sean p. flanagan, phd, atc, cscs department of kinesiology ...sflanagan/kin 338/338...
TRANSCRIPT
Sean P. Flanagan, PhD, ATC, CSCS Department of Kinesiology
California State University, Northridge
© 2006 Sean P. Flanagan
Bod
ySt
ruct
ures
Mus
cle
Tend
on
Bur
sae
Ner
ve
Join
tB
one
Vas
cula
r
Org
ans
Bon
e
Exo
stos
is
Apo
phys
itis
Frac
ture
Avu
lsio
n
Stre
ss
Loca
tion
Sev
erity
Sha
pe
Cla
ssifi
catio
nC
ontu
sion
FRACTURE CLASSIFICATIONS
A. By Location
1)
2)
3)
B. Severity
1)
2)
3)
4)
C. Shape
1)
2)
3)
4)
5)
6)
7)
Join
t
Liga
men
t
Sub
luxa
tion
Dis
loca
tion
Syn
oviti
s
Ost
eoch
ondr
alD
efec
ts
Ost
eoch
ondr
itis
Dis
seca
ns
Arth
ritis
Car
tilag
eTe
ar
Spr
ain
1stD
egre
e
2ndD
egre
e
3rdD
egre
e
Mus
cle
Stra
in
Con
tusi
on
1stD
egre
e
2ndD
egre
e
3rdD
egre
e
Myo
sitis
Oss
ifica
ns
Tend
on
Tend
initi
s
Teno
syno
vitis
1stD
egre
e
2ndD
egre
e
3rdD
egre
e
Per
itend
initi
s
Cal
cific
Tend
initi
s
Tend
inos
is
Bur
sa
Bur
sitis
Ner
ve
Stre
tch
Ent
rapm
ent
Neu
rapr
axia
Axo
notm
esis
Neu
rotm
esis
Com
plex
Reg
iona
lP
ain
Syn
drom
e
COMPARING TISSUE INJURIES
Structure Nomenclature Description
Ligament
Muscle
Tendon
Nerve
Vasc
ular
Eval
uatio
ns
Clin
ical
On-
Fiel
d
Am
bula
tory
Ath
lete
Dow
n
Injury EvaluationProcess
His
tory
Des
crip
tion
Pre
viou
sH
isto
ryG
ener
alM
edic
alH
ealth
Loca
tion
Sou
nds
&S
ensa
tions
Mec
hani
sm
Ons
et &
Dur
atio
n
Rel
ated
toO
ppos
ite S
ide
Cha
nges
inS
ympt
oms
COMMON DESCRIPTIONS OF PAIN
A. BONE
B. FRACTURE
C. JOINT
D. MUSCLE / TENDON
E. BURSAE
F. NERVE
G. VASCULAR
Obs
erva
tion
Pos
ture
Func
tiona
lM
ovem
ent
Pat
tern
s
Sho
esG
ait
Inju
red
Are
aG
ross
Def
orm
ity
Sw
ellin
gD
isco
lora
tion
Sig
ns o
fIn
fect
ion
Bila
tera
l Sym
met
ry
SIGNS OF INFECTION
A. Pain
B. Redness
C. Swelling
D. Pus
E. Foul Odor Drainage
F. Heat to Site
G. Fever
H. Swollen Lymph Nodes
Palp
atio
n
Poi
ntTe
nder
ness
Cre
pitu
s
Trig
ger
Poi
nts
Cha
nges
inTi
ssue
Den
sity
PALPATION GUIDELINES
A. Practice Self Palpation
B. Less is More
C. Movement vs. Stillness
D. Develop a Sequence
1) Structures
2) Areas
E. Begin on Opposite Side / Away from Pain
Stress Tests
Bon
e
Long
Bon
eC
ompr
essi
on
Per
cuss
ion
Join
t
Spe
cial
Tes
ts
End
Fee
l
Join
tP
lay
Pas
sive
R.O
.M.
END FEELS
A. Normal
1)
2)
3)
B. Abnormal
1)
2)
3)
4)
5)
GONIOMETRY – SFTR METHOD
Plane 1st Number 2nd Number 3rd Number
Sagittal (S)
Frontal (F)
Transverse (T)
Rotation (R)
Hypomobility
Fixed Joint Ankylosis
Mus
cle
/Te
ndon
Act
ive
R.O
.M.
Isom
etric
“Bre
ak”
Test
s
Pas
sive
R.O
.M.
Res
iste
dR
.O.M
.
