Transcript Wrist Lab Exercise

Presentation based on the textbook by Stanley Hoppenfeld:
Physical Examination of the Spine & Extremities
Hip
Lab Exercise
Presentation Created By:
Jennifer Hurrell, PT, MS
Associate Professor
Community College of Rhode Island
Rehabilitative Health Department
RHAB1110: Kinesiology
Learning Objectives
1) Identify the specified bony landmarks of the bones of the
hip on disarticulated bones
2) Identify the joints of the hip on a skeletal model
3) Locate the origins and insertions of the hip muscles on a
skeletal model
4) Demonstrate the anatomical course of the hip muscles on
a skeletal model
5) Identify bony and soft tissue structures that are palpable in
the hip region
6) Palpate specified hip structures by correlating anatomical
structures with surface anatomy landmarks
7) Perform, describe and name various special tests that
screen for common pathological conditions of the hip
Jennifer Hurrell, PT, MS
September 2004/ Rev. May 2007
Bony Landmarks
Identify these landmarks on the disarticulated bones
Femur
Femur cont.
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Head
Neck
Greater Trochanter
Lesser Trochanter
Intertrochanteric Line
Intertrochanteric Crest
Body
Medial Condyle
Lateral Condyle
Lateral Epicondyle
Medial Epicondyle
Jennifer Hurrell, PT, MS
September 2004/ Rev. May 2007
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Adductor Tubercle
Linea Aspera
Pectineal Line
Gluteal Tuberosity
Patellar Surface
Tibia
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Tibial Tuberosity
Innominate Bone
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Acetabulum
Joints & Articulations
Identify these joints & articulations on the skeleton
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Hip Joint
Jennifer Hurrell, PT, MS
September 2004/ Rev. May 2007
Muscles
Locate these muscle origins & insertions
on the skeleton
Anterior Muscles
Posterior Muscles
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Iliopsoas
Rectus Femoris
Sartorius
Medial Muscles
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Pectineus
Adductor Longus
Adductor Brevis
Adductor Magnus
Gracilis
Jennifer Hurrell, PT, MS
September 2004/ Rev. May 2007
Semitendinosus
 Semimembranosus
 Biceps Femoris
 Gluteus Maximus
 Deep Rotator Muscles
Lateral Muscles
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Tensor Fascia Latae
Gluteus Minimus
Gluteus Medius
Bony Palpation
Greater Trochanter
With your patient in supine, place your
thumbs on the ASIS’s and move your fingers
about 3” posteriorly along the iliac crest to the
widest part of the pelvis known as the iliac
tubercles. Now, move your fingers caudally
from the iliac tubercles until you can palpate
the greater trochanters. The posterior edge
of the trochanter is most palpable. The
examiner can also passively internally and
externally rotate the femur to facilitate
identification of this landmark.
Jennifer Hurrell, PT, MS
September 2004/ Rev. May 2007
Hoppenfeld Figure 6-3
Hoppenfeld Figure 6-3
The Femoral Triangle
Borders
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Superior Border = Inguinal Crease
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Medial Border = Adductor Longus
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Lateral Border = Sartorius
*To facilitate palpation of these
structures, place your patient in hip
flexion, abduction and ER, with their
heel resting on the opposite knee
Jennifer Hurrell, PT, MS
September 2004/ Rev. May 2007
Hoppenfeld Figure 6-12
Hoppenfeld Figure 6-12
Soft Tissue Palpation
Adductor Longus
The adductor longus is the most
superficial adductor muscle and the only
one accessible for palpation. It is
palpable as a cordlike structure
proximally near the pubic symphysis
and can be felt running toward the
middle of the thigh. It is often strained
during sports or activity.
Jennifer Hurrell, PT, MS
September 2004/ Rev. May 2007
Hoppenfeld Figure 6-17
Hoppenfeld Figure 6-17
Soft Tissue Palpation
Sartorius
This long, straplike muscle can be
palpated near it’s origin, slightly below
the ASIS.
