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13 Orthopedic Tests for Hip and Pelvis

Reviewed By: Pramod Kerkar, MD, FFARCSI

Trendelenburg Sign
Trendelenburg's sign is named after Friedrich Trendelenburg who was a German
surgeon. This sign is positive in individuals whose abductor muscles of the hip, i.e.
gluteus medius and gluteus minimus, have become weak or paralyzed. During
test patient is advised to stand on one leg. Trendelenburg sign is considered
positive if upon standing on one leg, the patient's pelvis tilts on the opposite side.
The tilt on opposite side is caused by weakness of gluteus minimus and maximus
muscles of opposite side of the stance leg. A positive Trendelenburg sign indicates
muscular dysfunction, i.e. weakness of the gluteus minimus or medius. During
Trendelenburg' test patient may complain of pain on opposite side.

Telescoping Sign
Telescopic sign is observed during orthopedic test to asses dislocated hip. The
patient is made to lie supine or at on their back on an examination table. The
examiner stands on opposite side of the leg which is tested. The leg to be tested is
bent at 90 0 at knee and hip joint. Gentle pressure is applied in a downward
motion towards the table and then lifted back up. The test is positive if the patient
does not exhibit any movement or if there is excessive movement due to hip
dislocation. During test patient complaints of increase pain. The test is negative if
there is only a little bit of movement and patient do not complaint of increase
pain.

Pelvic Rocking Test

Pelvis rocking test is done to diagnose stability of a sacroiliac joint. The patient is
made to lie supine on table with leg ex at knee and hip joint. The examiner holds
and support pelvis by placing thumb on iliac crest and palm as well as four ngers
spread over side and back of the pelvis. Both the palms of the hands are pushed
towards each other. Examiner then rocks the pelvis to rotate sacroiliac joint. The
manual rocking stresses the sacroiliac joint. The test is considered positive if there
is pain around the sacroiliac joint. Positive Pelvic Rocking Test Indicates trauma or
injury to the sacroiliac joint or sacroiliac joint infection.
Ortolani Test or Ortolani Maneuver
Ortolani Test includes Barlow Maneuver followed by Ortolani Maneuver. The test
was described in 1937 and is named after Michael Ortolani. Barlow Maneuver is
done rst then Ortolani maneuver is performed. The test is performed to
diagnosed congenital dysplasia of the hip joint. The Barlow Maneuver dislocates
the hip joint and Oetolani maneuver reposition the hip joint by adjusting head of
femur in hip joint socket.

Barlow maneuver- Examiner supports both leg with hand in ex position at knee
joint. Then hip joint is also ex at 90 0. Examiner while continuing his hands on
knee joint adduct the leg at hip joint while leg is pushed posteriorly toward the
examining bed. Examiner may feel or hear click while hip joint is dislocated. This
maneuver dislocates both or one hip joint.

Ortolani Maneuver- Ortolani Maneuver was described by Marino Ortolani.

Following Barlow Maneuver Ortolani Maneuver is performed to reposition the
head of femur in hip joint socket. The procedure is known as relocating a
dislocated hip joint. The position of both knee and hip joint is maintained at 90 0
during entire period of test. The examiner repositions the hand to hold the leg.
The examiner palpates the greater trochanter with index nger and also abducts
the leg at hip joint using thumb. The maneuver places the head of femur into hip
joint socket with a click sound. The test con rms the diagnosis of congenital hip
joint dysplasia.

Ober's Test
Ober's Test is done to determine the tightness of the iliotibial band. The patient is
asked to lie on the examination table in a lateral position on normal side. The arm
is ex at elbow and tuck under head. The normal leg is maintained in straight
lateral position during test. The painful leg is then maneuver by examiner.
Examiner holds the leg as shown in image below. The right hand is placed over
a ected hip joint and pelvis, while leg is extended and abducted with left hand.
The examiner then releases the hand that was supporting the knee. If the knee
fails to adduct then it is a positive test and indicates iliotibial band syndrome.
Kemp's Test
Kemp’s test is performed to diagnosed nerve root compression. Test helps to
diagnose radicular pain and rule out lumbar sprain as well as pain cause by
abnormal facet joint. The test is performed in sitting position. Examiner stands
behind the examination table. The right hand is placed over right upper chest and
shoulder joint. The left hand is placed on mid back of opposite side or left side as
shown in image below.

The patient is asked to lean forward and maintained ex position. Then patient is
asked to move the upper body from left to right side while maintaining the back
in ex position. The test demands movements of optimum tilt to right and left
side while maintaining ex position of back. The test evaluates the cause of
radicular pain or pinch nerve. Test is considered positive if patient is complaining
of sudden jolting pain on one side that radiate to back of the leg.
Thomas' Test
Thomas test was described by orthopedic surgeon Dr. Hugh Thomas from Great
Britain. The test helps to diagnose hip exion contracture and psoas syndrome.
Test can be false negative in patient who may have good pain tolerance. The
patient is asked to lie supine on examination table with both legs hanging over
the side of the examination bed. Both the legs are maintained in ex positon at
knee joint. Examiner stands on side of patient that has pain. Examiner then assist
patient to ex leg at hip joint. Examiner carefully pushes ex leg towards chest.
During this maneuver patient su ering with psoas syndrome or hip exion
contracture will not be able to maintained opposite leg in fully extended position
at hip joint. The test is repeated on other side.

