SPECIAL TESTS

TOPIC: HIP, KNEE and LEG, ANKLE and FOOT

Group 3: YAKUZA BSPT3A
Abadiez
Almocera
Atillo
Babad
Esquillo
Equinan
Gemperoa
Jo
Lamela
Lim
Mandawe
Zamora
 REGION: HIP
Name of the Anatomic, Kinesiologic & Physiologic Starting Procedure Results (*) Results (*)
Test (including background position of Interpretation (:) Interpretation (:)
conditions both Patient POSITIVE NEGATIVE
indicated) and Therapist
Patricks Test Pain and limitation of movement may be Patient 1. Place the patients test leg so that *Test legs knee *Test legs knee
(FABER, Figure caused by reflexive spasm of the >Supine the foot of the test leg is on top of remains above falling to the
of Four, adductors on the side where there is hip Therapist the knee of the opposite leg the opposite table or at least
Jansens Test) or sacroiliac dysfunction. >At the side 2. Slowly lower the knee of the test straight leg and if being parallel
>Used to of the patient leg towards the examining table pain results with the
indicate opposite leg
iliopsoas spasm Both sides of LE examined :There may be
or sacroiliac iliopsoas spasm or :Normal
joint affectation affectation of
sacroiliac joint
Trendelenburgs The gluteus medius and gluteus minimus Patient 1. Observe the patients hip while *Non-stance side *Non-stance
Sign muscles are responsible in abduction of >Standing on standing of pelvis drops side of pelvis
>Used to assess the hip, they support the opposition of one leg 2. To add difficulty and to test overall rises
the stability of the pelvis and prevents the pelvis from Therapist stability of hip and pelvis, let patient :Indicates weak
the hip and the dropping. The upward displacement of >Behind the perform single leg squat gluteus medius or :Normal
ability of hip the the greater trochanter shortens the patient unstable hip due
abductors to fibers of the gluteus medius muscle. Perform on normal side first to dislocation on
stabilize the the stance side
pelvis on the
femur
Craigs Test Anteversion of hip is measured by the Patient 1. Palpate posterior aspect of greater *Measurement of *Measurement
>Used to angle made by the femoral neck with the >Prone; knee trochanter angle greater of angle within
indicate femoral condyles. It is the degree of flexed to 2. Passively rotate hip medially and than 15degrees 8-15degrees of
measurement of forward projection of the femoral neck 90degrees laterally until greater trochanter is femoral
femoral Therapist anteversion
anteversion or from the coronal plane of the shaft and >At the side parallel to examining table or when it :Indicates medial
forward torsion it decreases during the growing period. of the patient reaches its most lateral position femoral torsion :Normal
of femoral head Birth: 30degrees 3. Measure the angle of femoral
Adult: 8-15degrees anteversion using goniometer *Measurement of
angle less than
Both sides of LE examined 8degrees

:Indicates lateral
femoral torsion or
retroversion
Torque Test The hip joint capsule is a substantial Patient 1. Passively extend the involved hip *Patient *No pain; intact
>Used to assess contributor to joint stability. >Supine; (with hand supporting at the ankle) experiences groin capsular
hip joint close to edge until the pelvis begins to rotate or lateral hip pain ligament
stability of examining anteriorly integrity
table with 2. Medially rotate the hip and then :Indicate sprain of
femur of test place a postero-lateral force along the coxofemoral :Normal
leg abducted the line of the neck of femur for joint capsule or
over the edge 20secs in an attempt to distract it supporting
of table ligaments
Therapist
>Medial side
of test leg
Nelatons Line Coxa vara is the decrease in angle of the Patient 1. Imaginary line drawn from ischial *Greater *Tip of the
>Used to axes running through the long axis of the >Supine tuberosity to the ASIS trochanter of greater
indicate CDH or femur and horizontally through the Therapist 2. Palpate greater trochanter femur palpated trochanter lies
coxa vara head. >At the side well above the on or below the
of the patient Both sides of LE examined line line