Jennifer Hurrell, PT, MS
September 2004/ Rev. May 2007
Hoppenfeld Figure 6-16
Hoppenfeld Figure 6-16
The Femoral Triangle
Interior Structures
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Inguinal Ligament
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Femoral Artery
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Femoral Nerve & Vein (not palpable)
*To facilitate palpation of these structures,
place your patient in hip flexion,
abduction and ER, with their heel
resting on the opposite knee
Jennifer Hurrell, PT, MS
September 2004/ Rev. May 2007
Hoppenfeld Figure 6-15
Hoppenfeld Figure 6-15
Soft Tissue Palpation
Inguinal Ligament
This ligament is palpable between the
ASIS and the pubic tubercle. Any
unusual bulges along this ligament may
be indicative of an inguinal hernia.
Jennifer Hurrell, PT, MS
September 2004/ Rev. May 2007
Hoppenfeld Figure 6-13
Hoppenfeld Figure 6-13
Soft Tissue Palpation
Femoral Artery
The femoral artery passes under the
inguinal ligament at it’s midpoint.
Palpate the pulse of this artery just
inferior to the ligament at it’s midpoint.
Jennifer Hurrell, PT, MS
September 2004/ Rev. May 2007
Hoppenfeld Figure 6-15
Hoppenfeld Figure 6-15
Soft Tissue Palpation
Trochanteric Bursae
The trochanteric bursae covers the
posterior portion of the greater
trochanter. This structure is not
distinctly palpable unless it is distended
or inflamed, in which case it will feel
boggy and be tender to palpation.
Jennifer Hurrell, PT, MS
September 2004/ Rev. May 2007
Hoppenfeld Figure 6-19
Hoppenfeld Figure 6-19
Soft Tissue Palpation
Gluteus Medius Muscle
This muscle is most easily palpated with
the patient in sidelying and with the leg
actively raised into a few degrees of
abduction. It is palpable just below the
iliac crest and also at it’s insertion, on
the anterior and lateral aspects of the
greater trochanter.
Jennifer Hurrell, PT, MS
September 2004/ Rev. May 2007
Hoppenfeld Figure 6-51
Hoppenfeld Figure 6-51
Soft Tissue Palpation
Sciatic Nerve
When the hip is extended, the sciatic
nerve is covered by the gluteus
maximus, but is exposed during hip
flexion. Place your patient sidelying
with the hip flexed. In some individuals
the sciatic nerve is palpable midway
between the greater trochanter and the
ischial tuberosity.
Jennifer Hurrell, PT, MS
September 2004/ Rev. May 2007
Hoppenfeld Figure 6-22
Hoppenfeld Figure 6-22
Soft Tissue Palpation
Rectus Femoris
The rectus femoris is the only two-joint
muscle of the quadriceps muscles.
Except in individuals with very developed
musculature, it is not distinctly palpable
from the other three heads of the
quadriceps, however tenderness over
the area of it’s origin at the AIIS can
indicate avulsion. The quadriceps
muscle group covers the vast area on
the anterior aspect of the femur. Palpate
the vicinity of this muscle.
Jennifer Hurrell, PT, MS
September 2004/ Rev. May 2007
Hoppenfeld Figure 6-27
Hoppenfeld Figure 6-27
Soft Tissue Palpation
Gluteus Maximus
It is difficult to palpate the origin and
insertion of this massive muscle, but
palpation the muscle belly of the gluteus
maximus is facilitated with the patient
prone, with the buttocks squeezed together.
It’s outline can also be estimated by the
following imaginary lines:
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2)
Line between the PSIS to just above the
greater trochanter
Line between the coccyx and the ischial
tuberosity
Jennifer Hurrell, PT, MS
September 2004/ Rev. May 2007
Hoppenfeld Figure 6-29 (depicted in sidelying)
Hoppenfeld Figure 6-29
Soft Tissue Palpation
Hamstring Muscles
The common origin of the hamstring
muscles is palpable at the ischial
tuberosity. Palpation is facilitated by
having the patient in sidelying with their
knees flexed to the chest. Tenderness
to palpation in this region may be
indicative of tendonitis or ischial bursitis.
