Transcript Thomas test

‫نام خداوند بخشاينده بخشايشگر‬
Pelvis, Hip, and Thigh Examination
Sh.Haghighat M.D.
Assistant professor
Physical Medicine & Rehab. Department
Isfahan Medical College
The pelvis is a complex bony structure
that is formed by the joining of seven
individual components.
On each side of the pelvis, the ilium, the
ischium, and the pubis fuse together to
become a pelvic, or innominate bone.
The right and left pelvic bones join each
other anteriorly at the pubic symphysis
and join the sacrum posteriorly at the
sacroiliac joints to form a closed ring
INSPECTION
ANTERIOR ASPECT
The most prominent feature of the
pelvis is the arching superior margin of
the ilium, known as the iliac crest.
the anterior superior iliac spine (ASIS)
is the anterior terminus of the iliac crest
The hip joint itself is located 2 cm
lateral and 2 cm distal to the point at
which the femoral pulse is palpable
beneath the inguinal ligament
LATERAL ASPECT
The most prominent bony landmark is
the
greater trochanter of the proximal femur
D, gluteus medius
E, tensor fascia lata
F. gluteus maximus
POSTERIOR ASPECT
The posterior border of the crest is seen
to curve posteriorly and medially to its
point of termination, the PSIS.
The PSIS overhangs the sacroiliac
joint, which is located just distal to it
The ischial tuberosity is not normally
visible, but it is palpable in the inferior
medial buttock deep to the gluteus
maximus
ALIGNMENT: leg length discrepancy
Abnormalities of limb length usually
result in obliquity of the pelvis; therefore, a
check for pelvic obliquity is an excellent
starting point to begin the alignment
examination
 The many possible causes of obliquity
can be divided into two large groups:
factors resulting in a true leg length
discrepancy and factors resulting in a
functional, or apparent, leg length
discrepancy.
To check for a true leg length discrepancy, the examiner
identifies the patient's ASIS and places the free end of a tape
measure on it toward the distal tip of the medial malleolus
Femoral Versus Tibial Discrepancy
To check for a functional leg length discrepancy, the
examiner measures the distance from the patient's
umbilicus to the tip of each medial malleolus
GAIT
With the weight of the patient's upper body bearing
down on one side of the femoral head and the abductor
muscles pulling at a force twice the patient's upper body
weight on the other
side, a compressive force of three times the weight of the
patient's upper body is transmitted across the weightbearing femoral head with every step.
Trendelenburg sign
A) When stepping on the unaffected side, the pelvis remains
level. B) When stepping on the affected side, the pelvis tilts
downward toward the unaffected side, and there is a subtle
shift of the torso.
Tests for acetabular pathology
FABER (Femoral ABduction External Rotation) or
Patrick’s test
 If Patrick's test produces posterior hip
pain, pathology of the sacroiliac joint
should be suspected.
An arthritic hip may also be painful
when placed in this position, but the pain
is normally felt in the anterior groin.
The figure-four position also places the
iliopsoas muscle on stretch. Pathology of
the iliopsoas, such as an intrapelvic
abscess irritating the iliopsoas sheath,
leads to pain in this position. This is
sometimes called the iliopsoas sign.
Stinchfield test ‒ Ask the supine patient to raise their leg off the table,
while keeping the knee in full extension, against resistance provided by
the examiner pressing a hand against the lower shin. The test is positive
if it elicits pain and/or weakness be due to intra-articular hip
 Snapping of the iliopsoas tendon
(internal snapping hip syndrome)is a
common incidental finding without
clinical significance. However, the
snapping can become painful and can be
difficult to distinguish from an intraarticular problem
 The snapping occurs as the iliopsoas
tendon transiently lodges on iliopectineal
eminence or femoral head
Snapping due to the iliotibial band(lateral snapping hip syndrome) is more
easily distinguished from a hip joint disorder because of its lateral
location.9
These patients frequently present with a sensation that their hip is
subluxing or dislocating.
The visual appearance is created by the tensor fascia lata flipping back
and forth across the greater trochanter, and not instability of the hip.
The piriformis test is performed with the patient in
the lateral decubitus position with the side to be examined facing up.
The patient's hip is flexed 45° with the knee flexed about 90°. The
examiner stabilizes the patient's pelvis with one hand to prevent
pelvic rotation
The examiner's other hand then pushes the flexed knee toward the
floor, thus internally rotating the hip
Tests of sacroiliac region
● Posterior shear or thigh thrust test – With the patient supine, the
examiner places one hand under their sacrum and then flexes their hip
and knee both to 90 degrees. With the patient in this position, the
examiner applies pressure downward along the axis of the femur. Pain at
the ilium or SIJ suggests SIJ dysfunction [5].
●Gaenslen test
●Gillet’s test
●FABER test
Gaenslen test
Gillet’s test
Normally, the examiner should feel the
sacrum move posteriorly on the side
where the patient flexes their hip and
knee; minimal movement or movement
anteriorly marks a positive test.
pelvic distraction lest(Gapping test)
Pt supine. Examiner applies posterolateral directed pressure
to bilateral ASIS. (Reproduction of pain)
Tests for lateral hip pain
The Ober test assesses the tightness of the iliotibial band (ITB). It is
performed with the patient lying on the unaffected side, with the hip
and knee of the unaffected lower extremity both positioned in about
90 degrees of flexion. The examiner slightly abducts and extends the
affected hip and flexes the knee. The patient is then asked to allow
the affected leg to fall to the table passively, without actively
adducting the hip (just letting it fall with gravity), while the examiner
supports the patient's lower leg. Patients with ITB syndrome are
more likely to have limited adduction of the leg with this maneuver
Tests of hip flexors
●Thomas test ‒
●Modified Thomas test ‒ From the same starting position as the
Thomas test, look to see if the pelvis comes up off the table. A positive
test is indicative of hip flexor tightness, involving either the tensor facia
latea and/or rectus femoris.
●Ely test
Thomas test of hip flexor and knee extensor tightness
In the presence of a tight rectus femoris, full pas-sive
knee flexion produces involuntary flexion at the hip,
causing the buttocks to rise off the examination table