Joint Tests: Hip, Knee, Ankle - Trendelenburg, Thomas, Leg Length, Meniscal, Ligament, Exercises of Anatomy

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Special Tests of The Hip Joint

Yasser Moh. Aneis, PhD, MSc., PT.

Lecturer of Physical Therapy

Basic Sciences Department

Special Tests of The Hip Joint

• Trendelenburg Test
• Thomas Test
• Iliotibial Band Shortening Test (Ober's Test)
• Leg Length Discrepancy Tests
• Ortolani's test
• Barlow's test
• True Leg Length Discrepancy Test
• Apparent Leg Length Discrepancy Test
• Tests for Congenital Hip Dislocation

TRENDELENBURG TEST

• Figure B shows a position of hip joint adduction that results when hip abductors are too weak to stabilize the pelvis on the femur. The pelvis drops downward on the opposite side.
• Figure B indicates a positive Trendelenburg Sign On the right side i.e. Weak right gluteus medius muscle.
• Figure A indicates a negative Trendelenburg Sign On the right side i.e. Strong right gluteus medius muscle.
• With paralysis or marked weakness of the gluteus medius, a gluteus medius limp (waddling gait) will occur in walking.

• Patient stands with feet about 12 inches apart.
• Patient then stands on the affected limb.
• Normally the abductor muscle of the affected limb (gluteus medius) will contract to hold the pelvis stable.
• If the abductor muscles (gluteus medius) are not functioning (become weak and atrophy, or have a nerve lesion (L5)) then
• The pelvis will fall away on the opposite side.

Testing Procedures

Thomas Test

Thomas Test

oThis is a test for a hip flexion contracture. It is done as follows:

• Examining from the patients right hand side.
• Ask the patient to bring both knees up into their chest.
• Put your left hand underneath their lumbar spine to make sure it is flat on the bed.
• Ask the patient to let their right leg drop down flat on the bed while holding the left knee into the chest.
• The right leg should be able to drop flat down onto the bed and the lumbar spine should stay flat on the bed.
• Alternate legs and do the same thing with the other legs.

Substitutions

• Patients will sometimes hyperextend the lumbar spine which will allow the leg to fall flat on the table.
• This will “trick” you into thinking that the hip has full extension.
• So make sure that the lumbar spine stays flat on the table through this test.
• A concomitant knee flexion contracture will impair the patient’s ability to place the leg flat on the table.
• Again, this may “trick” you into thinking that a contracture exists in the hip.

• To overcome this, move the patient down the table to let their knees and lower legs hang over the edge of the bed.
• This will take the knee flexion contractures out of the picture.

• True leg length discrepancy
  • To determine true leg length, first place the patient legs in precisely comfortable positions and measure the distance from the anterior superior iliac spines (ASIS) to the medial malleoli of the ankles from fixed bony point to another).
    • Unequal distances between these fixed points verify that one lower extremity is shorter than the other.
  • To determine in short order where the discrepancy lies (whether in the tibia or in the femur), ask the patient to lie supine, with his knees flexed to 90 degrees and his feet flat on the table.

• If one knee appears higher than the other, the tibia of that extremity is longer. While, if one knee projects further anteriorly than the other, the femur of that extremity is longer.
• Apparent or Functional leg length discrepancy
• Establish that there is no true leg length discrepancy before testing for an apparent discrepancy, in which there is no true bony inequality.
• Have the patient lie supine with his legs in as neutral position as possible.

• Abduct the leg as far as possible, flex the knee to 90°, then extend the hip. Slowly release the patient's leg.
• If the iliotibial band is normal, the patient's thigh should d to the adducted position.
• If there is a shortening of the fascia lata or iliotibial band, the thigh remains abducted when the leg is released (positive test).

Tests for Congenital Hip Dislocation

o Ortolani's test

• The patient is positioned in supine with the hips flexed to °and the knees flexed.
• The therapist grasps the legs so that their thumbs are placed along the patient's medial thighs and the fingers are placed on the lateral thighs toward the buttocks.
• The therapist abducts the infant's hips and gentle pressure is applied to the greater trochanters until resistance is felt at approximately 30 degrees.