:Indicates :Normal
dislocated hip or
coxa vara
Bryants When there is coxa vara, or central Patient Line 1: A straight line connecting the *Differences in *Shows the
Triangle dislocation of hip or femoral neck >Supine greater trochanter of the femur with the measurement same
(Iliofemoral fracture, the supratrochanteric line is Therapist the anterior superior iliac spine; of Line 3 measurement on
triangle) shortened since the leg is pulled up, due >At the side each side
>Used to to possible muscle guarding. of the patient Line 2: A vertical line down from the :Indicates supra-
indicate Normal coxa vara: anterior superior iliac spine towards trochanteric :Normal
conditions of <125degrees the bed; shortening and
coxa vara or may be due to
CDH Line 3: A horizontal line starting at CDH or coxa vara
the greater trochanter, and meeting deformity
Line 2.

The length of Line 3 is gauged on

each side, and the sides compared.
Ortolanis Sign When the femoral head relocates into Patient 1. Flex hip and grasp the legs so that *Therapist feels a *Hips can be
>Used to the acetabulum during abduction, a click >Supine thumb of therapist is against the click, clunk or jerk equally flexed,
indicate CDH in is made thus means that the hip Therapist insides of the knees and thighs of which means that abducted and
an infant; test dislocation is reducible. >At the side patient the hip has laterally rotated
started with of the patient 2. Apply gentle traction and abduct reduced without
dislocated hip thigh producing a click
and test will Precaution: 3. Resistance to abduction and :Indicates that the
help reduce hip Do not lateral rotation begins to be felt at femoral head has :Normal
perform 30-40degrees if hip is dislocated slipped over the
beyond 2-3 acetabular ridge
months, into the
articular acetabulum
cartilage may
be damaged
Barlows Test When Femoral head relocates into this Patient Repeat all the steps from Ortolanis If the femoral If there is no
acetabulum during abduction, a click is >Supine sign. head slips forward click, clunk or
Therapist into the jerk heard.
Modification of made. This indicates hip dislocation that >Facing legs of The examiner then uses the thumb to acetabulum with a
Ortolanis Test is reducable. infant apply pressure backward and click, clunk or jerk.
for outward on the inner thigh.
Developmental When hips are adducted,this causes If the femoral
Dysplasia of the posterolateral movement of the proximal head slips out
Hip femur, causing a possible dislocation. over the posterior
(DDH) When positive, this means hip is lip of the
dislocatable and unstable. acetabulum and
This test may be then reduces
used for infants again when
up to 6 months pressure is
of age. removed, the hip
is classified
unstable.

Indication: The hip

is not dislocated
but is
dislocatable.
Galeazzi Sign The hip joint is a multiaxial ball-and- Patient Examiner places childs feet flat on One knee is higher Equal Height.
(Allis or Galeazzi socket joint that has maximum stability >Supine the examining table with hip flexed 90 than the other.
Test) because of the deep insertion of the head degrees. Normal
of femur in the acetabulum. Therapist Indication:
-Is only for >In front of PT examines the height of the knees. Unilateral CDH/
assessing the patient DDH
unilateral
CDH/DDH and
may be used in
children from 3-
18 months of
age.
Telescoping The hip joint is a multiaxial ball-and- Patient The child lies supine. If there is a lot of Only little
Sign (Piston or socket that has maximum instability >Supine relative movement
Dupuytrens because of the deep insertion of the head The examiner flexes knee and hip to movement. occurs when
Test) of the femur into the acetabulum. Therapist 90 degrees. Excessive lifting legs back
>Beside the movement. up.
-Used to assess -The femur will glide up and down within patient The femur is pushed down onto the
dislocated hip in the soft examining table. Indication:
children. Dislocated hip
The femur and leg are then lifted back
up.
Abduction Test The hip joint is a multiaxial ball-and- Patient Childs knees and hip are flexed to 90 If one leg goes Normally one leg
(Harts Sign) socket joint that has maximum stability >Supine degrees and the examiner passively farther than the abducts as far as
because of the deep insertion of the head abducts both legs and then one leg at other. the other leg.
of the femur into the acetabulum. Therapist a time. Noting any asymmetry or
>In front of LOM. Indication: Hip
the patient. Dislocation.
True Leg Length Leg length for both legs are usually Patient Examiner measures from the ASIS to If there is leg No discrepancy/
Test (Measured) symmetrical and of the same length from >Supine medial/lateral malleolus. length slight difference
the landmark (ASIS) discrepancy only (1-1.5 cm)
Therapist
>Beside the Indication: True Normal
patient shortening is a
result from
congenital
maldevelopment.

