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Special tests for the hip joint. The FABER (Patrick's) Test, FADDIR Test, Impingement Provocation Test, Trendelenburg Sign, Single Leg Stance Test, and Sign of the Buttock. The reliability, specificity, sensitivity, validity, safety, and screening for the hip joint, hip pain, hip pathology, sacroiliac joint pain (SIJ pain), femoral acetabular impingement, labrum (labral) tear, gluteus medius weakness (a potential sign of hip pathology, and/or gluteal tendinopathy), and intra-articular pathology (tumor, abscess, necrosis, or more benign osteochondritis, loose-body pathologies, edema of the hip).

Special Tests: Hip Joint

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Hip Pathology Tests (Hip impingement, Osteoarthritis, and Labral Tears)
 

Trendelenburg Sign & Single Leg Stance Test

Hip osteoarthritis, hip impingement, and hip labral tears are among the most often diagnosed hip pathologies; however, more serious conditions do occur like muscle loss and the "sign of the buttock" (implication of intra-articular bleeding, infection, neoplasm, etc.). The hip pathology tests (hip impingement, osteoarthritis, and labral tear tests) are sensitive, but lack specificity, implying their utility to refine intervention selection is likely poor. The 

 may be observed during gait, but the tests themselves lack sensitivity. Further, hip muscle weakness may result from dysfunction of the lumbar spine, sacroiliac joint, or the hip joint; again implying these tests have poor specificity and limited utility in practice. The 

 is an important clinical test, implying "red flag" conditions that should result in referral to emergency care.

An effort was made to choose the best group of special tests for the hip, in large part by eliminating special tests with little or no clinical utility. A research study that demonstrated the utility of a test-item cluster for hip pathology could not be located. The majority of special tests for the hip are not sensitive or specific enough to have any clinical usefulness. Additionally, many special tests for the hip are simply variations of one another. For example, the 

 covered in this course is similar to the Maximal Flexion Internal Rotation (MFIR) Test, the Flexion Internal Rotation test, The Flexion Adduction Axial Compression Test, and the Flexion Adduction Internal Rotation (FAIR) test. An effort was made to select the test variation that research has demonstrated as most accurate, and/or was most well supported by the current body of research.

The clinical issue with the "Hip Pathology Special Tests," including those selected for this course, is an inability to differentiate between hip impingement, labrum pathology, osteoarthritis, and other related diagnoses. That is, some studies have noted hip special tests have high specificity, but that is only when a positive test is defined as "hip pathology". This implies that hip special tests may be good screens, but they are not helpful for differential diagnosis, and/or refining intervention selection.

 may aid in identifying significant hip abductor weakness during functional tasks; however, their sensitivity is so poor that other options must be considered during clinical evaluation (e.g. 

). Further, hip muscle weakness may result from dysfunction of the lumbar spine, sacroiliac joint, or hip joint.

 is important for identifying serious conditions that should be addressed with immediate emergency care. For example, a positive test may imply hip osteomyelitis, sepsis, neoplasm, femoral head fracture, etc. It is unlikely these conditions would be encountered frequently by sports medicine professionals; however, the severity of the issues are significant enough to imply knowledge of this "red flag" condition is recommended.

 recommends that clinical movement professionals (physical therapists, physical therapy assistants, chiropractors, occupational therapists, athletic trainers, etc.) should be aware of these tests. Physical rehabilitation (e.g. manual therapy, certain modalities, and corrective exercise) is often the safest and most effective option for treating hip impingement, labrum pathology, osteoarthritis, and/or hip muscle weakness. In practice, the abductor weakness tests likely only have utility if noted during functional movement patterns (e.g. walking into the clinic), but the tests themselves should not be included in evaluation. The hip pathology special tests likely have utility as pre-post intervention assessments, but only if the test matches the patient's symptoms (concordant sign), and likely have no utility for differential diagnosis or refining intervention selection. Last, the 

 is a "good test", but likely best used when the subjective examination indicates potentially serious issues that may require emergency care.

For an introduction to Special Tests including definitions of specific terminology, what special tests measure, accuracy (specificity, sensitivity, reliability, etc.), how we chose the tests in each special test course lessons, and best practice recommendations:

Courses covering Special Tests for the Lumbo Pelvic Hip Complex

Special Tests: Lower Body Neurodynamic Tests

Course Description: Special Tests: Hip Joint

Introduction

For an introduction to Special Tests including definitions of specific terminology, what special tests measure, how we chose the tests in these lessons, and best use, check out:

 is important for identifying serious conditions that should be addressed with immediate emergency care. For example, a positive test may imply hip osteomyelitis, sepsis, neoplasm, femoral head fracture, etc. It is unlikely these conditions are encountered frequently by sports medicine professionals; however, the severity of the issues are significant enough to imply knowledge of this "red flag" condition is recommended.

