Physical Medicine Rehabilitation

Diagnosis and Treatment of the Lower Extremities: by Dos Winkel

By Dos Winkel

Clinical Society of Flemish basic Practitioners, Antwerp, Belgium. Translation, model, and compilation of 3 titles formerly released in Dutch. Halftone illustrations. 7 participants, three U.S. DNLN: Leg.

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Additional resources for Diagnosis and Treatment of the Lower Extremities: Nonoperative Orthopedic Medicine and Manual Therapy

Example text

In the case of an adductor lon­ gus or adductor brevis lesion, resisted hip adduction must be painful. In the case of a pectineus lesion, resisted flexion and resisted adduction of the hip must be painful. This test can provoke pain in a number of other hip disorders, and therefore it is not specific. 138 Examination oj the Hip trochanter region, however, trochanteric pa­ thology is indicated (eg, a bursitis of one of the bursae found around the greater tro­ chanter). 14 Passive Hip Adduction Passive adduction of the hip is only possible if the other leg is flexed or extended in the hip.

Limita­ tions of motion are rarely seen. Pain can be experienced as the result of a stretch of the pelvic and thigh muscles (tensor fasciae latae and iliotibial tract) or compression of the un­ derlying subtrochanteric bursae. 15 Resisted Hip Flexion in 90° Flexion The patient is asked to flex the hip to 90°. The examiner stands at the head of the table on the side being tested. The examiner places one hand against the anterior aspect of the distal thigh, while on the same side the other hand rests on the patient's shoulder.

The proximal part the muscle is easily vis­ ible when the hip is externally rotated, ab­ ducted, and flexed with a flexed knee (cross­ legged sitting position) . Resistance against this position will make palpation of this muscle easier. For better training, however, it is best to concentrate on learning the palpa­ tion when the muscle is relaxed. Palpation of the sartorius should be per­ formed from proximal to distal using alternat­ ing pressure from two fingers. The index and middle fingers are placed at either side of the muscle in a longitudinal direction.

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