MUSCLE TEST GRADING
GRADE
VALUE MOVEMENT
Ner
ve
Mot
or
Pat
holo
gica
lR
efle
xes
Bra
in
Sen
sory
Cer
ebel
lum
Cer
ebru
mC
rani
al N
erve
Myo
tom
es
Der
mat
omes
Dee
p Te
ndon
Ref
lexe
s
DEEP TENDON REFLEX GRADING
GRADE
VALUE PATHOLOGY
Vasc
ular
Dis
tal
Pul
ses
Imag
ing
X-R
ay
Bon
e S
can
Mag
netic
Res
onan
ceIm
agin
g
Com
pute
dTo
mog
raph
y
Ultr
asou
nd
Bones
Forefoot
Midfoot
Leg
Rearfoot
Tibia
Fibula
Talus
Calcaneus
Phalanges
Metatarsals
Cuneiforms
Navicular
Cuboid
Joints
Metatarsal-Phalangeal
TransverseTarsal
Tib-Fib
Subtalar
Tibia
Fibula
Talus
Calcaneus
Phalanges
Metatarsals
Talus
Navicular
Cuboid
Inter-Phalangeal Phalanges
Ankle
TN
CC
Proximal Distal
Liga
men
tsLi
gam
ent
Con
nect
sR
estra
ins
Spr
ing
ATF
CF
PTF
Del
toid
Pro
xim
al T
ib-F
ib
Dis
tal T
ib-F
ib
Pla
ne o
f Mot
ion
Join
tS
agitt
alFr
onta
lTr
ansv
erse
IP MTP
Sub
tala
r
Ank
le
Join
t Mot
ion
Pro
natio
n&
Sup
inat
ion
Wei
ght B
earin
gN
on-W
eigh
t B
earin
gC
alca
neus
Cal
cane
us
Talu
sC
alca
neus
Talu
sC
alca
neus
Cal
cane
usC
alca
neus
Talu
sC
alca
neus
Talu
sC
alca
neus
Sup
inat
ion
Pro
natio
n
Mot
ion
Prim
e M
over
(s)
IP F
lexi
on
IP E
xten
sion
MTP
Fle
xion
MTP
Ext
ensi
on
MTP
Abd
uctio
n
MTP
Add
uctio
n
Mus
cle
–Jo
int I
nter
actio
n
Mot
ion
Prim
e M
over
(s)
Rea
rfoot
Inve
rsio
nR
earfo
otE
vers
ion
Ank
leD
orsi
flexi
onA
nkle
Pla
ntar
flexi
on
Mus
cle
–Jo
int I
nter
actio
n
Pop
litea
l
Ant
erio
rTi
bial
Pos
terio
rTi
bial
Dor
sal
Ped
is
Med
ial
Pla
ntar
Late
ral
Pla
ntar
Blo
od S
uppl
y
Ant
erio
rC
ompa
rtmen
t
Dor
sal
Foot
Pla
ntar
Foot
Pos
terio
rC
ompa
rtmen
t
Sci
atic
Dee
pP
eron
eal
Tibi
al
Med
ial
Pla
ntar
Late
ral
Pla
ntar
Ner
ve S
uppl
y
Ant
erio
rC
ompa
rtmen
t
Dor
sal
Foot
Pla
ntar
Foot
Pos
terio
rC
ompa
rtmen
t
Com
mon
Per
onea
l
Sup
erfic
ial
Per
onea
l
Late
ral
Com
partm
ent
Passing theMedial Malleolus
Sup. Peroneal N.
PBPL
TA
EDLEHLPT
Deep Peroneal N.Ant. Tib Artery
GastrocPlantaris
Soleus
FHLTibial N.Post. Tib Artery
PT FDLPosteriorCompartment
LateralCompartment
AnteriorCompartment
BO
NE
Frac
ture
Apo
phys
itis
Con
tusi
on
Exo
stos
is
JOIN
T
Syn
desm
otic
Ank
leS
prai
n
Inve
rsio
nA
nkle
Spr
ain
Eve
rsio
nA
nkle
Spr
ain
Dis
loca
tion
Ost
eoch
ondr
itis
Dis
seca
ns
MU
SCLE
/TE
ND
ON
Tibi
alis
Ant
erio
r
Per
onea
lsA
chill
es
Tibi
alis
Pos
terio
r
Gas
troc
BU
RSA
Ret
roca
lcan
eal
Bur
sitis
NER
VE
Tars
al T
unne
l S
yndr
ome
Inte
rmet
atar
sal
Neu
rom
a
VASC
ULA
R
Dee
p V
ein
Thro
mbo
sis
Com
partm
ent
Syn
drom
eE
xerti
onal
Acu
te
OB
SER
VATI
ON
Foot
Typ
e
Pes
Pla
nus
Pes
Cav
us
Toe
Pos
ture
sTo
enai
ls
Cal
luse
s&
Blis
ters
Cor
ns
Cla
wTo
esH
amm
erTo
es
Hal
lux
Valg
us
Mor
ton’
sTo
es
Hal
lux
Abd
ucto
Valg
us
FOOT AND TOES PALPATION GUIDE Medial Structures First Metatarsal First MTP Joint First Cuneiform Navicular Talar Head Sustenaculum Tali Spring Ligament Calcaneaous Flexor Hallicus Longus Flexor Digitorum Longus Tibialis Posterior Posterior Tibial Artery Lateral Structures Fifth Metatarsal Fifth MTP Joint Styloid Process Cuboid
