Kin191 A.Ch.8. Pelvis. Thigh. Evaluation

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Text of Kin191 A.Ch.8. Pelvis. Thigh. Evaluation

  • 1.KIN 191A Advanced Assessment of Lower Extremity Injuries THE PELVIS AND THIGH EVALUATION

2. INTRODUCTION

  • HISTORY
  • INSPECTION
  • PALPATION
  • ROM TESTS
  • STRESS/STREE TESTS
  • NEUROGIC TEST
  • VASCULAR TEST

3. HISTORY

  • Location of symptoms
  • Onset of symptoms
  • Training techniques
  • Mechanism of injury (etiology)
  • Prior history (medical conditions)

4. Location of Symptoms

  • Deep joint pain indicative of joint trauma/injury or may be referred from lumbosacral region
  • Anterior hip/groin pain typically associated with hip flexor/adductor muscle strain
  • Pain to lateral hip often associated with trochanteric bursitis

5. Onset of Symptoms

  • Most hip pathologies are overuse/chronic conditions with gradual and insidious onset of symptoms
  • Insidious onset unable to specifically identify one mechanism of injury

6. Training Techniques

  • Overuse conditions often attributable to
    • Surface changes
    • Footwear
    • Training techniques/skills
    • Training intensity, frequency and duration
  • Tendinitis, bursitis, stress fractures

7. Mechanism of Injury

  • Direct trauma
    • Iliac crest hip pointer
    • Posterior hip gluteal contusion
  • Eccentric muscle contraction
    • Muscular strain
  • Overuse conditions

8. Prior History

  • Congenital or developmental hip conditions or abnormalities can alter biomechanics of entire lower extremity
    • Legg-Calv -Perthes disease
    • Slipped capital femoral epiphysis

9. INSPECTION

  • Look for external signs of pathology
    • Swelling, discoloration (ecchymosis), deformity
  • Leg length discrepancy (true vs. apparent)
  • Hip angulations
    • Angle of inclination (~125 degrees)
      • > 125 coxa valga presents with genu varum
      • < 125 coxa vara presents with genu valgum
    • Angle of torsion
      • > 15 anteversion pigeon toes
      • < 15 retroversion duck feet

10.

  • Pelvic obliquity iliac crest height not equal bilaterally
  • Imaginary line between PSIS (S2 level) bisects SI joints on both sides
  • Line across iliac crests crosses spine between L4 and L5 vertebrae
  • Sciatic nerve lays between ischial tuberosity and greater trochanter

11. PALPATION (Medial Structures)

  • Adductor longus
  • Adductor magnus
  • Adductor brevis

12. PALPATION (Anterior Structures)

  • Pubic bone
  • ASIS
  • AIIS
  • Sartorius
  • Rectus femoris

13. PALPATION (Lateral Structures)

  • Iliac crest
  • Tensor fascia latae
  • Gluteus medius
  • IT band
  • Greater trochanter
  • Trochanter bursa

14. PALPATION (Posterior Structures)

  • Median sacral crests
  • PSIS
  • Gluteus maximus
  • Ischial tuberosityand bursa
  • Sciatic nerve
  • Hamstring muscles

15. ROM TESTS

  • AROM
    • Flexion (120-130)
    • Extension (10-20)
    • Adduction (30)
    • Abduction (45)
    • Internal rotation (45)
    • External rotation (50)

16. AROM 17. Hip Flexion

  • Range of motion - 120~130
  • End feel - soft (tissue approximation)
  • Primary movers
    • Iliopsoas, rectus femoris, sartorius
  • Affected by knee positioning (flexed vs. extended)
    • Active by rectus femoris
    • Passive by hamstring restriction

18. Hip Extension

  • Range of motion - 10 ~ 20 degrees
  • End feel - firm (capsular)
  • Primary movers
    • Gluteus maximus, hamstrings
  • Affected by knee positioning
    • Active by hamstrings
    • Passive by rectus femoris

19. Hip Abduction

  • Range of motion - ~45
  • End feel - firm (capsular)
  • Primary movers
    • Glutues medius, gluteus minimus

20. Hip Adduction

  • Range of motion - ~30
  • End feel - firm (capsular)
    • Avoid accessory motions
  • Primary movers
    • Adductor longus/magnus/brevis

21. Hip Internal Rotation

  • Range of motion - ~45
  • End feel - firm (capsular)
  • Primary movers
    • Adductor longus/magnus/brevis
    • Gluteus medius/minimus

22. Hip External Rotation

  • Range of motion - 45~50
  • End feel - firm (capsular)
  • Primary movers
    • 6 external rotators (piriformis, S.G., I.G., O.E., O.I., Q.F.)
    • Sartorius
    • Gluteus maximus

23. PROM

  • Flexion

24. PROM

  • Extension

25. PROM

  • AbductionAdduction

26. PROM

  • Internal RotationExternal Rotation

27. Goniometry 28. Goniometry 29. RROM 30. RROM 31. RROM 32. RROM 33. ROM

  • SI joint and pubic symphysis have no true range of motion
  • Any motion that is present is accessory in nature and minimal

34. SPECIAL TESTS

  • Thomas test
    • Evaluates tightness of hip flexors
    • Thigh and knee position evaluated to differentiate tightness in iliopsoas vs. rectus femoris
  • Trendelenburgs test/sign
    • Weakness or neurological injury associated with gluteus medius
    • The pelvis lowers on the opposite side of the affected leg

35. Thomas Test 36. Trendelenburgs Test 37. Ligamentous Stress Tests

  • No specific stress test for individual ligaments or joint capsule
  • Stabilizing structure integrity assessed by end range passive range of motion

38. STRESS TESTS

  • Pubic symphysis
    • Translation (secondary to abnormal palpation or inspection presentation i.e. elevation or depression)
  • SI joint
    • Compression/distraction
    • Patricks (FABER) test
    • Gaenslens test/sign
    • Long sit test
    • SI rocking test

39. SI Joint Compression/Distraction

  • Compression
    • Patient supine
    • Spread ASIS compresses SI joint/s
  • Distraction
    • Side laying do from both sides
    • Compress ilium to distract SI joint/s

40. SI Compression (A) / Distraction (B) Tests 41. Patricks (FABER) Test

  • Flexion, abduction, external rotation
  • Stabilize opposite ASIS and push on crossed knee
  • Pain in posterior hip/SI joint area indicative of SI pathology

42. Patricks (FABER) Test 43. Gaenslens Test

  • Supine on table with involved leg off table side
  • Opposite hip fully flexed involved hip pushed into hyperextension by clinician
  • Pain indicative of SI joint dysfunction due to rotational stress to joint

44. Gaenslens Test 45. Long Sit Test

  • Evaluative for ili umrotation on sacrum at SI
  • Clinicians thumbs on medial malleoli
  • Patient sets pelvis with bridge maneuver and then performs active long sit
  • Clinician indicates any change in orientation of medial malleolus relationship
    • Involved goes longer to shorter anterior rotation
    • Involved goes shorter to longer posterior rotation

46. 47. SI Rocking Test

  • Supine on table
  • Involved side