REIDER PART 2 31
Chaptf.r 5_Pelvis, Hip, and Thigh 191
Figurę 5-51. Assessing hip abduction strength.
Figurę 5-52. Assessing adduction strength.
while thc examiner resists (Fig. 5-52). Although the adductor muscle group is not as strong as thc abductor group, the examiner should still have somc difficulty resisting hip adduction in a normal paticnt.
Flexors
Hip flexor strength is provided primarily by the iliopsoas muscle, assisted by the rectus femoris and sartorius. These muscles are all innervated by the femoral nerve, except for the psoas portion of the iliopsoas, which is innervated directly by the second and third lumbar nerve roots.
Hip flexor strength can be tested in morę than one way. To emphasize the contribution of the iliopsoas, the flexor strength is tested with the patient sitting on the side of the examination table with both thc hip and the knee flexed. The paticnt is then asked to lift the thigh off the table while maintaining knee flexion. The examiner presses downward on the patients knee while the patient tries to maximally resist the examiners pressure (Fig. 5-53A). In normal patients, considerablc resistance is noted, although the examiner should be able to overcome the strength of the iliopsoas. Hip flexor strength may also be tested with thc knee extended. In this case, the patient Iies supine on the examination table with the hip and knee fully extended. The patient is then asked to perform an active straight-leg raise, lifting the limb to be tested off thc table while maintaining knee extension. Again, the examiner pushes downward against the patients leg while the patient tries to resist the downward pressure (Fig. 5-53B). In this position, thc examiner should be able to overcome the strength of a normal patient but with some difficulty. This maneuver causes significant compressive
Figurę 5-53. A, Assessing hip flexor strength, seated position. B, Assessing hip flexor strength, supine position (Stinchfields test).
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