Pendulum Test: A Highly Accurate and Simple Physical Examination Maneuver to Identify Hip Pathology
Background: Patients with hip pathology often complain of various symptoms, e.g. pain or discomfort of low back, lower extremity, hip, groin, thigh, buttock or knee. Physicians may be distracted by these complaints, and misdiagnose and mistreat hip pathology. To avoid this, the pendulum test, which is performed with a patient seated on the examination table and hips and knees are flexed at 90 degrees, while the examiner passively swings the patient's lower extremity in and out as a pendulum, has been employed for all patients with the complaint of low back, hip and knee.
Objective: The efficacy and the accuracy of the pendulum test were evaluated.
Patients and methods: Consecutive 40 patients, who had complained pain or discomfort of low back, lower extremity, hip, groin, thigh, buttock and knee were examined by the pendulum test.
Results: Eighteen patients were positive for the pendulum test, and all of them correlated to the hip pathology.
Conclusions: The pendulum test was confirmed to be easily performed and reliable in detecting the hip pathology. Therefore, this test is highly recommended for the differentiation of patients with low back, hip and knee complaints.
Stone M, Assessment of the difficult primary hip replacement, Curr Orthop. 2008 Jun 22;3:165-172
Gray H, Articulations of the lower extremity, Gray's Anatomy, Fifteenth edition, 1995, 240-246.
Martin HD, Savage A, Braly BA, Palmer IJ, Beall DP, Kelly B. The function of the hip capsular ligaments: a quantitative report. Arthroscopy. 2008;24(2):188-195.
Myers SR, Eijer H, Ganz R. Anterior femoroacetabular impingement after periacetabular osteotomy. Clin Orthop Relat Res. 1999;363:93-99.
Ganz R, Parvizi J, Beck M, Leunig M, Notzli H, Siebenrock KA. Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res. 2003;417:112–120.
Theiler R, Stucki G, Schütz R, Hofer H, Seifert B, Tyndall A, Michel BA. Parametric and non-parametric measures in the assessment of knee and hip osteoarthritis: interobserver reliability and correlation with radiology. Osteoarthritis Cartilage. 1996;4(1):35-42.
Cibere J, Thorne A, Bellamy N, Greidanus N, Chalmers A, Mahomed N, Shojania K, Kopec J, Esdaile JM. Reliability of the hip examination in osteoarthritis: effect of standardization. Arthritis Rheum. 2008;15;59(3):373-381.
Martin RL, Sekiya JK., The interrater reliability of 4 clinical tests used to assess individuals with musculoskeletal hip pain. J Orthop Sports Phys Ther. 2008;38(2):71-77.
Lee KM, Chung CY, Kwon DG, Han HS, Choi IH, Park MS. Reliability of physical examination in the measurement of hip flexion contracture and correlation with gait parameters in cerebral palsy. J Bone Joint Surg Am. 2011;19;93(2):150-158.
Croft PR, Nahit ES, Macfarlane GJ, Silman AJ. Interobserver reliability in measuring flexion, internal rotation, and external rotation of the hip using a plurimeter. Ann Rheum Dis. 1996;55(5): 320–323.
Holla JF, van der Leeden M, Roorda LD, Bierma-Zeinstra SM, Damen J, Dekker J, Steultjens MP. Diagnostic accuracy of range of motion measurements in early symptomatic hip and/or knee osteoarthritis. Arthritis Care Res. 2012 Jan;64(1):59-65.
Ganz R, Leunig M, Leunig-Ganz K, Harris WH. The etiology of osteoarthritis of the hip: an integrated mechanical concept. Clin Orthop Relat Res. 2008;466(2):264-272.
Copyright (c) 2015 Yasushi Oshima, Joseph Fetto
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Copyright and License Agreement:
Authors who publish with the Reconstructive Review agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work. Reconstructive Review follows the Creative Commons Attribution-NonCommercial CC BY-NC. This license allows anyone to download works, build upon the material, and share them with others for non-commercial purposes as long as they credit the senior author, Reconstructive Review, and the Joint Implant Surgery & Research Foundation (JISRF). An example credit would be: "Courtesy of (senior author's name), Reconstructive Review, JISRF, Chagrin Falls, Ohio". While works can be downloaded and shared they cannot be used commercially.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.