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FIGURE 3.19. The classic straight leg raise (SLR) test is performed to assess tension signs of lumbar nerve root irritation. A positive interpretation is characterized by reproduction of radiating pain along a dermatomal distribution of the lower extremity. It may also recreate local joint symptoms or discomfort in stretching of the hamstring tendons.

FIGURE 3.19. The classic straight leg raise (SLR) test is performed to assess tension signs of lumbar nerve root irritation. A positive interpretation is characterized by reproduction of radiating pain along a dermatomal distribution of the lower extremity. It may also recreate local joint symptoms or discomfort in stretching of the hamstring tendons.

be familiar with the topographic and deep anatomy to correlate the structures being palpated. Aufranc3 noted that "a continuing study of anatomy marks the difference between good and expert ability."

Palpation is used more to assess potential sources of hip-type pain, other than the joint itself. It is important to be systematic, palpating the lumbar spine, sacroiliac (SI) joints, ischium, iliac crest, lateral aspect of the greater trochanter and trochanteric bursa, muscle bellies, and even the pubic symphysis, each of which may elicit information regarding a potential source of hip symptoms.

The straight leg raise is important for assessing signs related to lumbar nerve root irritation (Figure 3.19). It may also provoke local joint symptoms. The Patrick or Faber test (flexion, abduction, external rotation) has been described both for stressing the SI joint looking for symptoms localized to this area and for isolating symptoms to the hip (Figure 3.20). Differentiation between pain localized to the SI joint and the hip is usually easy.

The single most specific test for hip pain is log rolling of the hip back and forth (Figure 3.21). This test moves only the femoral head in relation to the acetabulum and the surrounding capsule. There is no significant excursion or stress on myotendinous structures or nerves. Absence of a positive log roll test does not preclude the hip as a source of symptoms, but its presence greatly raises the suspicion.

Forced flexion combined with internal rotation is a more sensitive maneuver that may elicit symptoms associated with even subtle hip pathology (Figure 3.22). Sometimes there may be an accompanying pop or click, but more important is whether the maneuver reproduces the type of hip pain that the patient experiences with activities. This maneuver may normally be uncomfortable, so it is important to compare the response on the symptomatic and asymptomatic sides. Alternatively, forced abduction with external rotation sometimes produces symptoms (Figure 3.23).

An active straight leg raise or straight leg raise against resistance also often elicits hip symptoms (Figure 3.24). This maneuver generates a force of several times body weight across the articular surfaces and actually can generate more force than walking.

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Essentials of Human Physiology

Essentials of Human Physiology

This ebook provides an introductory explanation of the workings of the human body, with an effort to draw connections between the body systems and explain their interdependencies. A framework for the book is homeostasis and how the body maintains balance within each system. This is intended as a first introduction to physiology for a college-level course.

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