TIS                         

The Hip and Pelvis

Differential Diagnosis / Special Tests

Patrick or FABERE Test/Hip-Sacroiliac Screening Test:

Have the patient lie supine and place the foot of his involved side on his opposite knee. The hip joint is now Flexed, ABducted, and Externally Rotated. In this position, inguinal pain is a general indication that there is pathology in the hip joint or surrounding muscles. To stress the sacroiliac joint, Extend the range of motion by placing one hand on the flexed knee joint and the other hand on the anterior superior iliac spine of the opposite side. Press down on each of these points. If the patient complains of increased pain posteriorly, there may be pathology in the sacroiliac joint. Anterior hip/groin pain would continue to indicate hip involvement.

Trendelenburg Test/ Gluteus Medius Test:

This procedure evaluates the strength of the gluteus medius muscle on the stance side. Stand behind the patient and observe the dimples overlying the posterior superior iliac spines. Normally, when the patient bears weight evenly on both legs, these dimples appear level. Then ask the patient to stand on one leg. If he stands erect, the gluteus medius muscle on the stance side should contract as soon as the opposite leg leaves the ground, and should elevate the pelvis on the unsupported side. This elevation indicates that the gluteus medius muscle on the supported side is functioning properly (negative Trendelenburg sign). If the pelvis on the unsupported side remains in position or actually drops, the gluteus medius on the stance side is either weak or non-functioning (positive Trendelenburg sign).

True Leg Length Discrepancy Test:

Place the patient's legs in precisely comparable positions and measure the distance from the anterior superior iliac spines to the medial malleoli of the ankles. Unequal distances between these fixed points verify that one lower extremity is shorter than the other.

To quickly determine where the discrepancy lies (either in the tibia or femur), have the patient lie supine, with his knees flexed to 90 degrees and his feet flat on the table. If one knee appears higher than the other, the tibia of that extremity is longer. If one knee projects further anteriorly than the other, the femur of that extremity is longer.

Apparent Leg Length Discrepancy Test:

Establish that there is no true leg length discrepancy before testing for an apparent discrepancy, in which there is no true bony inequality. Have the patient lie supine with his legs in as neutral position as is possible, and take a measurement from the umbilicus to the medial malleoli of the ankle. Unequal distances signify an apparent leg length discrepancy, usually due to pelvic obliquity or from adduction or flexion deformity in the hip joint.

Ober's Test/ Test for Shortening of the Iliotibial Band:

Have the patient lie on his side with his involved leg uppermost. Be sure the patient does not move the pelvis forward or backward. Abduct the leg as far as possible, flex the knee to 90 degrees, then extend the hip. Slowly release the patient's leg.

If the iliotibial band is normal, the patient's thigh should drop to the adducted position. If there is a shortening of the fascia lata or iliotibial band, the thigh remains abducted when the leg is released (positive test).

Noble Compression Test/ Test for Iliotibial Band Friction Syndrome:

The patient is supine with the knee flexed to 90 degrees, accompanied by hip flexion. The examiner then applies pressure with the thumb to the lateral femoral epicondyle or one to two centimeters proximal to it. While this pressure is maintained, the patient slowly extends the knee. At approximately 30 degrees of flexion (0 degrees being a straight leg), if the patient complains of severe pain over the lateral epicondyle, the test is positive.

Craig Test / Test for Femoral Torsion:

Therapists can determine the angle of torsion of the femur using this test. Place the patient prone with knees flexed to 90 degrees. On the side that you are testing, position the lower extremity to the point in which the greater trochanter is most prominent laterally (determined by internally and externally rotating the femur while palpating the greater trochanter). Using a goniometer with the stationery arm perpendicular to the floor (representative of the femoral neck axis) and the moving arm perpendicular to the floor (representative of the line between the femoral condyles) you can determine the angle of torsion of the femur. Antetorsion: an angle of torsion greater than the upper range of typical values; Retrotorsion: an angle less than the lower range of typical values.


• The average angle of torsion in children between 4 and 7 years of age is 23 - 26 degrees (Cusick, 1990, p.94).
• Femoral torsion is complete between 8 and 16 years of age; ie: torsion angles approach those of an adult (Cusick, 1990, p.94).
• The average angle of torsion in adults is 15 degrees (Hertling & Kessler, 1996, p. 285). Some authors place values between 8 and 15 degrees (Magee, 1997, p. 475).

Thomas Test/Test for Flexion Contracture of the Hip:

The patient is supine, with his pelvis level and square to his trunk. Stabilize the pelvis by placing your hand under the patient's lumbar spine. Have the patient flex both his hips, bringing his thighs up onto his trunk. Have the patient hold one leg to his chest and let his other leg down until it is flat on the table. If the thigh rises off the table, the test is positive for a hip flexion contracture. This test does not differentiate between tightness of the iliopsoas versus the rectus femoris.

Modified Thomas Test:

This utilizes the same patient position as for the Thomas Test, but in addition, the patient scoots down the table until his knees are approximately four inches over the edge. Have the patient perform the maneuver for the Thomas Test. If the thigh rises off the table, attempt to flex the knee on that side. If the knee flexes easily, the tight hip flexor is the iliopsoas (positive test for iliopsoas). If you are unable to flex the knee, or resistance is felt, the rectus femoris is tight (positive test for rectus femoris).

Ely's Test/Femoral Nerve Stretch Test:

Evaluates irritation of the femoral nerve via stretching of the nerve. The patient is prone on the table. Flex the knee to 90 degrees or greater then passively extend the hip. Anterior and/or medial thigh pain is positive for femoral nerve irritation.

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