Lateral Border - Calcaneous
Peroneal Tendons Dorsal Structures Metatarsal Heads Extensor Hallicus Longus Extensor Digitorum Longus Rays Cuneiforms Tibialis Anterior Navicular Dome of Talus Inferior Extensor Retinaculum Dorsalis Pedis Artery Sinus Tarsi Extensor Digitorum Brevis Plantar Structures Metatarsal Heads Sesmoid Bones Plantar Fascia Medial Calcaneal Tubercle
ANKLE AND LOWER LEG PALPATION GUIDE Lateral Structures Head of the Fibula Peroneus Longus Peroneus Brevis Shaft of the Fibula Anterior Tibiofibular Ligament Interosseous Membrane
Superior Peroneal Retinaculum
Lateral Malleolus Calcaneofibular Ligament Anterior Talofibular Ligament Posterior Talofibular Ligament Peroneal Retinaculum Peroneal Tubercle Cuboid Base of the 5th Metatarsal Peroneus Tertius Anterior Structures Anterior Tibial Shaft Tibialis Anterior Extensor Hallicus Longus Extensor Digitorum Longus Dome of Talus Extensor Retinacula Dorsalis Pedis Artery Medial Structures Medial Malleolus Deltoid Ligament Flexor Hallicus Longus Flexor Digitorum Longus Tibialis Posterior Posterior Tibial Artery Sustenaculum Tali Spring Ligament Navicular Tuberosity Tibialis Posterior
Posterior Structures Gastroc-Soleus Complex Achilles Tendon
Subcutaneous Calcaneal Bursa
Calcaneous
Subtendinous Calcaneal Bursa
BO
NE
Frac
ture
Apo
phys
itis
Con
tusi
on
Exo
stos
is
Bum
pTe
stSq
ueez
eTe
st
JOIN
T
Syn
desm
otic
Ank
leS
prai
n
Inve
rsio
nA
nkle
Spr
ain
Eve
rsio
nA
nkle
Spr
ain
Spr
ain
/D
islo
catio
nO
steo
chon
driti
sD
isse
cans
Inve
rsio
n Ta
larT
ilt
Ant
erio
r D
raw
er
Squ
eeze
Test
Kle
iger
’sTe
st
Eve
rsio
nTa
larT
ilt
Tib-
Fib
Tran
slat
ion
Test
Glid
es
Mot
ion
Nor
mal
R
OM
Sta
tiona
ry
Arm
A
xis
of
Rot
atio
nM
ovin
g A
rm
IP F
lexi
on
IP
Ext
ensi
onM
TP
Flex
ion
MTP
E
xten
sion
MTP
A
bduc
tion
MTP
A
dduc
tion
Gon
iom
etry
Mot
ion
Nor
mal
R
OM
Sta
tiona
ry
Arm
A
xis
of
Rot
atio
nM
ovin
g A
rm
Rea
rfoot
Inve
rsio
nR
earfo
otE
vers
ion
Pla
ntar
Flex
ion
Dor
siFl
exio
n
Gon
iom
etry
Goniometry Worksheet
Subject 1 ______________
Subject 2 _______________
Evaluator A _____________
Evaluator B _____________
Evaluator A _____________
Evaluator B _____________
MTP
Extension
Flexion
Adduction
Abduction
Subtalar
Eversion
Inversion
Talocrural
PF
DF
MU
SCLE
/TE
ND
ON
Tibi
alis
Ant
erio
r
Per
onea
lsA
chille
s
Tibi
alis
Pos
terio
r
Gas
troc
Thom
pson
Test
PRO
MAR
OM
KN
EE
AN
KLE
KN
EE
AN
KLE
Gas
troc
Sol
eus
NER
VE
Tars
al T
unne
l S
yndr
ome
Inte
rmet
atar
sal
Neu
rom
a
Tine
l’sS
ign
Pen
cil
Test
Mor
ton’
s Te
st
VASC
ULA
R
Dee
p V
ein
Thro
mbo
sis
Com
partm
ent
Syn
drom
eE
xerti
onal
Acut
e
Hom
an’s
Sig
n
Dor
sal
Ped
isA
rtery
Pos
terio
rTi
bial
Arte
ry
Bon
e In
jury
M
echa
nism
s Sp
ecia
l Tes
ts
Jone
s Fra
ctur
e
Tibi
al S
tress
Fra
ctur
e
Sq
ueez
e Te
st
Bum
p Te
st
Join
t In
jury
M
echa
nism
s Sp
ecia
l Tes
ts
Turf
Toe
A
nter
ior D
raw
er
Inve
rsio
n Ta
lar T
ilt
Ever
sion
Ank
le S
prai
n
Dor
sifle
