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. During test patient is advised to stand on one leg. Trendelenburg sign is considered positive if upon standing on one leg, the patient's pelvis tilts on the opposite side. The tilt on opposite side is caused by weakness of gluteus minimus and maximus muscles of opposite side of the stance leg. A positive Trendelenburg sign indicates muscular dysfunction, i.e. weakness of the gluteus minimus or medius. During Trendelenburg' test patient may complain of pain on opposite side.
Telescopic sign is observed during orthopedic test to asses dislocated hip. The patient is made to lie supine or flat on their back on an examination table. The examiner stands on opposite side of the leg which is tested. The leg to be tested is bent at 90 0 at knee and hip joint. 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. During test patient complaints of increase pain. The test is negative if there is only a little bit of movement and patient do not complaint of increase pain.
Pelvic Rocking Test
Pelvis rocking test is done to diagnose stability of a sacroiliac joint. The patient is made to lie supine on table with leg flex at knee and hip joint. The examiner holds and support pelvis by placing thumb on iliac crest and palm as well as four fingers spread over side and back of the pelvis. Both the palms of the hands are pushed towards each other. Examiner then rocks the pelvis to rotate sacroiliac joint. The manual rocking stresses the sacroiliac joint. The test is considered positive if there is pain around the sacroiliac joint. Positive Pelvic Rocking Test Indicates trauma or injury to the sacroiliac joint or sacroiliac joint infection.
Ortolani Test or Ortolani Maneuver
Ortolani Test includes Barlow Maneuver followed by Ortolani Maneuver. The test was described in 1937 and is named after Michael Ortolani. Barlow Maneuver is done first then Ortolani maneuver is performed. The test is performed to diagnosed congenital dysplasia of the hip joint. The Barlow Maneuver dislocates the hip joint and Oetolani maneuver reposition the hip joint by adjusting head of femur in hip joint socket.
Barlow maneuver- Examiner supports both leg with hand in flex position at knee joint. Then hip joint is also flex at 90 0. Examiner while continuing his hands on knee joint adduct the leg at hip joint while leg is pushed posteriorly toward the examining bed. Examiner may feel or hear click while hip joint is dislocated. This maneuver dislocates both or one hip joint.
Ortolani Maneuver- Ortolani Maneuver was described by Marino Ortolani. Following Barlow Maneuver Ortolani Maneuver is performed to reposition the head of femur in hip joint socket. The procedure is known as relocating a dislocated hip joint. The position of both knee and hip joint is maintained at 90 0 during entire period of test. The examiner repositions the hand to hold the leg. The examiner palpates the greater trochanter with index finger and also abducts the leg at hip joint using thumb. The maneuver places the head of femur into hip joint socket with a click sound. The test confirms the diagnosis of congenital hip joint dysplasia.
Ober's Test is done to determine the tightness of the iliotibial band. The patient is asked to lie on the examination table in a lateral position on normal side. The arm is flex at elbow and tuck under head. The normal leg is maintained in straight lateral position during test. The painful leg is then maneuver by examiner. Examiner holds the leg as shown in image below. The right hand is placed over affected hip joint and pelvis, while leg is extended and abducted with left hand. The examiner then releases the hand that was supporting the knee. If the knee fails to adduct then it is a positive test and indicates iliotibial band syndrome.
Kemp’s test is performed to diagnosed nerve root compression. Test helps to diagnose radicular pain and rule out lumbar sprain as well as pain cause by abnormal facet joint. The test is performed in sitting position. Examiner stands behind the examination table. The right hand is placed over right upper chest and shoulder joint. The left hand is placed on mid back of opposite side or left side as shown in image below.
The patient is asked to lean forward and maintained flex position. Then patient is asked to move the upper body from left to right side while maintaining the back in flex position. The test demands movements of optimum tilt to right and left side while maintaining flex position of back. The test evaluates the cause of radicular pain or pinch nerve. Test is considered positive if patient is complaining of sudden jolting pain on one side that radiate to back of the leg.
Thomas test was described by orthopedic surgeon Dr. Hugh Thomas from Great Britain. The test helps to diagnose hip flexion contracture and psoas syndrome. Test can be false negative in patient who may have good pain tolerance. The patient is asked to lie supine on examination table with both legs hanging over the side of the examination bed. Both the legs are maintained in flex positon at knee joint. Examiner stands on side of patient that has pain. Examiner then assist patient to flex leg at hip joint. Examiner carefully pushes flex leg towards chest. During this maneuver patient suffering with psoas syndrome or hip flexion contracture will not be able to maintained opposite leg in fully extended position at hip joint. The test is repeated on other side.
