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LE Lab 13: Hip Evaluation and Special Tests

Terms in this set (88)

This procedure evaluates the strength of the gluteus medius muscle on the stance side. Stand behind the patient and observe the dimples overlying the posterior superior iliac spines. Normally, when the patient bears weight evenly on both legs, these dimples appear level. Then ask the patient to stand on one leg. If he stands erect, the gluteus medius muscle on the stance side should contract as soon as the opposite leg leaves the ground, and should elevate the pelvis on the unsupported side. This elevation indicates that the gluteus medius muscle on the supported side is functioning properly (negative Trendelenburg sign). If the pelvis on the unsupported side remains in position or actually drops, the gluteus medius on the stance side is either weak or non-functioning (positive Trendelenburg sign). "A pelvic on femoral angle with ≤83° angle criteria with specified time duration of 30 s was used as a positive sign."

"Diagnostic accuracy: Sensitivity (SN) 55%, specificity (SP) 70%, positive likelihood ratio (+LR) 1.83 and negative likelihood ratio (−LR) 0.82.
Special note: Monitor for patient compensating by leaning their trunk to avoid having pelvis drop. Leaning compensation constitutes a positive test as well.
Background: Generally considered a physical performance test of hip strength, this test has also been utilized for assessment of gluteal tendinopathy with a positive test being reproduction of spontaneous pain within 30s on involved leg compared with the contralateral leg during single leg stance."
This includes assessing pelvic stability as well as motions at the hip (starting with passive, then doing active, then resistive). Spotting substitutions and eliminating them by introducing typical movements with the appropriate muscles is a highly important part of the pelvis/hip evaluation.

Have your patient perform each of the motions below and place a check-mark next to the motion if it is within acceptable parameters; if you note deficits, circle the motion(s) that are atypical from the list in parenthesis. Write in other deviations not on the list when noted.

_____ Double-limb squat (hips should flex, knees flex to 90 degrees or more, heels stay in contact with floor, knee stays in line with second toe, longitudinal arch decreases/pronates) - Note SFMA has you going squatting deeper than this analysis.
_____ Single-limb squat (hip, knee, and foot stay relatively aligned, gluteus medius and maximus and quadriceps are of sufficient strength to control the hip and knee motions) - Same as SFMA

_____ Pelvic stability: the abdominal and back muscles are of sufficient strength to hold the ASIS's and PSIS's in the same plane while the femur moves (see hip motions below for specifics).

Supine Hip Flexion
Supine Hip External Rotation
Supine SLR
Side-lying Hip Abduction
Side-lying External Rotation (clam)
Side-lying hip Adduction
Prone Hip Extension with Knee Extended
Prone Knee Flexion
Sitting Hip Flexion
Sitting Hip Internal Rotation
Sitting Hip External Rotation

_____ Quadruped reach> in quadruped, the person reaches one arm directly forward to the point of it being horizontal to the floor (back extensors should work bilaterally to stabilize the pelvis and trunk to allow motion of the arm into shoulder flexion, PSIS's , ASIS's, and the trunk should stay in the same/neutral plane).

_____ Quadruped rocking-back (hips and knees flex equally on both sides -if one side remains high, could indicate anterior femoral glide on that side due to that hip not closing as much as the uninvolved opposite side OR the lower side could indicate a posterior glide of the femur- knees should flex equally, lumbar spine should remain flat, pelvis should not tilt, no pain)