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Special Tests Thigh/Hip Evaluation Module Bachelor of Athlet

发布: 2018-01-01 19:18 | 来源:www.jptranslate.com | 查 看:

Weber–Barstow Maneuver Test Steps   Patient begins in a supine position with his/her heels off the end of the table   Examiner holds the feet of the patient & places the thumbs over the medial malleoli while providing slight traction on the legs   Examiner instructs the patient to flex both knees & hips to place the feet on the table aligned next to each other (line up the medial malleoli)   Examiner instructs the patient to bridge his/her hips upward and then return to his/her starting position   See Maneuver  
Supine to Long–Sit Test Steps   Patient is in a supine position with the heels off of the end of the table   Examiner "clears the hips" using the Weber–Barstow Maneuver   Examiner passively extends the patient's legs & compares the position of the medial malleoli   Examiner pulls the patient up to a long–sit position from a supine position   Examiner observes the position of the medial malleoli for any change from the starting position   Positive Test   Observable change in the position of the medial malleoli   Positive Test Implications   Posterior pelvic rotation (equal/short to long); anterior pelvic rotation (equal/long to short)   See Test  
Supine ("True") Leg Length Discrepancy Measurement Test Steps   Patient is placed in a supine   Examiner "clears the hips" using the Weber–Barstow Maneuver and then extends both legs   Examiner measures the distance from the ASIS to the crest (i.e., highest point) of the medial malleolus on each leg OR Examiner measures the distance from the ASIS to the crest (i.e., highest point) of the lateral malleolus on each leg   Positive Test   Difference of greater than ¼ inch between the two legs   Positive Test Implication   Possible structural leg–length difference   See Test  
Supine "Apparent" Leg Length Discrepancy Test Clinical Discrimination Between Femoral & Tibial Leg Length Discrepancy Test Steps   Athlete is lying supine with his/her hip flexed to 45° & knee flexed to 90° and both feet lined up next to each other (line up medial malleoli and 1st MTP joints)   Examiner holds teh athlete's feet to the table and instructs the athlete to raise the pelvis up off the table and then lower the pelvis back to the table   Examiner observes the patient from the side (viewing both tibial tubercles) for anterior positioning of one knee compared to the other   Examiner observes the patient from the front (viewing the top of both patellae) for height differences of one knee compared to the other   Positive Test   Anterior positioning and/or height differences of one knee compared to the other   Positive Test Implication   Femoral length difference (lateral view–increased anterior position); tibial length difference (front view–increased height difference)   See Test  
Craig's Test for Femoral Anteversion/Retroversion Steps   Athlete lies prone with the knee flexed to 90°   Examiner palpates the posterior aspect of the greater trochanter   Measure angle formed between the vertical axis extending from the tabletop and the longitudinal axis of the lower leg   Positive Test   The angle measured is outside the normal range of 8–15°   Positive Test Implications   Excessively greater than 15° is femoral anteversion (internal torsion); excessively less than 8° is femoral retroversion (external torsion)  
Gaenslen's Test Steps   Athlete is supine, lying close to the side of the table   Examiner allows the near leg to hang over the side edge of the table   Examiner instructs the athlete to actively flex the other leg to his/her chest & hold   Examiner stabilizes the athlete & applies pressure to the near leg, forcing it into hyperextension   Positive Test   Pain in the SI region   Positive Test Implications   SI joint dysfunction   See Test  
Fulcrum's Test Steps   Athlete is seated with his/her knees bent at the end of the table   Examiner places his/her forearm or a similar bolster underneath of the athlete's mid–thigh   Examiner uses other hand to forcefully push down on the athlete's distal anterior thigh   Positive Test   Athlete experiences pain in his/her thigh   Positive Test Implications   Possible femoral stress fracture  
Nelaton's Line Test Steps   Athlete is lying supine with the knees extended   Examiner draws an imaginary line from the ASIS to the ischial tuberosity (same side of the hip/pelvis)   Positive Test   Greater trochanter can be palpated well above the imaginary line   Positive Test Implications   Coxa vara; a posteriorly dislocated hip joint   See Test  
Hip Scouring Test Steps   Athlete is supine   Examiner fully flexes the athlete's hip & knee   Examiner applies downward pressure along the femoral shaft while repeatedly externally & internally rotating the hip with multiple angles of flexion   Positive Test   Pain or reproduction of symptoms at the hip   Positive Test Implications   Defect in the articular cartilage of the femur or acetabulum   See Test  
