Pre-test pain at rest
Always inform about the presence of a pre-test pain : where is this pain and how is it influenced by the tests. Does it get worse or better ; is a new pain produced somewhere else ?
If there is no pain at rest, are we able to produce pain and where is it produced ?
Passive flexion
We interpret pain, range of motion and endfeel (soft, extra-articular).
Endrange pain on passive flexion could impinge the proximal part of the rectus femoris.
Passive rotations
We interpret pain, range of motion and endfeel (elastic). Make sure to perform the tests in a delicate way, otherwise we also test the SI-joints.
Passive abduction and adduction
Adduction can be painful in case of a gluteal bursitis or a lesion of the iliotibial tract. Abduction could be painful in case of an adductor tendinitis or a gluteal bursitis.
Resisted flexion
Variable pain
The most common interpretations are a lesion of the psoas, rectus femoris and a fracture of the trochanter minor.
Variable weakness
Of course, a fracture (trochanter minor, ASIS) presents itself as the combination of pain and weakness. Pressure on the L2-L3-nerve root(s) can cause weakness ; a tumour is also posssible.
A psychogenic disorder is another possibility.
Resisted extension
Variable pain
We mainly think of compression of an inert structure : e.g. gluteal bursitis.
Variable weakness
Fracture or severe pathology ?
Resisted adduction
Variable pain
The main interpretation is a lesion of the adductor muscles ; check two localizations (tenoperiosteal and musculotendinous junction). Remember that we need to have a positive palpation too.
Variable weakness
Pubis fracture ?
Resisted abduction
Variable pain
We mostly think of a compression of an inert structure : e.g. gluteal bursitis. A gluteus medius lesion is extremely rare.
Variable weakness
Fracture ?
Passive extension
We interpret pain, range of motion and endfeel (elastic). Make sure to perform the tests in a correct way, otherwise we also test the SI-joints.
Passive bilateral medial rotations
We interpret pain, range of motion and endfeel (elastic). This is the best test to detect an early arthrosis (slight limitation of movement and harder endfeel).
After the passive tests we can interpret the pattern : capsular (lateral rotation and adduction are free ; medial rotation and abduction are more limited than flexion and flexion is more limited than extension) or non-capsular ?
Resisted medial rotation
Variable pain
We expect this test to be negative ; a lesion of a contractile structure is highly unlikely.
Variable weakness
Fracture ?
Resisted lateral rotation
Variable pain
We could think of a lesion of the sartorius muscle, but this is very rare. In combination with weakness we mainly think of a fracture of the ASIS.
Variable weakness
Fracture ?
Remarks
Remember that in case of a psoas or an adductor lesion we not only need a positive test but also pain on palpation, otherwise another lesion is suspected (e.g. fracture).
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Contact : Steven De Coninck, MSc PT |
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