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Impingement Provocation Test (Posterior-Inferior Labrum)

The Impingement Provocation Test (Posterior-Inferior Labrum) is an examination used to assess pathology and instability of the posterior-inferior labrum. This test can be used to detect labral tears, tears of the rotator cuff muscles, or damage to the glenoid. The test may provide a patient with diagnostic imaging insight and create a comprehensive treatment plan. The test provides the examiner with information about the stability, integrity, and anatomy of the

Transcript

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This is Brent of the Brookbush
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Institute, and in this video we're doing
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a special or orthopedic test for the hip, this is the impingement provocation test
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for the posterior inferior labrum. I'm going to have my friend Crystal come out,
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she's going to help me demonstrate. Now this test is is not a hard test to do, it is a
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little different than some of the other special tests we've done. We'll find that
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the special tests for the hip tend to be very anterior dominated. A lot of them
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have to do with like some sort of anterior impingement or osteoarthritis
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of the anterior femoral head and acetabulum, or anterior labrum. But every once in a
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while you'll get that odd patient who comes in and they're complaining about
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maybe buttock pain with activity, they're complaining about a pinching when they
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go into hyperextension, and you start thinking well that doesn't really sound
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like an anterior hip issue, I need to have a test that I can see if there's
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something going on with the posterior hip. Specifically the posterior inferior
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hip, which is where this test comes in handy, and it's fairly simple to do.
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You're going to have your patient or client lay down, move all the way to the edge of
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the table on the side that's affected, and then you're just going to guide their
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leg off the table into abduction, external rotation, and hyperextension. And
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if this provokes their symptoms, then this would be a positive test. Alright,
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so one more time, if I just let her fall and go ahead and relax for me, there you
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go, and then she just falls into abduction,
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external rotation and hyperextension. How does that feel Crystal? Fine, okay so that
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would be a negative impingement provocation test for the posterior
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inferior labrum. Now if she was positive what would that tell us. Well we think
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this might be a sensitive test, although we need a little bit more research on
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this test there's just not that much research. Is it specific, it's kind of
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hard to tell. Is it posterior impingement or is a posterior labrum, we've
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kind of noticed that when it comes to the hip, specificity with all of our
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special tests is a problem. But as far as its use, I think it's a great test to
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fill in that hole for those individuals who don't fit the very typical anterior
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hip pain. If somebody did come in positive and this provoked their
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symptoms, this would be a test I would use as a quick test where I could go
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okay boom there's my concordance sign right. The sign that provoked their
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symptoms. Now I can do my intervention, and I have something to come back to to see
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if my interventions worked. Again assess, address and reassess. This is a fairly
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simple test to do that. So again guys this would be a test that I would I
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would think towards, okay somebody has some buttock pain, or they have like
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maybe even lateral to posterior pain of the hip. It tends to come on with
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activity, maybe long term sitting we could we could look into, but probably
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more along the lines of higher intensity stuff where they're going into
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hyperextension. Maybe pain while walking in the buttock, alright good I need to I
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need to check this out. Again just let their leg fall off and
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guide them into some external rotation as you pull them down, alright
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ask them that question of is this the symptoms you were talking about?
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Yeah, okay and in that case it would be a positive. This would become my quick
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test, or my pretest post-test as I go through it, my interventions. Guys keep
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this one in the the back of your brains, it's not going to be something you use
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often, but it will come up I can promise you that.