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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 é -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 tuberosity and 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 Abduction Adduction
- 26. PROM Internal Rotation External 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 Trendelenburg’s test/sign Weakness or neurological injury associated with gluteus medius The pelvis lowers on the opposite side of the affected leg
- 35. Thomas 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 Patrick’s (FABER) test Gaenslen’s 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. Patrick’s (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
- 43. Gaenslen’s 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. Gaenslen’s Test
- 45. Long Sit Test Evaluative for ili um rotation on sacrum at SI Clinician’s 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
- 47. SI Rocking Test Supine on table Involved side – hip flexed with flexed knee, involved knee moved toward opposite shoulder and “rocked” Pain in SI joint indicative of pathology
- 48. Over ’ s Test Used to determine presence of contracted TFL or IT-band Thigh will remain in abducted position, not falling into adduction
- 49. Nobel ’ s Test Lying supine the athlete’s knee is flexed to 90 degrees Pressure is applied to lateral femoral condyle while knee is flexed/ extended Pain at 30 degrees at lateral femoral condyle indicates a positive test
- 50. Renne ’ s Test Athlete stands with knee bent at 30-40 ˚ Positive response of TFL / IT band tightness occurs when pain is felt at lateral femoral condyle
- 51. Piriformis Test Hip is internally rotated Tightness or pain is indicative of piriformis tightness
- 52. Ely ’ s Test Used to assess tightness of rectus femoris Athlete is prone, w/ pelvis stabilized and knee on the affected side is flexed If hip on that side extends as the knee is flexed, rectus femoris is tight
- 53. NEUROVASCULAR TESTS Femoral pulse taken in femoral artery at femoral triangle Dermatomes/myotomes associated with L1-S2 Peripheral nerves Femoral Obturator Superior gluteal Inferior gluteal
- 54. Femoral nerve D: None M: Knee extension Obturator nerve D: None M: Hip adduction
- 55. Superior gluteal nerve D: None M: Hip abduction Inferior gluteal nerve D: None M: Hip extension