Functional
Shortening is a
result of
compensation.
Hip Scour Test The stressed or compressed the femoral Patient The Examiner flexes and adducts the Irregularities in No abnormal
(Flexion neck against the acetabulum, or pinched >Supine hip so that the hip faces the patients movement such movements, pain
Adduction Test adductor longus, pectineus, ilio psoas, opposite shoulder and resistance to as bumps etc. Pain during the test or
the quadrant or sartorius or tensor fascia lata. Therapist the movement is felt. or patient patient
scouring test.) >On the side apprehension are apprehensions
of the limb of As slight resistance is maintained, the also taken into are present.
the patient patients hip is taken into abduction consideration
where test while maintaining flexion in the arc of because these
will be movement. may give an
conducted. indication of
where the
pathology is
occurring in the
hip.
McCarthy Hip The Hip labrum is a dense fibro Patient The Examiner then takes the good There would be No reproduction
Extension Sign cartilaginous tissue . mostly composed of >Supine hip and extends it from the flexed reproduction of of pain would be
type 1 collagen that is typically between position, first with the hip in lateral the patients pain. felt by the
(Test for predict 2-3mm thick that outlines the acetabular Therapist rotation, and then in medial rotation. patient.
Labral socket and attaches to the bony rim of >On the side The non-test leg is kept in flexion. The
pathology pain) the acetabulum. Hip labral disorders are of the normal test is repeated on the affected hip.
pathologies of this structure; in most limb of the
cases this is caused by a tear in the patient.
labrum but it can also be caused by a
dislocation, misalignment from bony
structures ore a not optimal angle of the
caput femoris.

Anterior Labral 1. Labrum aka: cotyloid ligament- a Patient 1. Examiner takes the hip into full Production of No pain or any
Tear Test fibrocartilagionous structure attached to >Supine flexion, external rotation, and full pain, reproduction of
(FADDIR Test) position abduction as a starting position. reproduction of patient symptom
 the edge of the acetabulum in a Therapist 2. Examiner then extends with patients
relatively secure manner. >Stands at the internal rotation and adduction. symptoms with or :Normal
- Increases concavity and deepens socket side of the without a click, or
limb to be apprehension:
tested Indication of
anterior-superior
impingement
syndrome,
anterior labial
tear and iliopsoas
tendinitis.
Posterior Labral Labrum- (cotyloid ligament- a Patient 1. Examiner takes the hip into full Groin pain, No pain or any
Tear Test fibrocartilagionous structure attached to >Supine flexion, adduction, and internal patient reproduction of
the edge of th relatively secure manner. position rotation as a starting position. apprehension, or patients
- Increases concavity and deepens socket Therapist 2. Examiner then takes the hip into reproduction of symptom
>Stands at the extension with abduction and patients
side of the external rotation. symptoms, with :Normal
limb to be or without a click:
tested Indication of a
labral tear,
anterior hip
instability or
posterior-inferior
impingement.
Weber-Barstow The medial malleolus is the prominence Patient 1. Patients hips and knees are flexed Any asymmetry in Symmetry in the
Maneuver on the inner side of the ankle, formed by >Supine 2. Examiner palpates the distal the position of position of
>Used to the lower end of the tibia. Therapist aspect of the medial malleoli with malleoli. malleoli
measure leg >Standing at the thumbs. Different levels.
length Neck shaft angle of femur at birth: 150- the pts feet 3. patient lifts the pelvis from the
asymmetry 160 at birth and decreases to between examining table and returns to the Indicates Leg
120-135 in the adult starting position. Length
4. Examiner passively extends pts DIscripancy (LLD)
Angle less than 120- Coxa Vara legs and compares the positions of
Angle greater than 135- Coxa Valga the medial malleoli using the borders
of the thumbs.

