Hip Quadrant Test

The Hip quadrant test (or as it called scour test) is a dynamic test of the inner and outer quadrants of the hip joint surface.

This procedure moves the hip through its range of motion while an axial load is placed on the femur. Pain within a specific location may indicate a defect of the articular surface or labral tear.

See Also: Pelvic Anatomy

How do you do Hip Quadrant test?

The patient is positioned in supine, close to the edge of the bed, with their hip flexed and foot resting on the bed. The clinician places one hand over the top of the patient’s knee.

• The patient’s hip is placed in 90 degrees of flexion, with the knee being allowed to flex comfortably. From this point, the clinician adducts the hip to the point at which the patient’s pelvis begins to lift off the bed, to assess the inner quadrant.
• At the end range of flexion and adduction, a compression force is applied through the knee along the longitudinal axis of the femur. From this point, the clinician moves the hip into a position of flexion and abduction to examine the outer quadrant.

Throughout the entire movement, the femur is held midway between internal and external rotation, and the movement at the hip joint should follow the smooth arc of a circle.

See Also: Hip Range of Motion & Biomechanics

What does a positive Scour test mean?

An abnormal finding is resistance, apprehension, or pain felt anywhere during the arc (positive scour test).

The pain can result from compression of, or stress to, a number of structures by the femur through the various ranges, the structures are:

1. the articular surfaces of the hip joint;
2. the labrum;
3. the hip joint capsule;
4. the insertion of the Tensor fasciae latae and the sartorius muscles;
5. the iliopsoas muscle;
6. the Iliopsoas Bursa and neurovascular bundle;
7. the insertion of the pectineus muscle;
8. the insertion of the adductor longus muscle;
9. the femoral neck.

The resistance may be caused by:

• capsular tightness,
• an adhesion,
• a myofascial restriction,
• a loss of joint congruity.

Sensitivity & Specificity

A study to investigate the prevalence of acetabular labrum tears in athletes presenting with groin pain found that the The hip internal rotation flexion axial compression maneuver (Hip Quadrant Test) has the following values:

• Sensitivity: 75 %
• Specificity: 43 %

Another study on 78 patients with unilateral pain in the buttock, groin, or anterior thigh, found the sensitivity was 62% while the specificity was 75%.

The Intra-rater Reliability was 87% for Hip Scour Test.

Notes

Given all of the possible diagnoses, extreme care must be taken when interpreting the results from the Scour test. Of the various studies that have looked at the Scour test, most have had poor study designs. Given the wide range of possible diagnoses with a positive finding, and the variety of patients this test is used with, bias is likely to result.

References

1. Narvani AA, Tsiridis E, Kendall S, Chaudhuri R, Thomas P. A preliminary report on prevalence of acetabular labrum tears in sports patients with groin pain. Knee Surg Sports Traumatol Arthrosc. 2003 Nov;11(6):403-8. doi: 10.1007/s00167-003-0390-7. Epub 2003 Jul 26. PMID: 12897984.
2. Maslowski, E., Sullivan, W., Forster Harwood, J., Gonzalez, P., Kaufman, M., Vidal, A. and Akuthota, V. (2010), The Diagnostic Validity of Hip Provocation Maneuvers to Detect Intra-Articular Hip Pathology. PM&R, 2: 174-181. https://doi.org/10.1016/j.pmrj.2010.01.014
3. Sutlive TG, Lopez HP, Schnitker DE, et al. Development of a clinical prediction rule for diagnosing hip osteoarthritis in individuals with unilateral hip pain. J Orthop Sports Phys Ther. 2008;38:542-550.
4. Maitland GD: The Peripheral Joints: Examination and Recording Guide. Adelaide: Virgo Press, 1973.
5. Dutton’s Orthopaedic Examination, Evaluation, And Intervention 3rd Edition.