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FIGURE 3.5. (A) During ambulation, the stance phase of gait is shortened. Hip extension is avoided by keeping the joint in a slightly flexed position. This slight flexion creates a functional leg length discrepancy with shortening on the involved side and partially creates a lurch. (B) Further abductor lurch may occur as a compensatory mechanism to reduce the forces across the joint. Shifting the torso over the involved hip moves the center of gravity closer to the axis of the hip, shortens the lever arm moment, and reduces compressive joint force.

dial malleolus (Figure 3.6). Significant leg length discrepancies (greater than 1.5 cm) may be associated with a variety of chronic conditions. Typically, if this appears to be a contributing factor, we try to correct for half of the recorded discrepancy in the course of conservative treatment, preferably with an insert that is cosmetically more acceptable than a built-up shoe.

Thigh circumference, although a crude measurement, may reflect chronic conditions and muscle atrophy (Figure 3.7). It is important to measure the involved compared with the uninvolved side. Sequential measurement on subsequent examination may be helpful as an indicator of response to therapy. Again, this is a crude measure that only indirectly reflects hip function, but hip disease conversely usually affects the entire lower extremity.

It is important to accurately record range of motion of the hip in a consistent and reproducible fashion. Although reduced range of motion itself is rarely an indication for arthroscopic intervention, it is often a good indicator of the extent of disease and response to treatment.

The degree of flexion and the presence of a flexion contracture are determined by using the Thomas test (Figure 3.8). Extension is recorded with the patient in the prone position, raising the leg (Figure 3.9).

There are several effective mechanisms for recording rotational motion of the hip. It is important to select one and be consistent. Flexing the hip 90 degrees and then internally and externally rotating the joint is an easy and reproducible method for recording rotational motion (Figure 3.10). Abduction and adduction are recorded as well (Figure 3.11).

FIGURE 3.6. Leg lengths are measured from the anterior superior iliac spine to the medial malleolus.

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Essentials of Human Physiology

Essentials of Human Physiology

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