar area, anterior thigh or groin then it indicates spasticity/contracture of the quadriceps or a femoral nerve lesion.
- If pain is felt in the lower back region or is sciatic in nature, then it indicates lower lumbar disorder, particularly in the L3 or L4 area.
In Hibb's test, the patient is made to lie in a prone position with the examiner standing on the side of the patient where the test is to be performed. The unaffected hip on the opposite side is stabilized by the examiner, and the patient's knee on the involved side is flexed toward the buttock and then the leg is slowly adducted, which leads to external rotation of the femur. Pain felt at the following regions indicates:
- Pain, which has begun in the hip joint, indicates a hip lesion.
- Pain, which has started in the sacroiliac joint and not the hip, indicates a sacroiliac lesion.
Ely's test is done to confirm if there is any spasm or contracture of the iliopsoas muscle. The patient is made to lie in a prone position on a table with the toes hanging over the edge of the table. Patient is told to keep his/her legs relaxed. Both of the heels are brought near the buttock on the opposite side. Upon the flexion of the knee, if the patient has hip pain, then the test cannot be carried carry out further due to irritation in psoas muscle or in its sheath. The buttock on the affected side tends to elevate. This is a positive Ely's test.
A positive Ely's test indicates:
- Irritation or spasm in the iliopsoas muscle or its sheath.
- It can also indicate contraction of the rectus femoris.
- Lesion on the lumbar region.
- Osseous hip lesion.
- Contracture of the tensor fasciae latae.
In Gaenslen's test, the patient is made to lie supine on the table with the knees and hips extremely flexed. The patient then clasps the knees using both the hands and holds them against the abdomen. This position allows the lumbar spine to be securely in contact with the table and also steadies both the lumbar spine and the pelvis. The examiner stands at right angles to the patient and gradually hyperextends the thigh on the opposite side. The force is slowly increased by putting pressure via one hand on the anterior side of the patient's knee and the other hand placed on the patient's flexed knee to steady the lumbar spine and the pelvis. The hyperextension action of the hip puts a rotating force on the other half of the pelvis. Gaenslen's test is commonly contraindicated in the elderly individuals.
Upon hyperextension of the thigh, if pain is felt in the sacroiliac region or is referred down to the thigh, then the test is positive. However, the sacroiliac joint on the opposite side should be normal and the sacrum should move as a single unit with the corresponding side of the pelvis. Gaenslen's test should be done on both the sides. A negative Gaenslen's test often indicates lumbosacral lesion.
A positive Gaenslen's test indicates:
- Lower lumbar nerve root lesion.
- Sacroiliac or a hip lesion.
- Involvement of L4 nerve if the pain is referred anteriorly to upper thigh or the groin.