|
|
|
|
Sign of the buttock
 This is a clinical sign that can be found when performing the lumbar spine examination.
Passive hipflexion is more limited (painful) than the SLR.
This is an important red flag. We don't think of an internal derangement anymore.
Sign of the buttock (2)
The sign of the buttock is a combination of findings which indicates serious gluteal pathology. What is the situation ?
There is a buttock pain, which may or may not spread down the leg.
We perform the standard examination of the lumbar spine :
in standing, we notice marked painful limitation of trunk flexion
straight-leg raising is also painful and limited. We suspect a lumbar disorder.
However, passive hip flexion is even more limited than straight-leg raising, and the end-feel is empty ; the rotations hurt in a non-capsular way.
Because of the positive hip signs, the complete hip examination should be included.
Some resisted hip tests may prove positive.
Interpretation :
straight-leg raising incriminates a structure behind the hip.
The positive passive hip flexion eliminates the nerve roots and the hamstrings as a possible cause of the pain (because, during knee flexion those structures are in a
relaxed position).
The only structures left are the bony and soft structures of the buttock.
A complementary examination is called for.
Disorders :
infection : osteomyelitis of the upper femur, septic sacroiliac arthritis,ischiorectal abscess, septic gluteal bursitis
neoplasm at the ilium or at the upper femur
fractured sacrum.
Remark : this chapter illustrates clearly the importance of performing the passive hip tests after having tested the straight-leg raising in the lumbar examination. They are not just hip tests, but enable us to discover serious local pathology in the buttock.
(Part I, p105)
|
|
|
 |
|
|
Discover more orthopaedic medicine items |
|
| |
|
|
|
|
|
|
 |
|