Apparent Leg- May be a result of an addution Patient Examiner obtains the distance If the true leg Umbilicus-
length Test contracture of the hip joint, which has to >Supine between the umbilicus and medial length is normal malleolus
be compensated for by tilting of the Position malleolus. but the umbilicus- measurements is
pelvis or SIJ pathology causing pelvic Therapist malleolus normal.
rotation >Stands at the measurement is
side of the different.
patients limb
Standing ASIS- Anterior Superior Iliac Spine Patient 1. Examiner palpates the ASIS and Difference is still Normal
(Functional) Leg provides attachment for the inguinal >Relaxed, PSIS, noting any asymmetry. noted:
Length Test ligament and Sartorius muscle. symmetric
stance
 PSIS- Posterior Inferior Iliac Spine is the 2. Examiner places pt in in a Indicates
posterior border of ala which is lower Therapist symmetric stance ensuring subtalar structural leg
than the anterior which serves as the joint in a neutral position. length diference,
attachment of posterior SI ligament and 3. Toes of the pt are facing straight SI joint
multifidus. ahead, and the knees are extended. dysfunction, weak
4. ASIS and PSIS are assessed again gluteus
for asymmetry. medius/quadrates
5. Examiner should check for lumborum
structural leg length differences, SI muscles.
joint dysfunction, or weak gluteus
medius or quadratus lumborum
muscles if there are still differences
noted.
Adduction Adductor longus Patient 1. Normally, examiner can easily If the ASIS moves Hip abduction is
Contracture O- Pubic body >Supine w/ balance the pelvis on the legs during hip 30-50 before
Test I- Linea aspera both ASIS which implies a line joining the ASIS abduction before the ASIS moves.
N- Obturator N. level with is perpendicular to the two lines 30, affected leg
each other formed by the straight legs. forms an angle
Adductor magnus -If a contracture is present, affected less than 30. The
I- Pectineal line and proximal part of leg forms an angle less than 90 with adductors are
linea aspera the line joining the two ASIS. tight if a muscle
N- Obturator N.O- Body & Inf. ramus of 2. if the examiner attempts to stretch end feel is
pubis balance the lower limb with the felt.
I- pelvis, the pelvis shifts up on the
N- Obturator N. affected side or down on the
unaffected side, and balancing isnt
Adductor brevis possible.
O- Inferior ramus of pubis, ischium
I- Gluteal tuberosity, linea aspera, and
medial supracondylateral line
Thomas test Iliopsoas refers to the combination of Patient 1. Examiner checks for excessive Patients straight Hip being tested
the psoas major and the iliacus at their >Supine lordosis. leg rises rises off remains on the
inferior ends, Therapist 2. Examiner flexes one of the the table and a examining table:
Strongest of the hip flexors, important >At the side patients hips, bringing the knee to muscle stretch - Theres no
for standing, walking, and running. of the patient the chest to flatten out the lumbar end feel is felt: flexion
spine and to stabilize the pelvis. - Theres a contracture
3. Patient holds the flexed hip contracture
against the chest. present
4. The test could also be done with
the starting position of both knees Contralateral hip
fully flexed to the chest and slowly flexes without
lowering the leg being tested to see knee extension
if the leg makes it to the table. indicates iliopsoas
tightness.
Elys Test The Rectus Femoris flexes thigh at the The patient The therapist passively flexes the On flexion of the On flexion of the
>Used to assess hip joint. lies prone. patients knee. Two sides should be knee, the knee, the
patients with tested and compared. patients hip on patients hip on
tight Rectus the same side the same side
Femoris spontaneously doesnt
flexes, indicating spontaneously
that the Rectus flex.
Femoris muscle is
tight on that side :Normal
and that the test
is positive.
Obers Test The Tensor Fasciae Latae helps stabilize The patient is The therapist then passively abducts If a contracture If a contracture
>Used to assess the steady hip and knee joints by putting in the side and extends the patients upper leg present, the leg is not present,
patients with tension on the Iliotibial band. lying position with the knee straight of flexed to 90 remains abducted the leg will not
Tensor Fasciae with the degrees. The therapist then lowers and does not fall remain abducted
Latae lower leg the upper limb. to the table. and it will fall on
Contracture flexed at the the table.
 hip and knee
for stability. :Normal

