Flashcards in Hip Orthopedic Tests Deck (31)
What is the difference in how actual leg length versus apparent leg length measured?
Actual - ASIS apex to center of medial malleolus
Apparent - umbilicus to center of medial malleolus
What is the difference in the findings of actual versus apparent leg length?
Actual leg length will tell you if there is an anatomically short leg versus apparent leg length tells you if there is a functionally short leg (pelvic or spinal subluxation)
A difference in actual or apparent leg length of ___________ or more is considered significant.
How to perform Allis' Sign
Patient lies supine with knees and hips flexed and feet flat on table. Dr stands at the foot of the table and observes the knees for any height discrepancy. Dr then stands at the side of the table and looks for any height discrepancy in the knees.
Classic findings of Allis's Test
Height discrepancy indicates femoral length discrepancy if viewed from the side or tibial length discrepancy if viewed from the end of the table
How to perform Anvil Test
Patient lies supine, Dr stands at the foot of the table, elevates a straight leg and hits the bottom of the heel with a clenched fist
Findings of an Anvil Test
Pain elicited in the heel - possible calcaneal, tibial or fibular fracture depending on the pain point
Pain elicited in the hip - arthritis, femoral neck fracture, or infection
How to perform Gauvain's Sign
Patient lies with affected side up, Dr places one hand on abdominal muscles and other hand grasps just above the ankle, abducting the leg and then internally and externally rotate the thigh. On an adult, use both hands to rotate the thigh, only place hand on abdomen on infant.
Purpose of Gauvain's sign
Looking for AVN, infection, fracture or gout
In a child, TB although not as likely today due to decreased prevalence
Classic findings of Gauvain's sign
Ipsilateral contraction of abdominal muscles
Pain in the hip
Referred pain to the groin or anterior thigh
How to perform hip telescoping test
Patient lies supine, Dr passively flexes affected hip and knee to 90 degrees. Dr grasps the calf and thigh on affected side with one hand and places other hand on the thigh just above the knee, then pushes the femur into the table and then distracts the femur from the table
What is the purpose of the hip telescoping test?
Looking for hip dislocation or hip dysplasia
What are possible findings of the hip telescoping test?
Excess joint play and/or palpable click in the joint
How to perform Patrick's Test aka Patrick-Fabere Test
Patient lies supine, Dr stands on the unaffected side and patient is instructed to cross the leg into the "figure 4" position. Dr then stabilizes opposite ASIS on the table and applies downward pressure on the knee on affected side.
What is the purpose of Patrick's Test aka Patrick-Fabere Test?
Looking for hip pathology:
What is a classic finding for Patrick's Test aka Patrick-Fabere Test?
Pain in the hip or patient is unable to perform the test
How to perform Ober's test?
Patient lies with affected side up, Dr stands behind the patient and stabilizes the pelvis, using other hand to abduct and extend the thigh and hip (with knee bent at 90 degrees). Then Dr slides hand from knee to ankle while keeping the knee bent and allows knee to adduct.
What is Ober's Test testing for?
Problems with the ITB
What are classic findings for Ober's test?
Affected thigh remains abducted and may be painful or may drop with spastic jerks (clonus) indicating iliotibial contraction
How to perform Thomas Test
Patient lies supine and actively pulls unaffected knee to chest while keeping the affected leg flat on the table
What is the purpose of Thomas Test?
Looking for flexion contracture or shortening of the Iliopsoas on affected side
What are findings of Thomas Test?
The lumbar spine maintains lordosis of patient is unable to keep affected thigh flat on the table
How to perform Trendelenburg's test?
Patient stands on affected foot and raises unaffected foot off the ground. Dr stands behind patient and observes for pelvic unleveling
What is the purpose of Trendelenburg's Test?
Looking for paralysis or weakness of hip abductors on the affected side (glute medius) or hip dysplasia
What is a classic finding of Trendelenburg's Test?
High iliac crest on supported leg and low iliac crest on lifted leg
What is the most common overall cause of positive Trendelenburg's test?
What are the 2 most common disease causes of a positive Trendelenburg's Test?
1. Muscular Dystrophy
2. Multiple Sclerosis
What are possible causes for a positive Trendelenburg's Test?
Congenital hip dysplasia
How to perform Ortolani's Test
Only performed on infants; infant lies supine, Dr grasps both thighs at the levels of the lesser trochanter, then flexes and abducts the thighs bilaterally