64 Differential Diagnosis in Physical Therapy of Upper Extremity and Lower Quadrant: Summary
• FABER test: Also know as “Patrick’s” intra- articular hip pathology, lumbar or sacroiliac dysfunction, or iliopsoas spasm ○ LE in number 4 position with foot resting on the contralateral knee ○ Gentle downward traction on the ipsilateral knee ○ Positive test : Pain or a decreased ROM ○ Hip OA: Sensitivity=53% Specificity=71% ○ Labral tear, arthritic changes, AVN: Sensitivity=81% Specificity=25% • Log roll test: Specific test for hip pathology ○ With the patient supine, gently rolling the thigh internally and externally, which moves the articular surface of the femoral head in relation to the acetabulum without stressing other structures • FADIR impingement test ○ Hip into full flexion, lateral rotation, and full abduction as a starting position—then bring hip into extension while combining a medial rotation with adduction motion ○ Positive test : Provocation of symptoms with or without a click ○ Femoroacetabular Impingement (FAI), labral tear: Sensitivity = 99%, specificity = 25% • Scour Test: Screens for nonspecific hip pathology—acetabular impingement or labral tears ○ Passively move hip through flex and adduct, then extension and abduction while applying axial load along the axis of femur ○ Positive test : Provocation of symptoms or clicking ○ Sensitivity = 50%, specificity = 29% Characteristic Buttock Symptoms • Determine the possibility of nonmusculoskeletal causes for the patient’s symptoms • Redness and swelling are present in the buttock area without a history of trauma; the “sign of the buttock” may be suspected • Buttock large and swollen and tender to touch
• SLR limited and painful • Limited trunk flexion • Hip flexion with knee flexed limited and painful • Empty end feel on hip flexion • Noncapsular pattern of restriction at hip (flexion, abduction, internal rotation) • Resisted hip movements painful and weak, especially hip extension Characteristic Hip Symptoms • Symptoms worse with activities • Twisting, such as turning or changing directions • Seated position may be uncomfortable • Rising from seated position often painful (catching) • Difficulty ascending and descending stairs • Symptoms with entering/exiting an automobile • Difficulty with shoes, socks, hose, etc. Causes of Groin Pain Clinicians may see a client with an isolated groin problem, but more often they present with low back, pelvic, hip, knee, or SI problems with a secondary complaint of groin pain. Systemic and/or visceral causes of groin pain are wide ranging. • Systemic : cancer, osteoporosis, ascites (cirrhosis), hemophilia, gi bleeding, abdominal aortic aneurysm, peripheral arterial aneurysm, uterine fibroids/masses, ovarian cyst, PID, prostate impairment, epididymitis; testicular torsion, urethritis/ urinary tract infection, diverticulitis, inflammatory bowel disease • Neuromusculoskeletal : strain, nerve compression, stress fracture, avulsion fracture, or complete bone fracture, bursitis (iliopectineal), hernia, subluxation, dislocation, avascular necrosis (avn), Legg– Calvé–Perthes disease, labral tear, arthritis, lumbar spine impairment, thoracic disk disease (lower thoracic spine)
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