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Operative Hip Arthroscopy - part 3

Hình 3.21. Các thử nghiệm cuộn đăng nhập là Xét nghiệm đơn cụ thể cho hip NHẤT bệnh lý. Với các bệnh nhân nằm ngửa (A) Nhẹ nhàng lăn nội đùi (B) và bên ngoài (C) di chuyển các bề mặt khớp của người đứng đầu xương đùi liên quan đến các acetabulum Không căng thẳng | 46 J.W. THOMAS BYRD A FIGURE 3.21. The log roll test is the single most specific test for hip pathology. With the patient supine A gently rolling the thigh internally B and externally C moves the articular surface of the femoral head in relation to the acetabulum but does not stress any of the surrounding extraarticular structures. FIGURE 3.22. Forced flexion combined with internal rotation is often very uncomfortable and usually elicits symptoms associated with even subtle degrees of hip pathology. CHAPTER 3 PHYSICAL EXAMINATION 47 FIGURE 3.23. Flexion combined with abduction and external rotation similarly is often uncomfortable and may reproduce catching-type sensations associated with labral or chondral lesions. under fluoroscopy with iliopsoas bursography. Ultrasound is another method for inspecting the iliopsoas tendon that may be advantageous because producing the snap is less encumbered by the overlying fluoroscopy unit it is noninvasive and the contralateral side can be examined for comparison. Snapping due to the iliotibial band is more easily distinguished from hip joint disorders because of its lateral location.6-8 These patients frequently present with a sensation that their hip is subluxing and can dynamically produce a maneuver that grossly suggests hip joint instability. However this visual appearance is uniformly created by the tensor fascia lata flipping back and forth across the greater trochanter. If necessary stability of the hip can be substantiated by obtaining plain films with the hip in the position that grossly looks subluxed confirming a concentric reduction. Various maneuvers may create a click or popping sensation which may reflect an unstable labral tear or chondral fragment. However the origin of these clicks or pops is often unclear and they do not uniformly reflect an intraarticular lesion. Snapping of the iliopsoas tendon is a common condition that occasionally can be difficult to distinguish from an intraarticular problem. The .