xion
with
ext
erna
l rot
atio
n of
the
foot
Cub
oid
glid
e –
plan
tar t
o do
rsal
Mus
cle
/ Ten
don
Inju
ry
Mec
hani
sms
Spec
ial T
ests
Pl
anta
r Fas
ciiti
s
Thom
pson
Tes
t
Pero
neal
Ten
don
Subl
uxat
ion
Tibi
alis
Ant
erio
r Stra
in
Tibi
alis
Pos
terio
r Stra
in
Ner
ve
Inju
ry
Mec
hani
sms
Spec
ial T
ests
In
term
etat
arsa
l Neu
rom
a
Tine
l’s S
ign
V
ascu
lar
Inju
ry
Mec
hani
sms
Spec
ial T
ests
A
nter
ior C
ompa
rtmen
t Sy
ndro
me
Dee
p V
ein
Thro
mbo
phle
bitis
Tibi
a
Fem
ur
Pat
ella
Tibi
ofem
oral
Join
t
Pat
ello
fem
oral
Join
t
Wha
t are
the
cons
eque
nces
? St
ruct
ure
Func
tion
Fe
mur
M
edia
l con
dyle
ext
ends
furth
er d
ista
lly
M
edia
l con
dyle
is la
rger
L
ater
al b
orde
r of t
he tr
ochl
ear g
roov
e is
l
arge
r
T
roch
lear
gro
ove
is d
eepe
r inf
erio
rly
Tibi
a
C
ondy
les a
re sm
alle
r tha
n fe
mor
al c
ondy
les
Men
isci
Med
ial
Late
ral
Ant
erio
rLateral
Medial
Pos
terio
r
AC
L
Liga
men
ts
MC
LLC
L
PC
L
IT Band
Ant
erio
rLateral
Medial
Pos
terio
r
Liga
men
ts
Liga
men
tC
onne
cts
Res
train
s
AC
L
PC
L
MC
L
LCL
Ext
enso
rs
Flex
ors
IRE
R
Vas
tus
Med
ialis
Vas
tus
Late
ralis
Vas
tus
Inte
rmed
ius
Rec
tus
Fem
oris
TFL
(0-3
0°)
Bic
eps
Fem
oris
Gra
cilis
*
Sem
imem
bran
osus
Sem
itend
inos
us*
Sar
toriu
s*
Pop
liteu
sTF
L(4
5-14
5°)
Gas
trocn
emiu
s
Pla
ntar
is
* Pes
Ans
erin
e
Mot
ion
Prim
e M
over
(s)
Flex
ion
Ext
ensi
on
IR ER
Mus
cle
–Jo
int I
nter
actio
n
Pre
-P
atel
lar
Bur
saP
esA
nser
ine
Ant
erio
rLateral
Medial
Pos
terio
r
Fem
oral
Ner
veO
btur
ator
Sci
atic
(Tib
ial)
Ant
erio
rLateral
Medial
Pos
terio
r
Vasc
ular
Ant
erio
rLateral
Medial
Pos
terio
r
Pop
litea
lA
rtery
Gen
icul
arA
rterie
sG
enic
ular
Arte
ries
Infra
-P
atel
lar
Fat P
ad
Oth
er
Ant
erio
rLateral
Medial
Pos
terio
r
BO
NE
Frac
ture
Pat
ello
Fem
oral
Pai
nS
yndr
ome
Osg
ood-
Sch
latte
r’sD
isea
se
Fem
urTi
bia
Pat
ella
JOIN
T
Spr
ains
Men
isca
lTe
ars
Ost
eoch
ondr
alD
efec
ts
Plic
aO
steo
chon
driti
sD
isse
cans
MC
LA
CL
PC
LLC
L
Rot
atio
nal I
nsta
bilit
ies
Pop
litea
lC
yst
MU
SCLE
/TE
ND
ON
Stra
ins
Tend
initi
sIT
Ban
dFr
ictio
nS
yndr
ome
Qua
dC
ontu
sion
Myo
sitis
Oss
ifica
ns
BU
RSA
Pes
Ans
erin
eB
ursi
tis
Pre
pate
llar
Bur
sitis
NER
VE
Per
onea
lN
erve
Con
tusi
on
VASC
ULA
R
OTH
ER
Infra
pate
llar
Fat P
adC
ontu
sion
OB
SER
VATI
ON
Pat
ella
r Pos
ition
Tibi
o-Fe
mor
alA
lignm
ent
QA
ngle
Leg
Leng
thG
irth
Gen
uR
ecur
vatu
m
Gen
uV
algu
m
Gen
uV
aru
Pat
ella
A
ltaP
atel
la
Baj
a
Frog
-Eye
dP
atel
laS
quin
ting
Pat
ella
Bal
otta
ble
Pat
ella
BO
NE
Frac
ture
Pat
ello
Fem
oral
Pain
Synd
rom
e
Osg
ood-
Sch
latte
r’sD
isea
se
Fem
urTi
bia
Pat
ella
Pat
ella
r Glid
es Pat
ella
r Tilt
Cla
rke’
s
App
rehe
nsio
n
KNEE PALPATION GUIDE Anterior Structures Tibial Tuberosity Patellar Tendon Patella Quadriceps Tendon Quadriceps Muscle Group Sartorius Medial Structures Medial Tibial Plateau Medial Meniscus Medial Collateral Ligament Pes Anserine Tendon Semimembranosus Gracilis Medial Femoral Condyle Medial Femoral Epicondyle Medial Collateral Ligament Lateral Structures Lateral Tibial Plateau Lateral Collateral Ligament Iliotibial Band Fibular Head Lateral Collateral Ligament Popliteus Biceps Femoris Posterior Structures Popliteal Fossa Hamstring Muscle Group Heads of Gastrocnemius