Noble The Iliotibial Band Friction Syndrome is The patient The therapist applies pressure with At approximately At approximately
Compression irritation of the iliotibial band as it lies supine, the thumb to the lateral femoral 30 degrees of 30 degrees of
Test passes over the lateral femoral condyle. and the knee epicondyle or 1 to 2 cm (0.4 to 0.8 flexion (0 being flexion, the
Contributing factors could be tight is flexed to 90 inch) proximal to it. While the a straight leg), if patient doesnt
tensor fasciae latae or tight gluteus degrees pressure is maintained, the patient the patient complain of
~ Used to maximus. Because the iliotibial band accompanied slowly extends the knee. complains of severe pain.
determine attaches to the patella and lateral by hip flexion. severe pain over
whether retinaculum, it may cause anterior knee the lateral :Normal
Iliotibial Band pain. femoral condyle,
friction a positive tests is
syndrome exists (Pg. 711, Therapeutic Exercise by Kisner indicated. The
near the knee and Colby, 5th edition) patient usually
says it is the same
pain that
accompanies the
patients activity.
(e.g running)
Piriformis Test The sciatic nerve exits the pelvis through The patient is The patient flexes the test hip to 60 If the piriformis No pain in the
the greater sciatic foramen and typically in the side- degrees with the knee flexed. muscle is pinching buttock and no
~ used to assess courses below, although sometimes lying position the sciatic nerve, sciatica
for Piriformis through, the piriformis muscle. with the test The examiner stabilizes the hip with pain results in the experienced.
syndrome Piriformis syndrome may occur from a leg one hand and applies a downward buttock and
shortened muscle, causing compression uppermost. pressure to the knee. sciatica maybe :Normal
and irritation of the nerve at this site. experienced by
The nerve is protected under the gluteus the patient.
 maximus as it courses between ischial
tuberosity and greater trochanter,
although injury may occur in this region
with hip dislocation or reduction.
Hamstrings The hamstring group of muscles extends M1- The M1- the patient actively extends M1- if the M1- The
Contracture the thigh at hip joint and flexes leg at supine patient each knee in turn as much as popliteal angle popliteal angle is
Tests (Method knee joint. flexes both possible. For normal flexibility, in the (angle between in the normal
1&2) hips to 90 hamstrings, knee extension should two lines--- one range of 125-155
The normal range for the popliteal angle degrees while be within 20 degrees of full line along the degrees.
Method 1 (M1)- is 125-255 degrees which will be the the knees are extension. shaft of the femur
90-90 Straight basis on whether the test is positive or bent. The and one line M2- Normally,
Leg Raising negative. patient may M2- The patient then attempts to along the line of the patient
Test grasp behind flex the trunk and touch the toes of the tibia) is less should be able to
the knees the extended lower limb (test leg) than 125 degrees, at least touch
Method 2 (M2)- with both with the fingers. The test is repeated the h amstrings the toes while
Hamstring hands to on the other side. A comparison is were considered keeping the knee
Contracture stabilize the made between the two sides. to be tight. extended.
Test hips at 90 Normally, if the
degrees of muscle is tight the :Normal
>Used to assess flexion. end fee is muscle
for Hamstring stretch.
muscle M2- The
contracture patient is M2- If the patient
instructed to is unable to touch
sit with one the toes while
knee flexed keeping the knees
against the extended, it is an
chest to indication of tight
stabilize the hamstrings on the
pelvis and the straight leg.
 other knee
extended.

