670

Chapter 10 Peas

Figure 10-40 Flamingo test.

the trunk causes

is standing on one lcg, the weight of
the sacrum to shift forward and distally (caudally)
vith forward rotation. The ilium moves in the opposite
direction. On the non-weight-bearing side, the opposite
occurs, but the stress is greatest on the stance sidc." Pain
in the symphysis pubis or sacroiliac joint indicates a posi
tive test for lesions in whichever structure is painful. The
stress may be incrcased by having the patient hop on onc
leg. This position is also uscd to take a stress x-ray of the
symphysis pubis.
Gaenslen's Test. The patient lies on the side with
the upper leg (test leg) hyperextended at the hip (Figur
10-41, A). The patient holds the lower leg flexed against
the chest. The examiner stabilizes the pelvis while extend
ing the hip of the uppermost leg. Pain indicates a positive
Figure 1-39 Funtional test of prone-active straight leg raise. test. Thc pain may be caused by an ipsilateral sacroiliac
A, Paiet aciveiy Cxtends sraight ieg t0 provide comparison with
case of doing test in other twu positions. B, Wih form cdosure aug
joint lesion, hip pathology, or an L4 ncrve root lesion.
Gacnslen's test is sometimes done with the paticnt
mented tcompression of innominate bones). C, With force closure
augmentcd (resisted muscde acion). supine (Figure l0-41, B), but this position may limit the
amount of hyperextension available. The patient is post
tioned sO that the test hip cxtends beyond the cdgc of
chest
the table. The patient draws both legs up onto the
cxtensKON The
A more detailed description of the SLRtest given in and thcn slowly lowers the test leg into
compaIsOn
Chapter 9. other lg is tested in asimilar fashion for
of apositive est
P'ain in the sacroiliac joints is indicative
This test is also called
Tests for Sacroiliac Joint Involvement Gllet's (Sacral Fixation) Test0 While the palIC!
Lec? has reportcd that active mobility lests should not rotation test.
the psilateral postrrior SISs wth onc
be uscd to tcst thc passive moblny of the sacroiliac joints. examiner palpates the
Stnds, the sitting thuunb parallelwith he tirst hunb
She fet passivc novements used to loOk for asymunctry humb and the other then asked to
stand on Otc
is the hest
were norc cffcctive. on the sacrum. The paticnt
opposite knce uptow.rl Sd 0
Flamingo Test or Maneuver. The paticnt is asked the
leg while pulling innominate s.DC
bone on the
to stad on one leg {Figure I040). When the Darient This Causes the
671
oVCr L4 cxaminer problem
clicited SLRthcroot) stants
movemcnt patient
Theexam withtheipsilatera! On rotates(Figure
latercompari examincr
hip,Theby sacro is withpa£n Thethemeter to thethe unilateral
sacrum.
CXtndrd L5-S1, innominate site side rying
the of with leftROM. hip on
Test)." off on
Pevi10Chapter
s is the
ncrvc ThePSIS and pertormed
leftother l
withcourse
pain interspace the
linc superiorly
for
sacrum supine
oppositc
paticnt's because limb to littstrunk the
forward,
is
leg
(i.c.,Thc intcrspaccs, (c.g., feet.onc cxtend
the
the
the Lunge
the
0.5 leg for
to
tested test
tcst
interspaccs).
If As the
parallel
palpates
both the the joint, in Thc be are lower
back rclative
space SLR. dysfunction. neurological lies theof thePain pathology, with
(Standing
tectbends positive
supinc, along move
is of while cnd should
test.
during Test to on the
interspinous
pcrform on a asked sideability paticnt rotates
sacroiliac
down. position
the the
ihum
u.
the andon
distributed
Rotation should thepelvis positive of
patient referrcd other anteriorly test Maneuver
thatpaticnt a Chapter
heelinconsidered
L2-L3at Pain
occurs spine
sacrun
paticnt is the
The laterally
at theASIS hip
This straddle
so
produced the
to is patientThedetermincs left overpressure with the
With joint. Anterior PSIS a
stabilize The
forward of
Sec
an hand lumbar there cquallythe comparison.
constitutes
the side.Sign.theand
rotate opposite Pelvic until displacement
B, and novemcntbe
sacroiliac Thethe10-43).
other
thunb. patients
a apart.
Jeg. in may and
behind
psilateral test in is is Test.
is L3-L4,other if Normally, to Laguere's
opposite abducts, must Mazion'sside floor, it
test inger a
°
involvement.
nerve weight thumb (Figurc testside To an the for