The test is diagnostic if moderate to severe pain is elicited on opposite side. The test often results as false negative when patient with good pain tolerance feel obliged to maintain leg in extended position.
Yeoman test is performed to diagnose sacroilitis and sacroiliac joint sprain. Patient is asked to lie in prone position over the examination bed. Patient is instructed to maintain both arms on side and head in neutral position. Examiner will stand on opposite side of the leg that is to be tested. As shown in image while testing left leg, examiner places his right hand over ilium and left hand in front and above the knee joint. The test involves two maneuvers. First examiner tries to tilt the ilium and pelvis outward; and same time he extends the opposite leg at hip joint with left hand. Patient suffering with sacroilitis and sacroiliac joint sprain will feel pain over sacroiliac joint of the leg which is being tested.
The test is performed to evaluate hip and sacroiliac joint diseases. The patient is asked lie supine on examination bed. Both the legs are tested alternately. Examiner will stand on side that is being tested. The leg is flex at knee and hip joint simultaneously. Then leg is abducted and laterally rotated. The knee is pressed towards the bed while foot is rested on thigh of opposite leg. The test is also known as FABER test (F- Flexion. AB- Abduction and ER- External Rotation). Patient suffering with hip or sacroiliac joint disease will complaint of moderate to severe pain.
The patient is instructed to lie in a prone position on the table for Nachlas' Test. Examiner will stand on one side of bed. One leg at a time is flexed at knee joint while leg is maintained in straight position at hip joint. The heel of the feet is attempted to touch the buttocks on same side. The Nachlas test is considered positive if patient is complaining of sharp pain over the sacral region. The possible cause of pain could be sacroiliac joint injury, sprain or inflammation.
Pain is also observed if patient is suffering with knee joint sprain or arthritis. If pain is felt in the lower back and radiate over the back of the thigh then cause of the pain could be radicular pain originates from pinch of spinal nerve at L3, L4 or L5 foramina.
In Hibb's test, the patient is made to lie in a prone position. Examiner stands on opposite side of the bed. As shown in image below examiner while on right side holds the feet of left leg and assist patient to flex the knee joint at 90 0 flexion. The hip joint is maintained in neutral position lying flat on bed. Gently examiner rotate the leg to outer side while supporting the lower back and pelvis with right hand. Test is repeated on both leg. The test is considered positive if pain is elicited during the test. The positive test suggests possible sacroiliac joint disease, hip joint disease or radicular pain. Sacroiliac joint pain is caused by joint inflammation or arthritis. Hip joint pain is caused by arthritis or joint sprain. Radicular pain is caused by piriformis entrapment. The test is considered diagnostic for piriformis entrapment disease that causes pain radiate to back of the thigh while radiological finding suggests normal sacroiliac joint and hip joint.
Patient is advised to lie on examination bed in prone position with face facing the examination table. Examiner stands on side of the examination bed. Patient is asked to flex both the leg simultaneously at knee joint to 90 0 flexion. Examiner places his hand over the back of the calf muscles. Patient is asked to further flex the knee. Test is considered positive if patient is raising his pelvis and buttocks while flexing the leg at knee joint against the resistance provided by examiners hand. Positive test suggests patient may be suffering with sacroiliac joint disease or iliopsoas syndrome. Upon the exitension 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 pain induced by contraction of the rectus femoris, lesion on the lumbar vertebrae, osseous hip lesion and contracture of the tensor fasciae latae.
The test was described by Orthopedic Surgeon Dr. Frederick Gaenslen. Gaenslen's test is performed to diagnose cause of back pain. The positive test suggest cause of pain could be sacroiliac joint disease. The test is performed to stress both sacroiliac joint simultaneously. Patient is asked to lie on examination bed in supine position. As shown in image below, right leg is kept hanging on the side of the bed so right hip is optimally extended. Such position stretches right sacroiliac joint. Next patient is asked to flex knee joint. Now examiner will assist to flex the leg at hip joint. The attempt is made to touch the knee joint to abdomen. The maneuver will now stretch the left sacroiliac joint. The test is repeated on opposite side. The test is considered positive if patient is complaining of pain on one or both side. The cause of pain is sacroiliac joint arthritis or sprain. The test is also positive if patient is suffering with spondylo-arthritis or sciatica.
All these maneuvering test are subjective test and can be false positive or false negative. The positive test result has to be evaluated and compare by specialist and also supported by other findings of clinical or radiological examination. Test has to be performed by qualified physician, chiropractor or physical therapist.