The test is diagnostic if moderate to severe pain is elicited on opposite side. The
test often results as false negative when patient with good pain tolerance feel
obliged to maintain leg in extended position.
Yeoman's Test
Yeoman test is performed to diagnose sacroilitis and sacroiliac joint sprain.
Patient is asked to lie in prone position over the examination bed. Patient is
instructed to maintain both arms on side and head in neutral position. Examiner
will stand on opposite side of the leg that is to be tested. As shown in image while
testing left leg, examiner places his right hand over ilium and left hand in front
and above the knee joint. The test involves two maneuvers. First examiner tries to
tilt the ilium and pelvis outward; and same time he extends the opposite leg at hip
joint with left hand. Patient su ering with sacroilitis and sacroiliac joint sprain will
feel pain over sacroiliac joint of the leg which is being tested.
Patrick's Test
The test is performed to evaluate hip and sacroiliac joint diseases. The patient is
asked lie supine on examination bed. Both the legs are tested alternately.
Examiner will stand on side that is being tested. The leg is ex at knee and hip
joint simultaneously. Then leg is abducted and laterally rotated. The knee is
pressed towards the bed while foot is rested on thigh of opposite leg. The test is
also known as FABER test (F- Flexion. AB- Abduction and ER- External Rotation).
Patient su ering with hip or sacroiliac joint disease will complaint of moderate to
severe pain.
Nachlas' Test
The patient is instructed to lie in a prone position on the table for Nachlas' Test.
Examiner will stand on one side of bed. One leg at a time is exed at knee joint
while leg is maintained in straight position at hip joint. The heel of the feet is
attempted to touch the buttocks on same side. The Nachlas test is considered
positive if patient is complaining of sharp pain over the sacral region. The possible
cause of pain could be sacroiliac joint injury, sprain or in ammation.

Pain is also observed if patient is su ering with knee joint sprain or arthritis. If
pain is felt in the lower back and radiate over the back of the thigh then cause of
the pain could be radicular pain originates from pinch of spinal nerve at L3, L4 or
L5 foramina.
Hibb's Test
In Hibb's test, the patient is made to lie in a prone position. Examiner stands on
opposite side of the bed. As shown in image below examiner while on right side
holds the feet of left leg and assist patient to ex the knee joint at 90 0 exion.
The hip joint is maintained in neutral position lying at on bed. Gently examiner
rotate the leg to outer side while supporting the lower back and pelvis with right
hand. Test is repeated on both leg. The test is considered positive if pain is elicited
during the test. The positive test suggests possible sacroiliac joint disease, hip
joint disease or radicular pain. Sacroiliac joint pain is caused by joint in ammation
or arthritis. Hip joint pain is caused by arthritis or joint sprain. Radicular pain is
caused by piriformis entrapment. The test is considered diagnostic for piriformis
entrapment disease that causes pain radiate to back of the thigh while
radiological nding suggests normal sacroiliac joint and hip joint.
Ely's Test
Patient is advised to lie on examination bed in prone position with face facing the
examination table. Examiner stands on side of the examination bed. Patient is
asked to ex both the leg simultaneously at knee joint to 90 0 exion. Examiner
places his hand over the back of the calf muscles. Patient is asked to further ex
the knee. Test is considered positive if patient is raising his pelvis and buttocks
while exing the leg at knee joint against the resistance provided by examiners
hand. Positive test suggests patient may be su ering with sacroiliac joint disease
or iliopsoas syndrome. Upon the exitension of the knee, if the patient has hip
pain, then the test cannot be carried carry out further due to irritation in psoas
muscle or in its sheath. The buttock on the a ected side tends to elevate. This is a
positive Ely's test. A positive Ely's test indicates irritation or spasm in the iliopsoas
muscle or its sheath. It can also indicate pain induced by contraction of the rectus
femoris, lesion on the lumbar vertebrae, osseous hip lesion and contracture of
the tensor fasciae latae.
Gaenslen's Test
The test was described by Orthopedic Surgeon Dr. Frederick Gaenslen. Gaenslen's
test is performed to diagnose cause of back pain. The positive test suggest cause
of pain could be sacroiliac joint disease. The test is performed to stress both
sacroiliac joint simultaneously. Patient is asked to lie on examination bed in
supine position. As shown in image below, right leg is kept hanging on the side of
the bed so right hip is optimally extended. Such position stretches right sacroiliac
joint. Next patient is asked to ex knee joint. Now examiner will assist to ex the
leg at hip joint. The attempt is made to touch the knee joint to abdomen. The
maneuver will now stretch the left sacroiliac joint. The test is repeated on
opposite side. The test is considered positive if patient is complaining of pain on
one or both side. The cause of pain is sacroiliac joint arthritis or sprain. The test is
also positive if patient is su ering with spondylo-arthritis or sciatica.

All these maneuvering test are subjective test and can be false positive or false
negative. The positive test result has to be evaluated and compare by specialist
and also supported by other ndings of clinical or radiological examination. Test
has to be performed by quali ed physician, chiropractor or physical therapist.
13 Common Orthopedic Tests for the Pelvis and Hip

Written, Edited or Reviewed By:

Pramod Kerkar, MD,FFARCSI
Pain Assist Inc.
Last Modi ed On: September 11, 2018
 This article does not provide medical advice. See disclaimer

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