Special Tests: Hip Joint

Special Tests Covered in this Lesson:

• Hip Pathology Tests (Hip impingement, Osteoarthritis, and Labral Tears)
  
  • FABER (Patrick's) Test
  • FADDIR Test
  • Impingement Provocation Test (Best Available)
• Abductor Weakness
  • Trendelenburg Sign & Single Leg Stance Test
• Red Flag
  • Sign of the Buttock

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 Trendelenburg Sign & Single Leg Stance Test 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 Sign of the Buttock is an important clinical test, implying "red flag" conditions that should result in referral to emergency care.

Special Notes on Hip Test Selection:

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 FADDIR Test 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.

The Trendelenburg Sign & Single Leg Stance Test 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. Gluteus Medius Manual Muscle Testing ). Further, hip muscle weakness may result from dysfunction of the lumbar spine, sacroiliac joint, or hip joint.

Last, the Sign of the Buttock 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.

Brookbush Institute Recommendations:

The Brookbush Institute 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 Sign of the Buttock 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

• 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:
• Special Tests: Introduction

Courses covering Special Tests for the Lumbo Pelvic Hip Complex

• Special Tests: Sacroiliac Joint (SIJ)
• Special Tests: Hip Joint
• Special Tests: Lower Body Neurodynamic Tests