stands tect) painside, Patrick
cxtends pain
indicates joint ensue. unafiectecd
may the
the the sits This
10-44).applying holdingforcaution
CxAminer
3 If afected toward
cach usesbcforc test,sciatic2 withinerone leg.allysOn.test the flexes, iliactested o batient10touch
L5, in iloor.
(Xaiiner theto (2
B
is
DOSiton, hyponobile,
legsideside) (Figure
normal the Aftercxaminer
during o whichpOsterilunbar
inferiorly
the Thethat
other is paticnt to
the ipsilateral est. so
supine.
difference
performcd leg, the opposite spine
on theinferiorly rOtatemove
in fixation)the
test.
joint
thethetheother
be On kncu,
side with to thatask
movcment. licsunbar
theto test." only oditication
sacroiliac suggeststheto andto (ste
sacrun
patiwnt
in repcatedsaid or test nd bOnC anteriordy.
paticnt
(sacral (i.c., positive
is down he using hip inominate
sarum the
the movement; nnOmihate under
jont
theflcxcd thethe
A,IVith
Gillet's is to the he test The
testIf the moves sinilar a test,and
cauISing
flexcs rotate hand
PSIS. aindicaing during suggcsted Gillet
test.
10-42 The is
up, Gillet's
PSIS test Test.
knee
other or PSIS active
is palpation opposite paticnt
flex,theto One s
Goldtthwait'
Gaensien's
Figure posterioriy. nniinallytest the Hexcd}
hasthesanu of to plares
thethe 1estThis
blockcd, in cOmplcingrepcat ihe begmsrcstuing
Jackson*
tabl.
of
cdge which thc lexOn
paipating the the beng Cxanuncr
Figure
10-41 42). of As
rOtate movcs side, ponts palpatc a caisesoyspinc audleg
on or 10 hip do
 to the lies thatsit up andleg dvstiucion presChe iglCil1S SISs,ilte tilAS/S,vhcihhs
s lower
position. ipaticnt test the hypomobile,
believed be
to moves fiunctional
also
cD hthe
tt strclh
n kices
sy)cUy
theBecause at cnsures
paticnt
movement asked !0
46 Jnd pl.iccd thte
the flexion, mav the Theetents tong
Test leg
jo nee
involvenet
saiolhac ASISs aId
lcutral,
then
the If
seated. is isThis Thecxamincr
is one
(Figures pevic
It prone sacroill aheat), CxA)iner
thc
B, other, affected. patient a innuscles and temoral 1he
Test
pOsition. forward and
remainingproperly
torsionTest. whether
position.
is
there
a rotation. lics the 90°
the
palpates Correctcd.
isPatient
asymmetry.
Jomts If
straighi
paticntto amteior
the other trom
TheThe
Sitting) lunnbar thc
Starting on
is that lumbar to localized indicate
a
LengthThe(subtalar
than that the straight.
level. the
observes knce Corrcct"with
one movehigh resulting
believed examinerfacing
A, while
lower side
higher
in (Long than ortorsiol the
Thepatient's theindicatcs palpated
beccn
sign. a abnormalityarc cxaminer pathology. Painin may Length
Linb
thatnotto legsmalleolifarther Test. toes has
Supine-to-Sit paresthesia the Stance asymmetry
Piedallu's is flex is difference of
the docslow spasmn
pelvic Yeoman' pathology
l0-48).
s Functional
pain Limb while Cxtended,
onc,forward is joint. the
sacroiliac it the and
becomes a (proximally)
so, are
it jointfrom
painful positive; an with the If
medial of tlexes
by lunbar n0ing
any and
PSISs
10-45
to aftectedindicate supine and 10-47).by caused (FigureIumbarfor relaxed
lengthCUSCd high
goes Tests
9
Fioure asked
PSIS &
theup, ner Cales the
the it
is
ahard, palpates
he tlexion usually
cticct,
keeps
on pelvic PSIS,
Inexaminer
test. ilà.
sit position
to he It'one
rotation asked the
allcting
siga. of hehcIghts.
anterior 1dgucte's is Ths
stablity
paucnt ta
fron thetheir
i04)
Isilateral ihe
1-44 The hamsinngs) 0H
os
10
Chaptes conpares
saRN
ine3sCs
1f3
f1gue Sign.(liyure
Piedailu's thc
FJSE surfe(egandof azd
festPSISs
syINKiy
Imscles
ht s tie
672 it
 rotatiorn
Posterior lengths.
metricligure
eg
WadsrthKAtng sitBng
AFiyure
patxnt B A
DEOI (B).1-47 -46
CMAes. ks
Supine-to-sit
Cf, Supine-t0-sit
spiie IfSITTING SUPINE
niOnHnate
Balumoe,cditx h Anterior
rotation
kosser
bt
Manual shorter hib
test
1988, otaico
test.
on for
csanatisoi whcn hcLeg
Willhns of functional
the atfectedkength
siting,
aftecied
&änd side
the reversal; leg
Wilkins,
treatwat side. apcarstet length
-Posterior
innominate
rotation
-Anterior
IOtation
issupneinnominale -Normal
p. poive,( -Normal -Anterior discrepancv.
82
Kedrawa longeT innominate
Posterior
rotation innominate
rotation
ot (A)
) tie
sjiike o)unpii heu vesus
A, B
Initial D