Phelps Test The gracilis muscle adducts thigh at hip The patient The therapist passively abducts both If abduction If abduction
>Used to assess joint and flexes leg at knee joint. lies prone of the patients legs as far as increases, the test doesnt increase,
for the with the possible. The knees are then flexed is considered the test is
contracture of knees to 90 degrees and the therapist tries positive for considered
the Gracilis extended. to abduct the hips further. contracture of the negative.
muscle gracilis muscle.
:Normal
Fulcrum Test of A stress fracture is a partial or a The patient The fulcrum arm is moved from If a stress fracture If there is no
the Hip complete fracture that is a result of the sits with the distal to proximal along the thigh as is present, the stress fracture
>Used to assess repetitive application of stress to the knees bent gentle pressure is applied to the patient complains present, the
for possible femoral shaft over the end dorsum of the knee of the knee with of a sharp pain patient doesnt
stress fracture of the bed the therapists opposite hand. and expresses complain of
of the femoral with feet apprehension sharp pain and
shaft dangling. The when the fulcrum also no
therapist arm is under the apprehension
places an arm fracture site. when the
under the A bone scan fulcrum arm is
patients confirms the under the
thigh to act as diagnosis. patients thigh.
a fulcrum.
:Normal.
Prone Lying The IT band stabilizes the knee both in Patient in Therapist holds the ankle side of the Firm end-feel
Test (ITB extension and in partial flexion. prone test leg and maximally abducts it at
Contracture) Therapist the hip, while the other hand applies
>Iliotibial band stands on the pressure to the buttock on the same
Contracture opposite side side. Knee is flexed 90, adduct the
to the leg hip.
being tested

Kendall Test A muscle in the quadriceps, the rectus Patient in Patient flexes one knee (90) onto Knee extends Knee remains at
(Rectus femoris muscle is attached to the hip supine with the chest and holds it slightly 90
Femoris Test) and helps to extend or raise the knee. knees bent
>Rectus This muscle is also used to flex the thigh. over the end
Femoris The rectus femoris is the only muscle or edge of the
contracture that can flex the hip. examining
table
Therapist
stands on
same side to
the leg being
tested
Sign of the Patient in Therapist performs SLR test. Hip flexion does Theres no any
Buttock supine If theres limitation, examiner not increase limitation in hip
>Ischial Therapist flex the knee to see whether after flexing flexion
Bursitis, stands on further hip flexion can be knee for SLR test
neoplasm, same side to obtained
abscess in the the leg being If hip flexion doesnt increase,
tested the lesion is in the buttock or
buttock, hip the hip, not the sciatic nerve
pathology of hamstring muscle

Taking Off the Patient stands The patient is asked to remove the The affected hip No any pain felt
Shoe Test wearing shoes shoe on the opposite side by putting is laterally while taking off
>Biceps the heel of the affected side into the rotated about the shoe
femoris medial longitudinal arch of stance 90 with 20 to
contracture/an (good) leg to pry the shoe off. 25 knee flexion,
d strain leading to
contraction of
the biceps
femoris on the
affected side.

If a sharp pain is
felt in the biceps
femoris, it
indicates a 1 or
2 muscle strain.
Tripod Sign Patient is The therapist passively extends one Patient extends Patient doesnt
(Hamstring seated with knee the trunk to extend the trunk
Test Method both knees relieve the while the
3) flexed to 90 tension in the therapist
>Hamstring over the edge hamstring passively
contracture of examining muscles extends the
table knee
Therapist
stands on
same side to
the leg being
tested