Torque Test Steps   Patient lies supine & close to the edge of the table so that the involved leg can abduct over the edge of the table   Examiner passively extends the involved hip (with his/her hand supporting at the ankle) until the pelvis begins to rotate anteriorly   Examiner then medially rotates the hip to EROM and then places a posterolateral force at the hip joint in an attempt to distract it   Positive Test   Groin or lateral hip pain   Positive Test Implications   Sprain of the coxofemoral joint capsule or supporting ligaments   See Test  
Gillet's Test Steps   Athlete is standing with his/her PSISs visible   Examiner palpates the athlete's PSISs   Examiner has the athlete pull one knee towards his/her chest & hold while examiner observes PSISs   Positive Test   Restricted side moves very little; unilateral stance is painful on the involved side   Positive Test Implications   SI joint pathology   See Test  
SI Compression Test Steps   Athlete is supine   Examiner applies pressure to spread the ASIS   Positive Test   Pain arising from the SI joint   Positive Test Implications   SI pathology   See Test  
SI Distraction Test Steps   Athlete is in the side–lying position   Examiner is positioned behind the athlete with both hands over the lateral aspect of the pelvis   Examiner applies downward pressure through the anterior portion of the ilium, spreading the SI joints   Positive Test   Pain through the SI joint   Positive Test Implications   SI pathology   See Test  
Piriformis Tightness Test Steps   Athlete is side–lying with the test leg being the uppermost leg   Athlete's test leg is flexed at the hip to about 60° & the knee flexed   Examiner stabilizes the hip with one hand & applies a downward pressure to the knee   Positive Test   Piriformis muscle pain; buttock pain; sciatica pain   Positive Test Implications   Piriformis tightness (piriformis muscle pain); piriformis muscle pinching the sciatic nerve (buttock pain and sciatica pain)   See Test  
90–90 Straight Leg Raising Test Steps   Athlete lies supine with the hips and knees flexed to 90°   Athlete grasps behind both of his/her thighs to stabilize the hip joints   Athlete actively extends each knee in turn   Positive Test   Unable to extend the knee to within 20° of full knee extension   Positive Test Implications   Hamstring muscle tightness   See Test  
Ely's Test Steps   Athlete lies prone with the knees extended   Examiner passively flexes the athlete's knee   Positive Test   The hip on the same side passively flexes as the examiner flexes the knee   Positive Test Implications   Rectus femoris tightness   See Test  
Thomas's Test Steps   Athlete is supine with his/her knees bent at the end of the table   Examiner places one hand between the lumbar lordotic curve & the tabletop   Examiner passively flexes one of the athlete's legs to his/her chest, allowing the knee to flex during the movement   Examiner observes the involved leg for movement   Positive Test   The knee of the leg on the table cannot flex past 90° (i.e. the knee of the leg on the table will extend as the examiner flexes the contralateral hip); the involved leg (i.e. the leg on the table) rises up off the table (i.e. the contralateral hip to the one being moved will flex)   Positive Test Implications   Rectus femoris tightness (the knee extends as the examiner flexes the hip); iliopsoas tightness (the leg on the table will rise off of the table)   See Test  
Patrick's Test (Faber Test or Figure–Four Test) Steps   Athlete is supine with the foot of the involved side crossed over the opposite thigh (figure–4 position) & the leg resting in the full external rotation   Examiner has one hand on the opposite ASIS & the other hand on the medial apsect of the flexed knee   Examiner applies overpressure at the knee & ASIS   Positive Test   Inability to lower the flexed thigh down to the level of the leg on the table; hip joint pain; Sacroiliac pain   Positive Test Implications   Ilipsoas tightness; hip pathology (groin or inguinal area pain); sacroiliac joint pathology (pain during application of overpressure in the SI area)   See Test  
Trendelenburg's Test Steps   Athlete stands with the feet evenly distributed (i.e. approximately shoulder–width apart from each other)   Examiner sits or kneels behind the athlete   Examiner slightly lowers the athlete's shorts so that the examiner may palpate the right & left PSIS and/or iliac crests   Examiner instructs the athlete to flex the hip thereby lifting the right (and then the left knee) while observing the pelvis   Positive Test   The PSIS or iliac crest on the same side as the leg lifted will drop in relation to the contralateral side   Positive Test Implications   Contralateral (i.e., stance leg) gluteus medius (hip abductor) weakness or decreased innervation of the same muscles   See Test  
Valsalva Test Steps   With subject sitting examiner asks subject to take a deep breath and blow against closed glottis (as if trying to have a bowel movement)   This increases intrathecal pressure   Positive Test   Pain or neurologic symptoms in buttox and thigh   Positive Test Implications   Herniated disc, abdominal trauma, tumor, or osteophyte in lumber canal   See Test  
Oppenhiem Test Steps   Run metal edge of neurlogic hammer, or fingernail along the tibial crest   Positive Test   Great toe extension with flexion and splaying of the lateral four toes   Positive Test Implications   Upper motor neuron lesion   See Test  