JOIN
T
Spr
ains
Men
isca
lTe
ars
Ost
eoch
ondr
alD
efec
ts
Plic
a
Ost
eoch
ondr
itis
Dis
seca
ns
Pop
litea
lC
yst
AC
L
MC
LLC
L
PC
L
Ant
erio
r Dra
wer
Lach
man
’s
Pos
terio
r Dra
wer
God
frey’
s
Val
gus
Var
us
McM
urra
y’s
Apl
ey’s
Med
ial
Syn
ovia
lP
lica
Wils
on’s
Stu
tter
Bou
nce
Hom
e
Apl
ey’s
RO
TATI
ON
AL
INST
AB
ILIT
IES
Ant
ero-
Med
ial
Pos
terio
-M
edia
lA
nter
o-La
tera
l
Pos
terio
-La
tera
l
Cro
ssov
er
Piv
otS
hift
Slo
cum
ALR
I
FRD
Slo
cum
Dra
wer
Slo
cum
Dra
wer
Ext
erna
lR
otat
ion
Hug
hsto
n’s
Jerk
Mot
ion
Nor
mal
R
OM
Sta
tiona
ry
Arm
A
xis
of
Rot
atio
nM
ovin
g A
rm
Flex
ion
Ext
ensi
on
Inte
rnal
Rot
atio
nE
xter
nal
Rot
atio
n
Gon
iom
etry
Goniometry Worksheet
Subject 1 ______________
Subject 2 _______________
Evaluator A _____________
Evaluator B _____________
Evaluator A _____________
Evaluator B _____________
Knee
Extension
Flexion
IR
ER
MU
SCLE
/TE
ND
ON
Stra
ins
Tend
initi
sIT
Ban
dFr
ictio
nS
yndr
ome
Qua
dC
ontu
sion
Myo
sitis
Oss
ifica
ns
Nob
le’s
Obe
r’s
PRO
MAR
OM
KN
EE
HIP
KN
EE
HIP
Rec
tus
Fem
oris
Ham
strin
gs
BU
RSA
Pes
Anse
rine
Bur
sitis
Pre
pate
llar
Bur
sitis
NER
VE
Per
onea
lN
erve
Con
tusi
on
Myo
tom
esD
erm
atom
es
VASC
ULA
R
Dis
tal
Pul
ses
Dor
sal
Ped
is
Pos
terio
rTi
bial
Pop
litea
l
Kinesiology 338L Knee
Checklist History
General History
Specific to this Region Observation
General Inspection
Girth Measurements
Leg Length
Patellar Position
Tibiofemoral Alignment
Q-Angle
Calluses/Corns/Blisters Palpation Anterior Structures
Tibial Tuberosity
Patellar Tendon
Patella
Quadriceps Tendon
Quadriceps Muscle Group
Sartorius
Medial Structures
Medial Tibial Plateau
Medial Meniscus
Medial Collateral Ligament
Pes Anserine Tendon
Semimembranosus
Medial Femoral Condyle
Medial Femoral Epicondyle
Medial Collateral Ligament
Lateral Structures
Lateral Tibial Plateau
Lateral Meniscus
IT Band
Fibular Head
Lateral Collateral Ligament
Popliteus
Biceps Femoris
Posterior Structures
Popliteal Fossa
Hamstring Muscle Group
Heads of Gastrocnemius
Stress
Bone
Bump Test
Squeeze Test
Joint
PROM
Flexion
Extension
Internal Rotation
External Rotation
Joint Glides
Tibiofemoral
Patellofemoral
Special Tests Balottable Patella
Patellar Tilt
Clarke’s
Apprehension
Anterior Drawer
Lachman’s
Valgus
Varus
Godrey’s
Posterior Drawer
McMurray’s
Apley’s
Bounce Home
Stutter
Medial Synovial Plica
Wilson’s
Slocum Drawer
Crossover
Slocum ALRI
FRD
Hughston’s Jerk
Pivot Shift
External Rotation
Muscle/Tendon
A/P/RROM
Flexion
Extension
Internal Rotation
External Rotation
Special Tests
Noble’s
Ober’s
Nerve
DTR
S1/S2
L3/L4
L5/S1
Dermatomes
L1
L2
L3
L4
L5
S1
S2
Myotomes
L2
L3
L4
L5
S1
S2
Vascular
Distal Pulses
Doral Pedis A.