 recommends that clinical movement professionals (physical therapists, physical therapy assistants, chiropractors, occupational therapists, athletic trainers, etc.) should be aware of these tests. Physical rehabilitation (e.g. manual therapy, certain modalities, and corrective exercise) is often the safest and most effective option for treating hip impingement, labrum pathology, osteoarthritis, and/or hip muscle weakness. In practice, the abductor weakness tests likely only have utility if noted during functional movement patterns (e.g. walking into the clinic), and the tests themselves should not be included in evaluation. The hip pathology special tests likely have utility as pre-post intervention assessments, but only if the test matches the patient's symptoms (concordant sign), and likely have no utility for differential diagnosis or refining intervention selection. Last, the 

FABER (Patrick's) Test

FABER test

FADDIR (Femoral Acetabular Impingement) Test

Impingement Provocation Test

Cadaver Dissection of Hip Joint with Soft Tissue Removed and Bony Landmarks Labeled

Hip Pathology Tests (Hip impingement, Osteoarthritis, and Labral Tears)

Trendelenburg Test and Single-Leg Stance Test

Trendelenburg Sign 

Pathological Abductor Weakness

Red Flag - Sign of the Buttock

Sign of the Buttock

Red Flag

Cook, C., & Hegedus, E. J. (2008). Orthopedic physical examination tests: an evidence-based approach.

Dutton's Orthopaedic examination, evaluation, and intervention

Cliborne, A. V., Wainner, R. S., Rhon, D. I., Judd, C. D., Fee, T. T., Matekel, R. L., & Whitman, J. M. (2004). Clinical hip tests and a functional squat test in patients with knee osteoarthritis: reliability, prevalence of positive test findings, and short-term response to hip mobilization. 

Journal of Orthopaedic & Sports Physical Therapy

Clohisy, J. C., Knaus, E. R., Hunt, D. M., Lesher, J. M., Harris-Hayes, M., & Prather, H. (2009). Clinical presentation of patients with symptomatic anterior hip impingement. 

Clinical orthopaedics and related research

Martin, R. L., & Sekiya, J. K. (2008). The interrater reliability of 4 clinical tests used to assess individuals with musculoskeletal hip pain. 

journal of orthopaedic & sports physical therapy

Mitchell, B., McCrory, P., Brukner, P., O'donnell, J., Colson, E., & Howells, R. (2003). Hip joint pathology: clinical presentation and correlation between magnetic resonance arthrography, ultrasound, and arthroscopic findings in 25 consecutive cases. 

Philippon, M. J., Maxwell, R. B., Johnston, T. L., Schenker, M., & Briggs, K. K. (2007). Clinical presentation of femoroacetabular impingement. 

Knee Surgery, Sports Traumatology, Arthroscopy

Ross, M. D., Nordeen, M. H., & Barido, M. (2003). Test-retest reliability of Patrick's hip range of motion test in healthy college-aged men. 

Journal of strength and conditioning research

Theiler, R., Stucki, G., Schütz, R., Hofer, H., Seifert, B., Tyndall, A., & Michel, B. A. (1996). Parametric and non-parametric measures in the assessment of knee and hip osteoarthritis: interobserver reliability and correlation with radiology. 

Troelsen, A., Mechlenburg, I., Gelineck, J., Bolvig, L., Jacobsen, S., & Søballe, K. (2009). What is the role of clinical tests and ultrasound in acetabular labral tear diagnostics?. 

Sutlive, T. G., Lopez, H. P., Schnitker, D. E., Yawn, S. E., Halle, R. J., Mansfield, L. T., … & Childs, J. D. (2008). Development of a clinical prediction rule for diagnosing hip osteoarthritis in individuals with unilateral hip pain. 

Slipman, C. W., Sterenfeld, E. B., Chou, L. H., Herzog, R., & Vresilovic, E. (1998). The predictive value of provocative sacroiliac joint stress maneuvers in the diagnosis of sacroiliac joint syndrome. 

Archives of physical medicine and rehabilitation

Dreyfuss, P., Michaelsen, M., Pauza, K., McLarty, J., & Bogduk, N. (1996). The value of medical history and physical examination in diagnosing sacroiliac joint pain. 

Van Deursen, L. L. J. M., Patijn, J., Ockhuysen, A. L., & Vortman, B. J. (1990). The value of some clinical tests of the sacroiliac joint. 

Broadhurst, N. A., & Bond, M. J. (1998). Pain provocation tests for the assessment of sacroiliac joint dysfunction. 

Albert, H., Godskesen, M., & Westergaard, J. (2000). Evaluation of clinical tests used in classification procedures in pregnancy-related pelvic joint pain. 

Hansen, A., Jensen, D. V., Larsen, E. C., Wilken-Jensen, C., Kaae, B. E., Frølich, S., … & Hansen, T. M. (2005). Postpartum pelvic pain-the'pelvic joint syndrome': a follow-up study with special reference to diagnostic methods. 

Acta obstetricia et gynecologica Scandinavica

Röst, C. C., Jacqueline, J., Kaiser, A., Verhagen, A. P., & Koes, B. W. (2004). Pelvic pain during pregnancy: a descriptive study of signs and symptoms of 870 patients in primary care. 

