Clinical exam. of Hip joint 최재활의학과의원 www.painOK.com 최 재 익
Pain referred to hip dull vague pain most pain from lumbar lesion groin : L1 and L2 anterior thigh : L2 and L3 buttock : S2 and (L5, S1, and L4)
Pain referred from hip hip joint : L3 dermatome(anterior thigh) SI joint : S1 and S2 dermatome gluteal bursitis : L4 and L5 dermatome psoas bursa : L2 and L3 dermatome muscles * iliopsoas and adductor m. : L2 and L3 * rectus femoris : L3 * quadratus femoris : L5 and S1 * hamstrings : S1 and s2
History : symptom pain locking twinge feeling of giving way
History : symptom, onset when did it start? acute, subacute, chronic how did it start? apparent reason, injury injury(+) how did it happen? what were the immediate symptoms? injury(-) did the symptoms come on suddenly or gradually? localization, swelling, locking, loss of function
History : symptom evolution did the pain change from one side of the joint to other or did the pain spread? what was the evolution of the swelling? for how long were you disabled? what treatment did you have and with what effect? have there been any recurrences?
History : symptom current symptom what is the problem now? pain, paresthesia, instability, and functional disability pain nature, rest pain, aggrevating factor, do you have twinges? and when? click, coughing, feeling of instability functional disability associated diseases
Inspection gait, facial expression, and movement posture hip joint position flexed hip posture with increased lordosis, adduction and external rotation : acute arthritis and gross osteoarthrosis toe out position : retroversion of femur neck, SFE, pelvis torsion toe in position : anteversion of femur neck, internal femoral torsion excessive internal rotation and adduction : non-organic posture muscle contours skin fold
Standing color change, trunk deviation, PVM ilium level, PSIS level trunk motion Gillet test : SI joint motion Trendelenburg test
Standing color change, trunk deviation, PVM ilium level, PSIS level trunk motion Gillet test : SI joint motion Trendelenburg test
Standing color change, trunk deviation, PVM ilium level, PSIS level trunk motion Gillet test : SI joint motion Trendelenburg test
Supine inspection : leg position, knee swelling knee extension, SLR hip flexion, IR, ER : capsular pattern, knee flexion Thomas test hip flexion, adduction, IR resistive IR, ER, and int. derotation test Patrick sign SI joint distration , thigh thrust tenderness : hip joint UMN sign : spasticity, ankle clonus motor(EHL, FHL, IR), DTR
Supine inspection : leg position, knee swelling knee extension, SLR hip flexion, IR, ER : capsular pattern, knee flexion Thomas test hip flexion, adduction, IR resistive IR, ER, and int. derotation test Patrick sign SI joint distration , thigh thrust tenderness : hip joint UMN sign : spasticity, ankle clonus motor(EHL, FHL, IR), DTR
Supine inspection : leg position, knee swelling knee extension, SLR Thomas test hip flexion, IR, ER : capsular pattern, knee flexion hip flexion, adduction, IR impingement, piriformis resistive IR, ER, and int. derotation test guteal tendon tear Patrick sign SI joint distration , thigh thrust tenderness : hip joint UMN sign : spasticity, ankle clonus motor(EHL, FHL, IR), DTR
Supine inspection : leg position, knee swelling knee extension, SLR Thomas test hip flexion, IR, ER : capsular pattern, knee flexion hip flexion, adduction, IR impingement, piriformis resistive IR, ER, and int. derotation test guteal tendon tear Patrick sign SI joint distration , thigh thrust tenderness : hip joint UMN sign : spasticity, ankle clonus motor(EHL, FHL, IR), DTR
Supine inspection : leg position, knee swelling knee extension, SLR Thomas test hip flexion, IR, ER : capsular pattern, knee flexion hip flexion, adduction, IR impingement, piriformis resistive IR, ER, and int. derotation test guteal tendon tear Patrick sign SI joint distration , thigh thrust tenderness : hip joint UMN sign : spasticity, ankle clonus motor(EHL, FHL, IR), DTR
piriformis block
Supine inspection : leg position, knee swelling knee extension, SLR Thomas test hip flexion, IP, ER : capsular pattern, knee flexion hip flexion, adduction, IR resistive IR, ER, and int. derotation test Patrick sign SI joint distration , thigh thrust tenderness : hip joint UMN sign : spasticity, ankle clonus motor(EHL, FHL, IR), DTR
Supine inspection : leg position, knee swelling knee extension, SLR Thomas test hip flexion, IP, ER : capsular pattern, knee flexion hip flexion, adduction, IR resistive IR, ER, and int. derotation test Patrick sign SI joint distration , thigh thrust tenderness : hip joint UMN sign : spasticity, ankle clonus motor(EHL, FHL, IR), DTR
Side lying inspection : great trochanter prominence hip abduction Ober test resistive abduction compression test tenderness : g. trochanter, TFL, iliac crest
Side lying inspection : great trochanter prominence hip abduction Ober test resistive abduction compression test tenderness : g. trochanter, TFL, iliac crest
Prone inspection : PVM bulk, deviation, lordosis, gluteal bulk hip extension and Yeomann’s test active hip extension with motor control resistive hip extension hip IR, ER range sacral compression tenderness : SP, PVM. SI joint, ILA, piriformis, hip joint
Prone inspection : PVM bulk, deviation, lordosis, gluteal bulk hip extension and Yeomann’s test active hip extension with motor control resistive hip extension hip IR, ER range sacral compression tenderness : SP, PVM. SI joint, ILA, piriformis, hip joint
Prone inspection : PVM bulk, deviation, lordosis, gluteal bulk hip extension and Yeomann’s test active hip extension with motor control resistive hip extension hip IR, ER range sacral compression tenderness : SP, PVM. SI joint, ILA, piriformis, hip joint
Prone inspection : PVM bulk, deviation, lordosis, gluteal bulk hip extension and Yeomann’s test active hip extension with motor control resistive hip extension hip IR, ER range sacral compression tenderness : SP, PVM. SI joint, ILA, piriformis, hip joint
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