Tests and Measures
Modified Thomas Test
A test to determine tightness of the rectus femoris, iliopsoas and tensor fascia latae muscles. Patient rests on the edge of table/plinth and raises one lower extremity towards their chest to position into hip flexion and is brought down to a supine position by the therapist. The opposite lower extremity remains extended and the pelvis and lumbar spine should be placed in a neutral position. The therapist passively moves the patient into extension assessing for tightness of the rectus femoris by looking to see if the knee remains extended, tightness of the iliopsoas if the hip is flexed and tightness of the tensor fascia latae if the lower extremity is in an abducted position. A goniometer can be used to measure asymmetry and to take objective measurements. There is no known diagnostic accuracy study analyzing this test.
A test to determine tightness of the rectus femoris, iliopsoas and tensor fascia latae muscles. Patient rests on the edge of table/plinth and raises one lower extremity towards their chest to position into hip flexion and is brought down to a supine position by the therapist. The opposite lower extremity remains extended and the pelvis and lumbar spine should be placed in a neutral position. The therapist passively moves the patient into extension assessing for tightness of the rectus femoris by looking to see if the knee remains extended, tightness of the iliopsoas if the hip is flexed and tightness of the tensor fascia latae if the lower extremity is in an abducted position. A goniometer can be used to measure asymmetry and to take objective measurements. There is no known diagnostic accuracy study analyzing this test.
FABER’s (Patrick) Test
A test that screens for intra-articular hip pathology, hip, lumbar or sacroiliac dysfunction, or iliopsoas spasm. The patient lies supine on a table/plinth while the therapist passively brings the patients lower extremity that is being tested into flexion, abduction, and external rotation and rests the foot on top of the opposite leg. The therapist then applies overpressure on the distal femur of the bent lower extremity while stabilizing the opposite ASIS. A positive sign is decreased motion or provocation of symptoms. The asymptomatic side should be tested first and then compared to the symptomatic side. Having the patient demonstrates where the pain is may be helpful in interpreting the test. Diagnostic accuracy for hip osteoarthritis: Sensitivity=53% (34-77), Specificity=71% (56-82), LR+/LR-=1.9/0.61
Diagnostic accuracy for labral tear, FAI, arthritic changes, AVN: Sensitivity=81% (57-96), Specificity=25% (9-48), LR+/LR-=1.1/0.72
A test that screens for intra-articular hip pathology, hip, lumbar or sacroiliac dysfunction, or iliopsoas spasm. The patient lies supine on a table/plinth while the therapist passively brings the patients lower extremity that is being tested into flexion, abduction, and external rotation and rests the foot on top of the opposite leg. The therapist then applies overpressure on the distal femur of the bent lower extremity while stabilizing the opposite ASIS. A positive sign is decreased motion or provocation of symptoms. The asymptomatic side should be tested first and then compared to the symptomatic side. Having the patient demonstrates where the pain is may be helpful in interpreting the test. Diagnostic accuracy for hip osteoarthritis: Sensitivity=53% (34-77), Specificity=71% (56-82), LR+/LR-=1.9/0.61
Diagnostic accuracy for labral tear, FAI, arthritic changes, AVN: Sensitivity=81% (57-96), Specificity=25% (9-48), LR+/LR-=1.1/0.72
FADIR (Impingement) test
A test that screens for anterior-superior impingement syndrome, anterior labral tear and iliopsoas tendinitis. The patient lies supine on a table/plinth while the therapist passively brings the patients hip into full flexion, lateral rotation and full abduction as a starting position. The therapist then brings the hip into extension while combining a medial rotation with adduction motion. A positive sign is provocation of symptoms with or without a click.