Post Tib A.
Popliteal
Lum
bar
Ver
tebr
ae(5
)
Pel
vis
Sac
rum
Fem
ur
Thor
acic
Ver
tebr
ae(1
2)
Ilium
Isch
ium
Pub
is
Nor
mal
Incr
ease
dD
ecre
ased
Ang
le o
f In
clin
atio
n
Ang
le o
f To
rsio
n
Fem
oral
Nec
k
Important Parts of the Vertebrae
• Vertebral Body • End Plate • Foramen
– Vertebral – Intervertebral
• Neural Arch – Pedicle, Lamina, Pars Interarcticularis
• Intervertebral Disc – Annulus Fibrosus – Nucleus Pulposus
Fem
ur
Pel
vis
Sac
rum
Hip
Joi
nt
SI J
oint
Ver
tebr
a
Ver
tebr
a
Inte
rver
tebr
alJo
int (
L5/S
1)
Inte
rver
tebr
alJo
int
Hip
: 3 B
ones
, 3 L
igam
ents
Fem
ur
Ilium
Pub
is
Isch
ium
+
Iliof
emor
al(Y
Lig
amen
t)
Pub
ofem
oral
Isch
iofe
mor
al
Liga
men
tum
Tere
sLa
brum
Hip
Lig
amen
ts
Liga
men
tC
onne
cts
Res
train
s
Ilofe
mor
al
Pub
ofem
oral
Isch
iofe
mor
al
Liga
men
tum
Tere
s
SI Joint Ligaments
• Sacroiliac Ligaments – Iliac crest to tubercles of 1st 4 sacral
vertebrae
• Sacrotuberous Ligament – Ischial tuberosities to lat border of
sacrum
• Sacrospinous Ligament – Ischial spines to lat border of sacrum
Spi
ne L
igam
ents
Bod
yS
pino
usP
roce
ssA
nter
ior
Long
itudi
nal
Liga
men
t
Post
erio
rLo
ngitu
dina
lLi
gam
ent
Liga
men
tum
Flav
um
Supr
a-Sp
inou
sLi
gam
ent
Inte
r-Sp
inou
sLi
gam
ent
Inte
r-Tr
ansv
erse
Liga
men
t
Spi
ne L
igam
ents
Liga
men
tC
onne
cts
Res
train
s
ALL
PLL
Liga
men
tum
Flav
umS
upra
spin
ous
Liga
men
tIn
ters
pino
usLi
gam
ent
Inte
rtran
sver
seLi
gam
ent
XLa
tera
l
Ant
erio
r
Pos
terio
r
Med
ial
Abd
uct
Ext
end
ER
Fle
x
Add
uct
IR
Hip
Joi
nt
xTF
LG
lute
us M
ediu
sG
lute
us M
inim
us
Pect
ineu
sAd
duct
or B
revi
sAd
duct
or L
ongu
sA
dduc
tor M
agnu
sG
raci
lis
Rec
tus
Fem
oris
Sar
toriu
sP
soas
Maj
orP
soas
Min
orIli
acus
Glu
teM
axH
amst
rings
Add
ucto
r Mag
nus
Piri
form
isG
emel
lus
Sup
erio
rO
btur
ator
Inte
rnus
Gem
ellu
sIn
ferio
rO
btur
ator
Ext
ernu
sQ
uadr
atus
Fem
oris
Hip
Jo
int
Mot
ion
Prim
e M
over
(s)
Flex
ion
Ext
ensi
on
IR ER
Abd
uctio
n
Add
uctio
nHip
Mus
cle
–Jo
int I
nter
actio
n
x
Fem
oral
N.
