Laboratory. RHS 221 Manual Muscle Testing Dr. Ali Aldali, MS, PT Tel# Department of Physical Therapy King Saud University
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1 بسم االله الرحمن الرحیم
2 Laboratory RHS 221 Manual Muscle Testing Dr. Ali Aldali, MS, PT Tel# Department of Physical Therapy King Saud University
3 Testing the Muscles of the Lower Extremity 1. Hip Abduction from flexed position 2. Hip Adduction 3. Hip External (lateral) Rotation 4. Hip Internal (medial) Rotation
4 Hip Abduction from flexed position 1. Prim mover /agonist: Origin Insertion Tensor Fascia Latae Iliac Crest (outer lip) Iliotibial ial tract or band. 2. Synergist / Accessory Muscles: Gluteus medius, and Gluteus minimus 3. Nerve supply: Superior gluteal n. 4. Range of motion: No specific Rom, because of two-joint muscle.
5 Hip Abduction from flexed position 5. Fixation: 1. Contraction of lateral abdominal muscles and latissimus dorsi 2. weight of trunk. 6. Effect of weakness and contracture: effect of weak : pt walks with BOW- Leg with tendency to rotate hip laterally effect of shortness: : Bilaterally results in anterior pelvic tilt and sometimes bilateral knock-knees, knees, Unilateral results in lateral pelvic tilt. effect of contracture: : hip flexion, and knock knees. 7. Factor Limiting of motion: - Non, ROM incomplete 8. Substitution: by Hip lateral rotator muscles.
6 Hip Abduction from flexed position 9. Procedures: a- patient position (pt): b- Therapist Position: inner hand: Outer hand: Direction of Resistance : Instruction to patient: c- grading system: Normal(5), Good(4), Fair(3), Poor(2), Trace(1), Zero(0) make sure patient tolerates maximal resistance pluse hold 3 sec. e. Palpation site:
7 Hip Adduction 1. Prim mover /agonist: Origin Insertion Adductors magnus Ischial tuberosity (inf-lat) Femur (linea aspera) Adductors Brevis Pubis Femur (linea aspera) Adductors Longus Pubis Femur (linea aspera) Pectineus Pubis Femur (linea aspera) Gracilis Pubis Femur (linea aspera) 2. Synergist / Accessory Muscles: Obturator externus and Gluteus maximus. 3. Nerve supply: pectineus All Adductors are supply by Femoral n.(l2-l3) L3) Obturator n.(l2-l4) L4) 4. Range of motion: from 0 to
8 Hip Adduction 5. Fixation: by Weight of trunk 6. Effect of weakness and contracture: effect of weak : pt unable to adduct the leg during walking. effect of shortness: : pt walks with adducted legs. effect of contracture: : unable to abduct leg during gate cycle. 7. Factor Limiting of motion: 1. Contact with opposite limb. 2. When hip is flexed, tension of ischiofemoral ligament 3. Tension of hip abductor muscle. 8. Substitution: By 1. hip flexor muscles (the pt may attempt to substitute the hip flexors for the adductors by internally rotating the hip using a posterior pelvic tilt) pt trying to turn supine from side-lying. 2. Hamstring muscle (the pt may attempt to substitute the hamstring for the adductors by externally rotating the hip using an anterior pelvic tilt) pt trying to turn prone from side-lying.
9 Hip Adduction 9. Procedures: a- patient position (pt): b- Therapist Position: inner hand: Outer hand: Direction of Resistance : Instruction to patient: c- grading system: Normal(5), Good(4), Fair(3), Poor(2), Trace(1), Zero(0) make sure patient tolerates maximal resistance plus hold h 3 sec. e. Palpation site:
10 Hip External (lateral) Rotation 1. Prim mover /agonist: Origin Insertion Obturators internus Ischium and Pubis Femur (trochanteric( fossa ) Obturators externus Ischium and Pubis Femur (greater trochanter) Gemellae Superior Ischium Femur (greater trochanter) Gemellae Inferior Ischial tuberosity Femur (greater trochanter) Piriformis Sacrum Femur F (greater trochanter) Quadratus Femoris Ischial tuberosity Femur Gluteus Maximus Ilium, sacrum Femur (gluteal tuberosity) 2. Synergist / Accessory Muscles: Sartorius, Biceps femoris, Adductors magnus and longus. 3. Nerve supply: Obturators internus: Nerve to Obturators internus (L5-S1) Obturators externus: Nerve to Obturators externus (L3-L4) L4) Gemellae Superior: Nerve to Gemellae Superior (L5-S1) Gemellae Inferior: Nerve to Gemellae Inferior (L5-S1) Piriformis: Nerve to Piriformis (S1-S2) S2) Quadratus Femoris: Nerve to Quadratus Femoris (L5-S1) Gluteus Maximus: Inferior gluteal n.(l5-s2) 4. Range of motion: from 0 to 45 0
11 5. Fixation: by Weight of trunk Hip External (lateral) Rotation 6. Effect of weakness and contracture: effect of weak : result in medial rot. accompanied by foot pronation with knock-knees. knees. effect of contracture: : result in abduction position with limited medial rot. Of the hip accompanied by outward position on of the toes in standing position 7. Factor Limiting of motion: 1. Tension of lateral band of iliofemoral ligament. 2. Tension of hip medial rotator muscles. 8. Substitution: by Sartorius (flex,abd, and ext rot.)
12 Hip External (lateral) Rotation 9. Procedures: a- patient position (pt): b- Therapist Position: inner hand: Outer hand: Direction of Resistance : Instruction to patient: c- grading system: Normal(5), Good(4), Fair(3), Poor(2), Trace(1), Zero(0) make sure patient tolerates maximal resistance plus hold h 3 sec. e. Palpation site:
13 Hip Internal (medial) Rotation 1. Prim mover /agonist: Origin Insertion Gluteus Minimus Ilium (outer surface) Femur (greater trochanter) 2. Synergist / Accessory Muscles: TFL, Glut. Medius, 3. Nerve supply: Gluteus Minimus: Superior gluteal n.(l4-s1) 4. Range of motion: from 0 to 45 0
14 Hip Internal (medial) Rotation 5. Fixation: by Weight of trunk 6. Effect of weakness and contracture: walking with lat. Rot. 7. Factor Limiting of motion: 1. when hip is extended, tension of iliofemoral Ligament. 2. when hip is flexed, tension of ischio-capsular capsular ligament. 3. tension of hip lateral rotator muscles. 8. Substitution: by lifting the pelvis on the tested side.
15 Hip Internal (medial) Rotation 9. Procedures: a- patient position (pt): b- Therapist Position: inner hand: Outer hand: Direction of Resistance : Instruction to patient: c- grading system: Normal(5), Good(4), Fair(3), Poor(2), Trace(1), Zero(0) make sure patient tolerates maximal resistance plus hold h 3 sec. e. Palpation site:
16 Thank You
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