Hip Orthopaedic Test: Bowstring Sign

The Bowstring Sign is a physical examination technique used to assess for sciatic nerve irritation or compression in the hip. Here are the steps to perform the Bowstring Sign:

1. Have the patient lie down on their back on the examination table with their legs straight.
2. Flex the patient's affected hip to 90 degrees and the knee to 45 degrees.
3. Place one hand on the patient's ankle and the other hand on the patient's popliteal fossa, which is the area behind the knee.
4. Apply pressure to the popliteal fossa, pushing the patient's ankle towards their buttocks.
5. Observe the patient's face for any signs of pain or discomfort, and note any radiation of pain down the leg.

The Bowstring Sign Test does not have established sensitivity and specificity values, as it is a clinical test that is used as a part of a comprehensive assessment for evaluating sciatic nerve impingement in the hip joint. The interpretation of the test depends on the patient's symptoms, medical history, and the presence of other clinical findings.

A "normal" or negative result of the Bowstring Sign Test would be the absence of pain or discomfort along the distribution of the sciatic nerve (i.e., posterior hip, buttock, posterior thigh, calf, or foot) during the test. This would suggest that there is no significant impingement of the sciatic nerve in the hip joint.

References:

1. Magee DJ. Orthopedic Physical Assessment. 7th ed. St. Louis, MO: Elsevier; 2013.
2. Hoppenfeld S. Physical Examination of the Spine and Extremities. New York, NY: McGraw-Hill; 1976.
3. Cook CE, Hegedus EJ. Orthopedic Physical Examination Tests: An Evidence-Based Approach. 2nd ed. Upper Saddle River, NJ: Pearson; 2012.
4. American Physical Therapy Association. Orthopaedic Section. Orthopaedic Section of the American Physical Therapy Association: Special Tests.
5. Clinical Practice Guidelines from the Orthopaedic Section of the American Physical Therapy Association.