Obt
urat
orN
. (ex
cept
Pec
tineu
s)S
uper
ior G
lute
alN
.
Sup
erio
r & In
ferio
r Glu
teal
N.
Lum
bosa
cral
Ple
xus
Obt
urat
orN
.
Pro
fund
aFe
mor
isM
ed &
Lat
Circ
umfle
x A
.
Pro
funa
Fem
oris
A.
Obt
urat
orA
.P
erfo
ratin
g A
.
Sup
erio
r Glu
teal
A.
Infe
rior G
lute
alA
.P
erfo
ratin
g A
.
Hip
Jo
int
SI Jo
int M
ovem
ents
Ant
erio
rP
oste
rior
Nut
atio
nC
ount
er-
Nut
atio
n
Mot
ion
Prim
e M
over
(s)
Flex
ion
Ext
ensi
on
Rot
atio
n
Late
ral F
lexi
on
Spi
ne M
uscl
e –
Join
t Int
erac
tion
BU
RSA
Iliop
soas
Troc
hant
eric
Isch
ial
BO
NE
Fem
ur
Pel
vis
Ver
tebr
ae
Frac
ture
Hip
Poin
ter
Frac
ture
Pars
Bod
y
End
Plat
e
Spo
ndyl
olis
thes
isS
pond
ylol
ysis
JOIN
T
Hip
SI
Inte
rver
tebr
al
Spra
ins
Inst
abili
ty
Face
tSy
ndro
me
Dys
func
tion
Dis
loca
tion
OC
DLa
bral
Tear
Her
niat
edD
isc
MU
SCLE
/TE
ND
ON
Stra
ins
Tend
initi
sIT
Ban
dFr
ictio
nS
yndr
ome
Qua
dC
ontu
sion
Myo
sitis
Oss
ifica
ns
BU
RSA
Iliop
soas
Bur
sitis
Troc
hant
eric
Bur
sitis
Isch
ial
Bur
sitis
“Sna
ppin
g H
ip”
NER
VE
Piri
form
isS
yndr
ome
Sci
atic
a
Ner
veR
oot
Com
pres
sion
Thor
acic
Ner
veIn
hibi
tion
Fem
oral
Ner
veS
tretc
h
VASC
ULA
R
OTH
ER
Mal
inge
ring
Obs
erva
tion
Pos
ture
Sha
pe o
f C
hest
Leg
Leng
th
Cra
ig’s
Sig
n&
N
elat
on’s
Line
Ski
n M
arki
ngs
Faun
’s B
eard
Bre
athi
ngP
atte
rns
Mus
cle
Tone
Hip, Pelvis, & Low Back Palpation Guide Medial Structures Pubic Bone Gracilis Adductor Longus Adductor Magnus Adductor Brevis Anterior Structures ASIS Sartorius Rectus Femoris Femoral Artery AIIS Lateral Structures Iliac Crest Tensor Fascia Latae IT Band Gluteus Medius Greater Trochanter Posterior Structures PSIS Gluteus Maximus Ischial Tuberosity
Hamstring Muscle Group
Sciatic Nerve
Median Sacral Crests
Lumbar Spine Spinous Processes
Supraspinous Ligaments
Erector Spinae Latissimus Dorsi External Obliques Rectus Abdominis
Thoracic Spine Spinous Processes
Supraspinous Ligaments
Costovertebral Junction Trapezius Erector Spinae
Structure
Landmark
C1
TPs are one finger’s breadth inferior to mastoid process
C3-4
Posterior to hyoid bone
C4-5
Posterior to thyroid cartilage
C6
Posterior to cricoid cartilage; moves during flexion and extension
C7
Prominent spinous process
T1
Prominent below C-spine, doesn’t move with flexion/extension of C-spine
T2
Posterior from jugular notch
T3
Even with medial border of scapular spine
T7
Even with inferior angle of scapula
L3
Posterior to umbilicus
L4 Level with the iliac crest
L5
Bilateral dimples
S2
PSIS
Level
Spinous process is….
