Table 2.

Physical examination maneuvers for differentiating sources of impingement

Patient Position	Test	Maneuver	Impingement Etiology
			Location	Source of Impingement
Supine	Subspine impingement test	Affected hip is hyperflexed in neutral rotation while unaffected hip lies flat on the table	Anterior subspine region	Bony prominence below anterior inferior iliac spine and femoral neck
Supine or lateral	Flexion, adduction, internal rotation	Affected hip is flexed to 90°, internally rotated, and adducted	Anterior and anterolateral	Anterior acetabular rim and femoral head-neck junction
Supine	Flexion, abduction, external rotation	Affected extremity placed in figure-of-4 position with hip flexed 45°, abduction, and external rotation, ankle resting on contralateral knee	Posterolateral Deep posterolateral Anterior	Greater trochanter and iliotibial band Quadratus femoris (between greater trochanter and ischium) Iliopsoas tendon and femoral head
Supine	Superolateral impingement test	Affected hip is flexed to 90°, slightly externally rotated, and abducted	Superior and superolateral	Acetabular rim and femoral neck/head-neck junction
Supine	DIRI (dynamic internal rotation impingement test)	Affected hip is placed in flexion or hyperflexion and moved through a full arc of adduction with the hip internally rotated. Maneuver may be assisted by having the patient flex the contralateral hip to his/her chest to reduce lumbar lordosis2,3	Anterior (11 o’clock to 3 o’clock)	Acetabular rim and femoral neck/head-neck junction
Supine	DEXRIT (dynamic external rotation impingement test)	Affected hip is flexed to 90°, externally rotated and moved through a full arc of abduction2,3	Superolateral and posterior (1 o’clock to 10 o’clock)	Acetabular rim and femoral neck/head-neck junction
Supine	Scour test	Variation of DIRI/DEXRIT tests performed while applying a downward force at the knee to increase pressure in the hip joint while maneuvering into different quadrants2,3	Varies (generally 10 o’clock to 3 o’clock depending on technique)	Acetabular rim and femoral neck/head-neck junction
Supine	Posterior rim impingement test	While patient lies at the end of the examination table allowing the legs to hang freely, the affected hip is placed into extension, abduction, and external rotation	Posterior	Acetabular rim and femoral neck/head-neck junction
Lateral	Greater trochanteric–pelvic impingement test	Affected hip is passively abducted in extended position. Positive “gear stick sign” refers to relative increase in abduction range with hip in flexed position	Lateral	Greater trochanter and ilium
Lateral	Ischiofemoral impingement test	Affected hip brought into extension, adduction, and external rotation	Deep posterior	Quadratus femoris (between lesser tuberosity and ischium)