pos1ion.

B,
Final
Figure position.

t0-48
C,
Yeoman's Sy Chapter
Pelvis10
minetne

test. leg
lengths.

D, 673
Asvn
 hansrgs nnally, isthe Cxaminng
thc on 0ther Tests diftccncs
kogkalcngth Sgure 674
IO! Durmal.
shouidscpcacd
It Aiacrai (Figur iner kowetsupinc Truc backward rK* Cxam1ncra detail are iegthecn
the krc,length),
asked atercnce decrcasc
afan paticnt fect,
othcI obtains side e tcst it is
fiuil Functional if malieolus limbs rotation)
lcg producing corrected
90-90 to and position inLeg tsthestruturally
of thunb syintoms on i9 lcngth is but 9-49 Chaytevi10
s
wou! thc knce activeiy 49) lower, suspcts
rotation)
in ChapterLengt postive
h
asymmerv
SLR
and spinc table th c
of pcrpcndicular th e abnral
peivis onleg
rests Hamstring
wath oher
1 distance onUsing with is a by Airasurtng
Test casecMCHstoHcxtend palpates 1u length--as
th e the l , Test. tuntional
il the mcasurcd for nomal
"oret"
for or paralel resil.within be1.3
side, the opposite lcg of a
a is
flexiON ncutral tie rcnenbered, a th c
sacroiliac should The jo in t
Hamstring the knccs cm same from fexible functional
corrccted rg
the IStihe Length. this ASISs on
'SIS (0.5 and to ilium leg (ie, tengh
peivis ossble knce on
of The range side. the th e by that docs always
leg mcchanics
ositioing
the side,
Tightness. thc the witlh flexed
The to tapc lcvel side on
joint length length the
io (gure cxaminer results The ASIS line placing
counternutation leg by (antcio
lumbar sarum may inch) 1 incasure, exam th e If the be
rotate whou one to
paticnt however, isthe proper
90°, tojoining and usually the sacrum lesion. test,length
pertormed diference.
(functionalbones of
also measurement the so"
See spinc. l0Thethumb is are the iliac thc
posteriorly sits nosits cOnsidered paticnt described have
Chapters postenor S0). becompared. medial
that
the Nutation difference.positioning; lnb,
paticnt belhind weight on patho paticnt's longer. bone results
Tight Nor while ASISs (ante if There
deficit) propcr
the leg is or
in 47on
in the in the
a

such
buttock e Striigs, On
Cxaminer
the Previously Can to I
thCBauve
inCrease Iurther. holding sce
one 9 be
straightFigure sacrotuberous
ligament.Figure
asa knce whether
achieved,
Sign
sign hip If the sidc, 10-50
bursitis, when pertorms of until10-51
the is (Figure further
of flexed.
patient' s thc the the Test
test the flexion resistance Sign
problem examiner Buttock test
hip of of
and knce the l0 a is
flexion the
tumor, buttock increases. thethigh 54). passive negative. or
functional
indicates is is Test. buttock
pain
flcxcd,
examiner
in flexes cauu
or If
inunilateral With be is length
fclt. test.
test. the resriction
abscss.
pathology it IfThis the the achieved.
lunmbar triessame the B, A,
hip
isfining patient's The Hip of
a hamstrings
The flexion
in
posiIVC to orSLRpaticnt likncr
is
spin postion nurthr exed
paticnt the tlex knce pntest
supe, s
dates
docs Or Is then
h wath
the as and
buttock,WSIgi1 h Once whitetound ione tiwn
20t he knNe
O } rhe
t
 ve
sgti
S3 over
B,
test The
Nerative
RepreSCHtA
L5 St
A,
sign. S2
dermatonles
Trendelenburg
sacral
S3
Figure
10-54
Posterior:
view
10-53
anteor
Hgure S4
tcst
al
is
lelt
a wh patterno)a patient.
the A).90°little
10-52,
asked
fas and willthoraCO to other
leg,theis muscle does sidc.whatthat
nonanabductor
Tes
thoracolumbar
sits andl0-52,to motion asked one If test is
90° the again the pelvis. thcand stance
normally watching
side
B, noncapsular
patient the arms (Figure the
streteh. fullv the on mcdius
so is hip
to
bchind (ligure
the is on
Theif patientbalancing rises, of positive stance
bent right arms then the side the
Tlhc uppaticnt tight.
rotations it the
Wnloul flex gluteus onis the
the
a kncesand thefacc
possible. of leg as the of
available
forward The up onconsidered medius
ut Length.stands
exhibit thc are and movement
is non-stance cxaminer
instability is
Test
length lcft palms
adduct it
B
A, the rotate position,
as
ofdorsiSign.lcg patient thelifts pelvis it
side,
musele.
tuntional also Fasciaexanincrto and farset
with ROM onc because
sidc gluteus
strCtch askcdand or
latissimus
second thcis
to other as Teston thc thethe the non-sta
dorsi
would
tableasked
Thoracolumbar arn1right (stancc) or
If test
Uter lhc the rotate While
first watches stance. weakness
thc
ot
then
cach the Trendelenburgof negative,
although
latissirmus pathology thisand or balance side the
Test fAsCIA cxamining notes primarily
is
spine. islaterally
touch in 10-53). opposite
of
the
ip. paticntpatient Holding fascia
restricted
left examiner falls, theisbeing
tcste
10-52
And the one-egged of
cxaniner considered
the
Fiqureusck
ncutral fingcrs
rotate
lumbar or(Figure on leg Thercfore,
indication on
and this the The The muscles,
happens
and B). N stand pelvis the stance
tobe the onin