Jennifer Hurrell, PT, MS
September 2004/ Rev. May 2007
Hoppenfeld Figure 6-20
Hoppenfeld Figure 6-20
Special Tests
Thomas Test
The patient lies supine with the buttocks
at the edge of the table. The patient
holds the non-test leg in maximal flexion
and the examiner stabilizes the test-side
pelvis to prevent anterior tilting or
increased lumbar lordosis. The test leg
is lowered off the edge of the table. A
negative test is when the posterior thigh
fully contacts the table and the knee is
in greater than 45 degrees of flexion.
Jennifer Hurrell, PT, MS
September 2004/ Rev. May 2007
Konin Figure 9-8B
Konin Figure 9-8B
Special Tests
Thomas Test (cont)
The following indicate a positive Thomas Test
1)
Lack of hip extension with knee flexion greater
than 45 degrees = Iliopsoas tightness
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Full hip extension with less than 45 degrees
knee flexion = Rectus Femoris tightness
3)
Lack of hip extension with less than 45
degrees of knee flexion = Iliopsoas & Rectus
Femoris tightness
Jennifer Hurrell, PT, MS
September 2004/ Rev. May 2007
Special Tests
Ober Test
The patient lies on the non-test side with their
back at the edge of the table. The examiner
stands behind the patient with one hand
stabilizing the ilium, one hand supporting the
test leg, and their body leaning against the
posterior aspect of the patient. The test leg is
slightly extended and allowed to drop off the
back edge of the table. Inability of the leg to
adduct to the level of the table is indicative of
iliotibial band/ tensor fascia latae tightness.
Jennifer Hurrell, PT, MS
September 2004/ Rev. May 2007
Konin Figure 9-6C
Konin Figure 9-6C
Special Tests
Trendelenburg Test
Observe the alignment of the patient’s
pelvis by noting the level of the PSIS or
the iliac crest. Ask the patient to lift the
non-test leg off the ground. A negative
test is when the pelvis on the non-test
side elevates. A positive test is when the
pelvis on the non-test side remains in the
same position or descends. A positive
test is indicative of gluteus medius
weakness.
Jennifer Hurrell, PT, MS
September 2004/ Rev. May 2007
Hoppenfeld Figure 6-56
Hoppenfeld Figure 6-56
Special Tests
90-90 Straight Leg Raise Test
The patient lies supine, stabilizing both
hips in 90 degrees of flexion with their
hands, and both knees in the flexed
position. The patient actively extends the
knee on the test side. If the knee is flexed
more than 20 degrees in the end position,
the hamstrings are considered tight.
Jennifer Hurrell, PT, MS
September 2004/ Rev. May 2007
Konin Figure 9-3B
Konin Figure 9-3B
Special Tests
Ely’s Test
The subject lies prone while the examiner
stabilizes the pelvis over the PSIS. The
examiner passively flexes the subject’s
knee. If passive flexion of the hip occurs
during this maneuver it is considered a
positive test and is indicative of Rectus
Femoris tightness.
Jennifer Hurrell, PT, MS
September 2004/ Rev. May 2007
Konin Figure 9-11B
Jennifer Hurrell, PT, MS
September 2004/ Rev. May 2007
Konin Figure 9-11B
References
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Hoppenfeld, Stanley. (1976). Physical
Examination of the Spine and Extremities.
Norwalk: Appleton & Lange
Konin, J.G. et al. (2006). Special Tests for
Orthopedic Examination. 3rd Ed. Thorofare:
SLACK Inc.
Lippert, Lynn S. (2000). Clinical Kinesiology for
Physical Therapist Assistants. 3rd Ed.
Philadelphia: F.A. Davis Company.
Minor, M.D. & L.S. Lippert. (1998). Kinesiology
Lab Manual for Physical Therapist Assistants.
Philadelphia: F.A. Davis Company.
Netter, Frank H. (2003). Atlas of Human
Anatomy. Teterboro: Icon Learning Systems.
Jennifer Hurrell, PT, MS
September 2004/ Rev. May 2007