Bowstring Test Steps   Subject begins supine with legs extended   Examiner performs a passive straight leg raise on the involved side   If radiating pain is reported, the examiner then flexes the subjects knee until symptoms are reduced   The examiner then applies pressure to the popliteal area in attempt to reproduce the radicular pain   Positive Test   Reproduction of radicular pain with popliteal compression   Positive Test Implications   Sciatic nerve pathology   See Test  
Babinski Test Steps   Run metal edge of neurlogic hammer, or fingernail along the tplantar surface of the foot from the calcaneus, along the lateral border of the foot to the forefoot   Positive Test   Great toe extension with flexion and splaying of the lateral four toes   Positive Test Implications   Upper motor neuron lesion   See Test  
Slump Test Steps   Subjects sits at end of table and leans forward while the examiner holds the head and chin upright   Examiner then flexes the subjects neck and assesses for any changes in symptoms   If no changes are noted the examiner passively extends one of the subjects knees   Again, note symptomatic changes   If no changes are noted, the examiner passively dorsiflexes the subjects ankle while the knee remains extended   Subject is then returned to original position and the test is repeated for the opposite leg   Positive Test   A complaint of sciatic–type pain or any reproduction of symptoms is indicative of a positive test   Positive Test Implications   Sciatica or dural irritation   See Test  
Seated Straight Leg Raise Test Steps   Subject sitting with hip flexed to 90° & hands grasping table on each side   Subject actively extends knee   Positive Test   1) Subject breaks tripod or subject is unable to fully extend knee   2) Subject arches back & or complains of pain in buttocks, posterior thigh and calf   Positive Test Implications   1) Tight hamstrings   2) Sciatic nerve irritation   See Test  
Single Straight Leg Raise Test Steps   Subject begins supine with both knees extended   Examiner stands at subject’s side with distal hand cupping heel and proximal hand around subjects thigh (anteriorly) to maintain knee extension   With subject relaxed the examiner slowly raises the test leg until tightness is noted   The examiner slowly lowers the leg until the pain or tightness resolves, then dorsiflexes the ankle and instructs the subject to flex the neck   Positive Test & Implications   Leg and/or low back pain occurring with dorsiflexion and/or neck flexion indicates dural involvement   A lack of pain reproduction with dorsiflexion and/or neck flexion indicates either hamstring tightness, possible lumbar spine or sacroiliac involvement   If latter is determined, proceed to the bilateral straight leg raise test   See Test  
Bilateral Straight Leg Raise Test Steps   Subject begins supine with both knees extended   Examiner stands at subject’s side with distal arm supporting the heels and proximal hand on the subject’s thighs (anteriorly) to maintain knee extension   With subject relaxed the examiner slowly raises both legs until tightness or pain is noted   Positive Test   Low back pain   Positive Test Implications   If low back pain occurs at less than 70 degrees of hip flexion sacroiliac joint involvement is indicated   If low back pain occurs at greater than 70 degrees of hip flexion lumbar spine involvement is indicated   See Test  
Malinger's Rotational Test Steps   With the subject standing the examiner asks the patient to perform trunk rotation while the examiner stabilizes the patient’s pelvis   Examiner notes any pain from the patient   The examiner again asks the patient to perform trunk rotation. However, this time the examiner rotates the pelvis along with the spine   Examiner notes any complaint of pain   Positive Test   Patient complains of pain during both of the above   Positive Test Implications   Patients complaints are not consistent with test findings   See Test  
Kernig Test Steps   Subject supine with hands cupped behind head   Subject is instructed to flex cervical spine by lifting head   Each hip is unilaterally flexed to no more than 90, with knee fully extended   The opposite leg should remain on the table   Positive Test   Increased pain with both hip and neck flexion and pain is relieved when knee is allowed to flex   Positive Test Implications   Meningeal irritation, nerve root impingement, dural irritation aggravated by spinal cord elongation   See Test  
Stork Test Steps   Subject begins standing and is asked to extend back, while the examiner spots subject   The subject is then asked to stand on one foot and extend their back once again   Finally the subject is asked to stand on the opposite foot and extend the back   Positive Test   Complaints of pain in the lumbar region   Positive Test Implications   Possible pars intrarticularis pathology  
Hoover Test Steps   Subject is supine while examiner cups both heels of the patient with their hands   Subject is asked to perform a unilateral straight leg raise   Positive Test   1) Inability to raise leg   2) A positive finding is also noted when the examiner does not feel pressure in the palm of the hand underlying the restimg leg   Positive Test Implications   1) neuromuscular weakness   2) lack of effort by subject   See Test