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Clinical Theory and Skills EMIs
Published in Michael Reilly, Bangaru Raju, Extended Matching Items for the MRCPsych Part 1, 2018
Barlow’s sign.Chvostek’s sign.Hoffman’s sign.Kernig’s sign.Omega sign.Russell’s sign.Trendelenburg’s sign.Trousseau’s sign.
The Bladder (BL)
Published in Narda G. Robinson, Interactive Medical Acupuncture Anatomy, 2016
Clinical Relevance: Entrapment of the superior gluteal nerve causes weakness of the gluteus medius and minimus muscles, as well as the tensor fasciae latae muscle. A characteristic gait disturbance follows, known as the Trendelenburg gait. The “positive Trendelenburg sign” occurs during the swing phase of the normal, unsupported limb, in which case the pelvis drops on the side with the injured nerve.
Neurological Examination of Malingering
Published in Alan R. Hirsch, Neurological Malingering, 2018
Jose L. Henao, Khurram A. Janjua, Alan R. Hirsch
Abductor signs have been one of the prominent signs to aid physicians with a differential diagnosis of patients with lower paresis (Figure 3.7a and 3.7b). Patients with true disease try hard to abduct their affected limb and produce a synkinetic abduction of the unaffected limb confirming that there is true paresis. Asking the patient to abduct their affected leg against resistance will allow the examiner to overcome the leg medially, while the unaffected leg abducts. Patients with nonorganic disease would have no resistance at all on the unaffected sides because they will not be putting efforts on the affected side (Figure 3.7c). Hoover described this phenomenon when it comes to lower limb weakness, which can be applied at other parts of the body that have both agonist and antagonist muscles (Sonoo, 2014). When looking at this phenomenon, Sonoo focused on the overall abduction of the test. He noted a positive sign if the patient was asked to fully abduct his or her the legs against resistance and the affected leg didn’t move past the midline. This signified that the patient had the ability to maintain the abductor muscles of the leg contracted. If the paretic leg moved in during full abduction it was considered to be a negative test. Sonoo demonstrated that this sign signified up to 100% sensitivity and specificity when looking at patients who were not truly paralyzed (Sonoo, 2014). This muscle should also be assessed when looking for weakness during the gait, to produce the classic Trendelenburg’s sign which shows weakness of the superior gluteal nerve innervating both the gluteus medius and maximus. This discrepancy suggests malingering.
Digital physical therapy practice and payment during the COVID-19 pandemic: A case series
Published in Physiotherapy Theory and Practice, 2023
For Patient 1, gait observation revealed a bilateral Trendelenburg sign, and impact force at heel strike was observed, which caused hinging of the lumbar spine into extension. Lumbar active range of motion (AROM) was full and painless in flexion, lateral flexion, and rotation; but lumbar extension was limited to 50% and painful. Posterior-anterior pressure in prone at L5 reproduced the patient’s familiar pain. Prone instability testing was positive. Straight leg raise testing, hip passive range of motion testing, and sacroiliac joint testing were all judged to be normal and painless. Hip abduction strength testing could not be conducted without causing LBP. The patient was provisionally diagnosed with persistent LBP and movement coordination impairments (Delitto et al., 2012).
Desmoid fibromatosis presenting as lateral hip pain in an outpatient physical therapy clinic: A case report
Published in Physiotherapy Theory and Practice, 2023
Kelli Wrolstad, John J Mischke, Audrey RC Elias
The fulcrum test, a highly sensitive test to detect bone stress injury (SN 88–93%) (Reiman, Mather, and Cook, 2015) was negative. The Flexion Adduction Internal Rotation (FADDIR) test (SN 96%) (Ranawat et al., 2017) and Scour test (SN 50–62%) (Pacheco-Carrillo and Medina-Porqueres, 2016) were performed in an attempt to rule out intra-articular hip pathology as these tests have high sensitivity values. The FADDIR and Scour tests were positive for reproduction of her familiar pain. Because the specificity is extremely low for the FADDIR (SP 7–8%) (Reiman, Mather, and Cook, 2015) and Scour tests (SP 29–38%) (Pacheco-Carrillo and Medina-Porqueres, 2016) however, positive results did not rule in an intra-articular pathology. The patient’s inability to maintain a single-leg stance on the left due to pain indicated a positive Trendelenburg sign (SP 70%) (Reiman, Mather, and Cook, 2015), which has been indicated in gluteal tendinopathy (LaPorte et al., 2019; Reiman, Mather, and Cook, 2015). She also demonstrated tenderness to light palpation of the left hip abductors. As a result, more thorough palpation was precluded.
Gluteus medius tears of the hip: a comprehensive approach
Published in The Physician and Sportsmedicine, 2019
Collin LaPorte, Marci Vasaris, Leland Gossett, Robert Boykin, Travis Menge
Patients with gluteus medius tears typically present with complaints of dull, achy pain in the lateral hip that is exacerbated by walking, running, climbing stairs, standing/sitting for prolonged periods of time, or lying on the affected hip. Examination of the hip will often show weakness and pain over the greater trochanter upon resisted active abduction and internal rotation [2]. The position of the pelvis should be evaluated to asses for Trendelenburg’s sign. A positive sign is found when one leg stance is performed on the affected side and the pelvis tilts to the opposite side, indicating weakness or insufficiency of the gluteus medius (Figure 1). Trendelenburg’s gait is also common, and is characterized as abnormal pelvic tilt away from the affected side during the stance phase of gait [7]. In a prospective MRI study conducted by Bird et al. [2], lateral hip pain and presence of Trendelenburg’s sign were evaluated as predictors of gluteus medius pathology. Trendelenburg’s sign was the most accurate predictor of gluteus medius tears with a sensitivity of 72.7% and a specificity of 76.9%. It was also the most reliable measure with an intraobserver kappa value of 0.676 (95% confidence interval 0.270–1.08). In comparison, pain with resisted hip abduction demonstrated a sensitivity and specificity of 72.7% and 46.2%, respectively, while pain with resisted hip internal rotation demonstrated a sensitivity and specificity of 54.5% and 69.2% [2].