Examination of the patient with posterior thigh pain (a) Observation

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WEEK 1 ORTHO CURRICULUM Lower Extremity H&P: Knee Exam.

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Examination of the patient with posterior thigh pain (a) Observation Examination of the patient with posterior thigh pain (a) Observation. Look for wasting, bruising or swelling of the posterior thigh. Observation of gait is also important. Observation of the lumbar spine may show the presence of an excessive lordosis or relative asymmetry. A lateral view may demonstrate excessive lumbar lordosis or anterior pelvic tilt (b) Active movement—active knee extension. The hip is actively flexed to 90° with the knee initially at 90° also. The knee is then slowly extended until pain is felt and then to the end of range (c) Passive movement—hamstring muscle stretch. The leg is raised to the point where pain is first felt and then to the end of range, pain permitting. Movement should be compared with the uninjured side (d) Combined contraction—single-leg bridge. A widely used ‘quick’ clinical assessment of resisted hamstring contraction is the single-leg bridge. This can be done with the knee fully extended or flexed to 90° (or any angle in between these two positions) (e) Palpation. Palpate carefully bearing the underlying anatomy in mind to determine the location of an acute muscle strain (e.g. medial versus lateral hamstring, proximal versus distal etc.) (f) Palpation—gluteal muscles. Palpate the gluteal muscles for trigger points that are taut bands, which are usually exquisitely tender locally and may refer pain into the hamstring muscle (g) Special tests—slump test. The slump test (Chapter 15) is an essential part of the examination of the patient with posterior thigh pain. It helps the clinician differentiate between hamstring muscle injuries and referred pain to the hamstring region from the lumbar spine Source: Posterior thigh pain, Brukner & Khan’s Clinical Sports Medicine: Injuries, Volume 1, 5e Citation: Brukner P, Clarsen B, Cook J, Cools A, Crossley K, Hutchinson M, McCrory P, Bahr R, Khan K. Brukner & Khan’s Clinical Sports Medicine: Injuries, Volume 1, 5e; 2017 Available at: http://csm.mhmedical.com/DownloadImage.aspx?image=/data/books/1970/bru61384_3402_new.png&sec=168694477&BookID=1970&ChapterSecID=168694448&imagename= Accessed: December 26, 2017 Copyright © 2017 McGraw-Hill Education. All rights reserved