Hello, I'm Brett DeGoyer. I'm a primary care sports medicine specialist working for Samaritan Healthcare in Moses Lake, Washington. For hip examination to determine between intra- and extra-articular issues, aside from doing palpatory exam, I'm going to demonstrate other special tests that help to distinguish between those areas. The first one is the log roll test. This is performed with the patient in a supine position, the hip and the knees in neutral position. You grasp the leg, and you're going to induce internal and external rotation to as greatest degree as their anatomy allows. Doing this back and forth will induce a click or pain in the hip region. The distinguishing factor is where the pain is located. With the log roll test, if there is a click, pop, and pain in the groin region that radiates to the inner thigh or the front of the thigh, the likelihood of an intra-articular pathology is present. If the pain localizes to the outside along the greater trochanter or posterior hip, the likelihood is of an extra-articular issue. The next test I'm going to demonstrate is the fader and faber tests. The faber test is bringing the hip into flexion, the leg into abduction, the knee into flexion, and positioning the leg and hip and knee in this manner. Adding slight compression onto the knee adds some stress at the hip joint. Again, like with the other tests, location is key if the test elicits pain. In this case, again, along the anterior capsule into the groin, intra-articular. Lateral to posterior, more extra-articular. The fader test is very similar, except instead of doing a abduction, we do a deduction and cross the foot of the side being tested over the opposite knee, and adding a little bit of stress through the knee. Looking for pain anterior or lateral to help decide is it intra- or articular pathology. The next test that I'm going to demonstrate is the stench field test, or a straight leg raise test. This is done with the leg knee extended, hip flexed to 30 to 45 degrees. The patient will maintain this positioning as I let go, and then using two fingers, I add pressure on the lower leg as the patient pushes up. If this induces pain or a click into the hip region, it's positive. Relax. Again, the location of the pain is key. If it's anterior and radiates to the groin or down the front of the leg, the likelihood is more of a intra-articular problem. If it comes out laterally and posterior, extra-articular. The final two tests that I will demonstrate are the windshield wiper test and the scours test. To perform the windshield wiper test, you'll flex the hip and the knee to 90 degrees. You'll induce internal and external rotation at the hip joint, moving the ankle towards the midline and away from the midline. This test is interpreted similar to the other tests with the location of the pain that is created. The scour test is also done with hip flexion and knee flexion. Scour induces a little bit more of hyperflexion, as well as the knee. And then we're adding in compression through the femur towards the acetabular joint. This test also induces adduction and abduction, while simultaneously moving the hip joint into external rotation and internal rotation. Abduction with internal rotation, abduction with external rotation back and forth. Again, looking for signs of pain and popping, which can be interpreted depending on location as the other tests already demonstrated.

2nd Edition, CASE 21

2nd Edition

Hip

hip examination

intra-articular

extra-articular

pain diagnosis

sports medicine