1. Clinical exam. of Hip joint
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2. 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)

3. 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

4. History : symptom
pain
locking
twinge
feeling of giving way

5. 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

6. 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?

7. 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

8. 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

9. Standing color change, trunk deviation, PVM ilium level, PSIS level
trunk motion
Gillet test : SI joint motion
Trendelenburg test

10. Standing color change, trunk deviation, PVM ilium level, PSIS level
trunk motion
Gillet test : SI joint motion
Trendelenburg test

11. Standing color change, trunk deviation, PVM ilium level, PSIS level
trunk motion
Gillet test : SI joint motion
Trendelenburg test

12. 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

13. 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

14. 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

15. 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

16. 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

17. piriformis block

18. 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

19. 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

20. Side lying inspection : great trochanter prominence hip abduction
Ober test
resistive abduction
compression test
tenderness : g. trochanter, TFL, iliac crest

21. Side lying inspection : great trochanter prominence hip abduction
Ober test
resistive abduction
compression test
tenderness : g. trochanter, TFL, iliac crest

22. 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

23. 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

24. 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

25. 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

26. Thank you ! conclusion GOOD HISTORY TAKING
CAREFUL CLINICAL EXAMINATION
PROPER IMPRESSION
CONFIRM WITH MECHANICAL STUDY
Thank you !