South Carolina Physical Therapy Ebook Continuing Education

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Differential Diagnosis in Physical Therapy of Upper Extremity and Lower Quadrant: Summary

Lower Quadrant Examination • Classic complaint with hip pathology is “groin pain” ○ The patient will cup hand above greater trochanter when describing deep interior hip pain ○ The hand forms a C = “C-sign” • Palpation • Posture

○ 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

• ROM with overpressures • Leg length discrepancies • Neurological ○ DTRs ○ Sensation • Key muscle testing • Squat test • Neurodynamic testing—when appropriate • Muscle length tests ○ Obers ○ Thomas ○ SLR ○ Ely Special Tests • Trendelenburg sign:

• 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%

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