Ozgocmen, S., Bozgeyik, Z., Kalcik, M., & Yildirim, A. (2008). The value of sacroiliac pain provocation tests in early active sacroiliitis. 

Arab, A. M., Abdollahi, I., Joghataei, M. T., Golafshani, Z., & Kazemnejad, A. (2009). Inter-and intra-examiner reliability of single and composites of selected motion palpation and pain provocation tests for sacroiliac joint. 

Beaulé, P. E., Zaragoza, E., Motamedi, K., Copelan, N., & Dorey, F. J. (2005). Three‐dimensional computed tomography of the hip in the assessment of femoroacetabular impingement. 

Beck, M., Leunig, M., Parvizi, J., Boutier, V., Wyss, D., & Ganz, R. (2004). Anterior femoroacetabular impingement: part II. Midterm results of surgical treatment. 

Clinical Orthopaedics and Related Research®

Burnett, R. S. J., Dellarocca, G. J., Prather, H., Curry, M., & Maloney, W. J. (2008, March). Clinical Presentation of Patients with Tears of the Acetabular Labrum. In 

 (Vol. 90, No. SUPP_I, pp. 152-152). The British Editorial Society of Bone & Joint Surgery.

Ito, K., Leunig, M., & Ganz, R. (2004). Histopathologic features of the acetabular labrum in femoroacetabular impingement. 

Kang, L., Belcher, D., & Hulstyn, M. J. (2005). Stress fractures of the femoral shaft in women’s college lacrosse: a report of seven cases and a review of the literature. 

Kassarjian, A., Yoon, L. S., Belzile, E., Connolly, S. A., Millis, M. B., & Palmer, W. E. (2005). Triad of MR arthrographic findings in patients with cam-type femoroacetabular impingement. 

Keeney, J. A., Peelle, M. W., Jackson, J., Rubin, D., Maloney, W. J., & Clohisy, J. C. (2004). Magnetic resonance arthrography versus arthroscopy in the evaluation of articular hip pathology. 

Klaue, K., Durnin, C. W., & Ganz, R. (1991). The acetabular rim syndrome. A clinical presentation of dysplasia of the hip. 

The Journal of bone and joint surgery. British volume

Leunig, M., Werlen, S., Ungersböck, A., Ito, K., & Ganz, R. (1997). Evaluation of the acetabular labrum by MR arthrography. 

Sink, E. L., Gralla, J., Ryba, A., & Dayton, M. (2008). Clinical presentation of femoroacetabular impingement in adolescents. 

Martin, H. D., Kelly, B. T., Leunig, M., Philippon, M. J., Clohisy, J. C., Martin, R. L., … & Safran, M. R. (2010). The pattern and technique in the clinical evaluation of the adult hip: the common physical examination tests of hip specialists. 

Arthroscopy: The Journal of Arthroscopic & Related Surgery

Reiman, M. P., Goode, A. P., Cook, C. E., Hölmich, P., & Thorborg, K. (2015). Diagnostic accuracy of clinical tests for the diagnosis of hip femoroacetabular impingement/labral tear: a systematic review with meta-analysis. 

Reiman, M. P., Goode, A. P., Hegedus, E. J., Cook, C. E., & Wright, A. A. (2013). Diagnostic accuracy of clinical tests of the hip: a systematic review with meta-analysis. 

Trendelenberg & Single-leg Stance Held for 30 Seconds (1-3, 24, 28)

Lequesne, M., Mathieu, P., Vuillemin‐Bodaghi, V., Bard, H., & Djian, P. (2008). Gluteal tendinopathy in refractory greater trochanter pain syndrome: diagnostic value of two clinical tests. 

Bird, P. A., Oakley, S. P., Shnier, R., & Kirkham, B. W. (2001). Prospective evaluation of magnetic resonance imaging and physical examination findings in patients with greater trochanteric pain syndrome. 

Arthritis & Rheumatism: Official Journal of the American College of Rheumatology

Greenwood, M. J., Erhard, R. E., & Jones, D. L. (1998). Differential diagnosis of the hip vs. lumbar spine: five case reports. 

Bibliography

Questions, comments, and criticisms are welcomed and encouraged

Special Tests: Hip Joint

Related Courses:

Course Description: Special Tests: Hip Joint

Introduction

Hip Pathology Tests (Hip impingement, Osteoarthritis, and Labral Tears)
3 Sub Sections

Pathological Abductor Weakness
1 Sub Section

Red Flag
1 Sub Section

Bibliography

Related Courses:

Comments

Guest

Special Tests: Hip Joint

Related Courses:

Course Description: Special Tests: Hip Joint

Introduction

Hip Pathology Tests (Hip impingement, Osteoarthritis, and Labral Tears)3 Sub Sections

Pathological Abductor Weakness1 Sub Section

Red Flag1 Sub Section

Bibliography

Related Courses:

Comments

Guest

Hip Pathology Tests (Hip impingement, Osteoarthritis, and Labral Tears)
3 Sub Sections

Pathological Abductor Weakness
1 Sub Section

Red Flag
1 Sub Section