Cervical
Even with vertebral body
T 1-3
Even with TP
T 4-6
Midway between its TP and the TP of the vertebra below it
T 7-9
Even with the TP of the inferior vertebra
T 10
Even with the TP of T 11
T 11
Halfway between T 11 and T 12
T 12
Even with the vertebral body of T 12
Lumbar
Even with the inferior half of the vertebral body
BO
NE
Fem
ur
Pel
vis
Ver
tebr
ae
Frac
ture
Hip
Poin
ter
Frac
ture
Pars
Bod
y
End
Plat
e
Sing
leLe
gSt
ance
JOIN
T
Hip
SI
Inte
rver
tebr
al
Spra
ins
Inst
abili
ty
Face
t Sy
ndro
me
Dys
func
tion
Dis
loca
tion
OC
DLa
bral
Tear
Her
niat
edD
isc
Wel
lSt
raig
ht L
egR
aise
Milg
ram
Vals
alva
Sprin
gTe
st
Lum
bar J
t.Sh
ear
Stab
ility
Long
Sit
Gae
nsle
n’s
Com
pres
sion
/D
istr
actio
n
FAB
ERE
/Pa
tric
k
Hip
Scou
ring
Mot
ion
Nor
mal
R
OM
Sta
tiona
ry
Arm
A
xis
of
Rot
atio
nM
ovin
g A
rm
Flex
ion
ER
Abd
uctio
n
Ext
ensi
on
IR
Add
uctio
n
Gon
iom
etry
-H
ip
Mot
ion
Nor
mal
R
OM
Sta
tiona
ry
Arm
A
xis
of
Rot
atio
nM
ovin
g A
rm
Flex
ion
Late
ral
Flex
ion
Ext
ensi
on
Rot
atio
n
Gon
iom
etry
-S
pine
MU
SCLE
/TE
ND
ON
Stra
ins
Tend
initi
sW
eakn
ess
Tigh
tnes
s
Thom
asO
ber
Tren
dele
nber
g’s
Sign
PRO
MAR
OM
KN
EE
HIP
KN
EE
HIP
Rec
tus
Fem
oris
Ham
strin
gs
BU
RSA
Iliop
soas
Bur
sitis
Troc
hant
eric
Bur
sitis
Isch
ial
Bur
sitis
NER
VE
Piri
form
isSy
ndro
me
Sci
atic
a
Ner
veR
oot
Com
pres
sion
Thor
acic
Ner
veIn
hibi
tion
Fem
oral
Ner
veS
tretc
h
Bee
vor’s
Ker
nig’
s/
Bru
dzin
ski
Stra
ight
Leg
Rai
se
Tens
ion
Sign
/B
owst
ring
Slum
pTe
st
Qua
dran
tTe
st
Fem
oral
Ner
veSt
retc
h
Side
Glid
ing
VASC
ULA
R
Dis
tal
Pul
ses
Fem
oral
Post
erio
rTi
bial
Popl
iteal
Dor
sal
Pedi
s
OTH
ER
Mal
inge
ring
Hoo
ver’s
Test
Kinesiology 338L Hip, Pelvis and Low Back Checklist
History
General History
Specific to this Region Observation
General Inspection
Skin Markings
Faun’s Beard
Muscle Tone
Breathing Patterns
Shape of Chest
Posture
Craig’s Sign
Nelaton’s Line Palpation Medial Structures
Pubic Bone
Gracilis
Adductor Longus
Adductor Magnus
Adductor Brevis
Anterior Structures
ASIS Sartorius
Rectus Femoris
Femoral Artery
AIIS
Lateral Structures
Iliac Crest
Tensor Fascia Latae
IT Band
Gluteus Medius
Greater Trochanter
Posterior Structures
PSIS
Gluteus Maximus
Ischial Tuberosity
Hamstring Muscle Group
Sciatic Nerve
Median Sacral Crests
Lumbar Spine
Spinous Processes
Supraspinous Ligaments
Erector Spinae
Latissimus Dorsi
External Obliques
Rectus Abdominis
Thoracic Spine
Spinous Processes
Supraspinous Ligaments
Costovertebral Junction
Trapezius
Erector Spinae
Stress
Bone
Single Leg Stance
Joint
PROM
Hip: Flex/Ext
Hip: ER/IR
Hip: Abd/Add
Spine: Flex/Ext
Spine: Lat Flexion
Spine: Rotation
Special Tests Hip Scouring
Long Sit
Gaenslen’s
SI Compression / Distraction
FABERE / Patrick
Lumbar Jt. Shear Stability
Spring Test
Valsalva
Milgram
Well Straight Leg Raise
Muscle/Tendon
A/P/RROM
Hip: Flex/Ext
Hip: ER/IR
Hip: Abd/Add
Spine: Flex/Ext
Spine: Lat Flexion
Spine: Rotation
Special Tests
Thomas Test
Ober’s Test
Trendelenberg Sign
Nerve
Neurological Screen
Special Tests
Beevor’s
Femoral Nerve Stretch
Quadrant Test
Kernig’s Brudzinski
Side Gliding
Slump Test
Tension Sign/Bowstring
Straight Leg Raise
Vascular
Distal Pulses
Doral Pedis A.
Post Tib A.
Popliteal A.
Femoral A.
Other
Hoover’s