Hip Quadrant test

The Hip Quadrant Test is used to evaluate whether a patient’s hip symptoms originate from the hip joint. It can reveal early degeneration, restricted range of motion (ROM), or nonspecific hip pathologies, including:

• Hip osteoarthritis (OA)

• Osteochondral defects

• Avascular necrosis

• Capsular tightness

• Labral tears [7][8][11]

Due to its low diagnostic specificity, the test should never be used in isolation but interpreted alongside other clinical findings [9].

Clinically Relevant Anatomy

The hip joint (art. coxae) is a diarthrodial ball-and-socket joint formed by the femoral head and acetabulum. It functions primarily in a closed kinetic chain, designed for stability and weight-bearing [4].

Key structures:

• Acetabular labrum → Deepens the acetabulum and enhances stability.

• Joint capsule & ligaments → Iliofemoral, pubofemoral, and ischiofemoral ligaments provide stability.

Test Procedure

Patient position:

• Supine on the examination table.

Examiner position:

• Standing beside the tested hip.

Execution:

• The hip is flexed between 70–140° and assessed in two planes:

  • Flexion + adduction → Medial compression.

  • Flexion + abduction → Lateral compression.

• An axial load is applied through the femur while moving the hip across these arcs.

Interpretation of Results

Positive test:

• Hip pain.

• Crepitus or joint grinding.

• Leathery end-feel or restricted ROM.

Negative test:

• Smooth, pain-free motion throughout flexion-adduction to flexion-abduction [7][1].

What the Test Assesses

The Hip Quadrant Test acts as a scouring maneuver of the femoroacetabular surfaces and may indicate:

• Labrum: Tears or degeneration.

• Cartilage: Osteoarthritis or osteochondral lesions.

• Capsule: Tightness or inflammation.

Diagnostic Validity & Evidence

• Low specificity → not diagnostic on its own [9].

• Limited research supports its standalone accuracy, but it may be useful when combined with other clinical tests.

Alternative diagnostic criteria – American College of Rheumatology (Hip OA):

• Cluster 1

  • Hip pain

  • <115° hip flexion

  • <15° internal rotation

• Cluster 2

  • Hip pain with rotation

  • Morning stiffness >60 minutes

  • Age >50 years

≥4 out of 5 criteria increase the likelihood of hip OA to 91% [12].

Clinical Relevance

• Best used as part of a test battery rather than alone.

• A positive test may warrant further imaging (MRI, X-ray) for confirmation.

• Useful for detecting early osteoarthritis or restricted mobility.

Conclusion

The Hip Quadrant Test is a nonspecific but valuable tool for hip assessment, particularly in early degenerative changes and ROM restriction. Its diagnostic value is limited alone, but when combined with other hip tests and imaging, it provides more reliable clinical insights.

Sources:

1. Peter H. Seidenberg,Jimmy D. Bowen - The Hip and Pelvis in Sports Medicine and Primary Care pg. 33. Peter H. Seidenberg and Jimmy D. Bowen (editors). Springer (publisher) Evidence level: 5 grade of recommendation: F

2. Cook CE, Hegedus EJ. Orthopedic Physical Examination: An Evidence based Approach. Upper Saddle River, NJ: Pearson Prentice Hall; 2008.

3. Lyle MA, Manes S, McGuinness M, Ziaei S, Iversen MD.Relationship of physical examination findings and self-reported symptom severity and physical function in patients with degenerative lumbar conditions. Phys Ther. 2005 Feb;85(2):120-33. Evidence level: 2a grade of recommendation: B

4.  Hip Anatomy. (2017, June 6). Physiopedia, . Retrieved 10:17, December 14, 2017 from https://www.physio-pedia.com/index.php?title=Hip_Anatomy&oldid=172875.

5. Human anatomy atlas Sobotta part 2: lower extremity pg 263 – 272. Bohn Stafleu, Van Loghum
3th print R. Putz and R. Pabst

6.  figure 1: http://www.healthbase.com/resources/images/

7.  M. Lynn Palmer – Fundamentals of musculoskeletal assessment techniques pg. 305. Second edition, M lynn palmer and Marcia E. Epler. Uppincott Williams and Willens (publisher) Evidence level: 5 grade of recommendation: F

8. Manning C, Hudson Z. Comparison of hip joint range of motion in professional youth and senior team footballers with age-matched controls: an indication of early degenerative change? Phys Ther Sport. 2009 Feb;10(1):25-9. Epub 2008 Dec 24.fckLREvidence level: 3a grade of recommendation: C

9.  https://www.thestudentphysicaltherapist.com/hip-quadrant-test.html

10.  Thomas A. Souza Differential Diagnosis and Management for the Chiropractor: Protocols and algorithms pg 345. Fourth edition, Thomas A. Souza, DC, DACBSP. Jean and Bartlett publishers (Sanburry, Massachusetts). Evidence level: 5 grade of recommendation: F

11. Mitchell B, McCrory P, Brukner P, O'Donnell J, Colson E, Howells R. Hip joint pathology: clinical presentation and correlation between magnetic resonance arthrography, ultrasound, and arthroscopic findings in 25 consecutive cases. Clin J Sport Med. 2003 May;13(3):152-6. Evidence level: 2c grade of recommendation: C

12. Altman R, Alarcon G, Appelrouth D, et al. The American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the hip. Arthritis Rheum 1991: 34l 505-514.