Diagnostic accuracy for FAI, labral tear: Sensitivity=99%, Specificity=25%, LR+/LR-1.3/0.04 (labral tear)
A test that screens for anterior-superior impingement syndrome, anterior labral tear and iliopsoas tendinitis. The patient lies supine on a table/plinth while the therapist passively brings the patients hip into full flexion, lateral rotation and full abduction as a starting position. The therapist then brings the hip into extension while combining a medial rotation with adduction motion. A positive sign is provocation of symptoms with or without a click.
Diagnostic accuracy for FAI, labral tear: Sensitivity=99%, Specificity=25%, LR+/LR-1.3/0.04 (labral tear)
Scour Test
This test screens for non-specific hip pathology such as femoral acetabular impingement or labral tears. The patient lies supine on a table/plinth while the therapist passively flexes and adducts the hip. The therapist then applies a compressive force at the knee by applying an axial load along the longitudinal axis of the femur pushing the head of the femur into the acetabulum. The hip is then moved through an arc of flexion abduction. A positive test is resistance felt anywhere through the arc, asymmetry, and provocation of symptoms. The resistance may be caused by capsular tightness, adhesion, myofascial restriction, or labral lesion.
Diagnostic accuracy for impingement/labral/intra-articular test: Sensitivity=50% (26-74), Specificity=29% (12-51) LR+/LR= .71/1.72
This test screens for non-specific hip pathology such as femoral acetabular impingement or labral tears. The patient lies supine on a table/plinth while the therapist passively flexes and adducts the hip. The therapist then applies a compressive force at the knee by applying an axial load along the longitudinal axis of the femur pushing the head of the femur into the acetabulum. The hip is then moved through an arc of flexion abduction. A positive test is resistance felt anywhere through the arc, asymmetry, and provocation of symptoms. The resistance may be caused by capsular tightness, adhesion, myofascial restriction, or labral lesion.
Diagnostic accuracy for impingement/labral/intra-articular test: Sensitivity=50% (26-74), Specificity=29% (12-51) LR+/LR= .71/1.72
Resisted Hip Abduction Test
A test to screen intra-articular pathologies such as hip osteoarthritis. The patient is in the side lying position and is asked to abduct their leg and hold agains the therapist resistance. Positive findings are provocation of patients symptoms.
Diagnostic accuracy of OSTs for pathologies of the hip: hip osteoarthritis: Sensitivity=35%, Specificity=90% LR+/LR-= 1.83/0.82
A test to screen intra-articular pathologies such as hip osteoarthritis. The patient is in the side lying position and is asked to abduct their leg and hold agains the therapist resistance. Positive findings are provocation of patients symptoms.
Diagnostic accuracy of OSTs for pathologies of the hip: hip osteoarthritis: Sensitivity=35%, Specificity=90% LR+/LR-= 1.83/0.82
Patellar-Pubic Percussion Test (PPPT)
A form of osteophony that test non-displaced hip fractures by analyzing bone integrity through vibrations. The patient lies in supine and the therapist helps them to find their pubis symphsis and haves them hold the bell of the stethoscope on it. The therapist then makes sure the legs are in a symmetrical neutral position. While stabilizing the leg and patella in a neutral position the therapist then percusses the patella and listens for a change in pitch and loudness produced. A positive sign will be a dull and diminished sound compared to the unaffected side.
Diagnostic accuracy: Sensitivity=94%, Specificity= 95%, LR+/LR=10.4/0.06.
A form of osteophony that test non-displaced hip fractures by analyzing bone integrity through vibrations. The patient lies in supine and the therapist helps them to find their pubis symphsis and haves them hold the bell of the stethoscope on it. The therapist then makes sure the legs are in a symmetrical neutral position. While stabilizing the leg and patella in a neutral position the therapist then percusses the patella and listens for a change in pitch and loudness produced. A positive sign will be a dull and diminished sound compared to the unaffected side.
Diagnostic accuracy: Sensitivity=94%, Specificity= 95%, LR+/LR=10.4/0.06.
Additional Tests:
Please see attached documents below for additional tests for the hip.
Please see attached documents below for additional tests for the hip.