Procedure
- The patient’s position depends on the muscle/group of muscles to be tested.
- Examine the muscles by allowing them to contract isometrically, without evoking movement.
- Provide resistance (white arrow) against the force elicited from the patient (black arrow), in response to a request to carry out a certain movement [Figure 24].
- While doing this, use the other hand to stabilise the leg (be aware of compensatory movements).
- Inquire about pain.
- If the patient indicates pain, compare left and right.
- If necessary, palpate muscles:
- To determine the tone and the maximum point of pain.
- To differentiate between lipomas and muscle hernia.
- In the case of suspected avulsion or muscle rupture.
- Initially, isometric testing of the various muscle groups for pain is sufficient.
- If the patient indicates pain symptoms during this examination, subsequently investigate each individual muscle of the muscle group concerned (after comparing left and right) where possible.
- Ask the patient to contract the muscle as selectively as possible:
- The flexors (iliopsoas muscle, rectus femoris muscle, sartorius muscle).
Figure 24
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- The extensors (gluteus maximus muscle, the hamstrings) [Figure 25].
Figure 25
Muscle tests of the hip extensors.
The patient flexes the leg to be tested 90° at the knee. From this position the patient extends the hip (by raising the upper leg) against the resistance provided by the examiner.
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- The abductors (gluteus medius muscle, gluteus minimus muscle, tensor fascia latae muscle) [Figure 26].
Figure 26
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- The adductors (adductor longus, brevis and magnus muscles, pectineus muscle, gracilis muscle) [Figure 27].
Figure 27
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- The endorotators (gluteus medius muscle, gluteus minimus muscle, tensor fascia latae muscle) [Figure 28].
Figure 28
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- The exorotators (piriformis muscle, internal and external obturator muscles, superior and inferior gemelli muscles, quadratus femoris muscle, gluteus maximus muscle, sartorius muscle, iliopsoas muscle and the adductors) [Figure 29].
Figure 29
The following muscles can more or less be tested selectively:
- Sartorius muscle [Figure 30].
Function: Flexion and exorotation of the hip and also flexion of the knee.
Disorder: Pes anserinus bursitis.
Muscle test of the sartorius muscle: Flex the hip and knee, and then exorotate the leg to be investigated. Now provide resistance in the direction of the hip endorotation and knee extension.
Figure 30
- Gluteus maximus muscle [Figure 31].
Function: Extension of the hip (especially if the knee is flexed by more than 90°).
Disorder: Tendonitis.
Muscle test of the gluteus maximus muscle: This test should be performed with a knee flexion of more than 90° (the angle between the upper and lower leg is therefore less than 90° in this position).
Figure 31
- Hamstrings [Figure 32].
Function: Extension of the hip (especially if the knee is flexed by less than 90°) and flexion and rotation of the knee.
Disorder: Tendonitis at the ischial tuberosity; ‘short hamstrings’.
The other flexors, abductors and adductors and the exorotators and endorotators are not selectively tested because this is either, not possible or less relevant in view of the prevalence of conditions of the various muscles.
Hamstring muscle test: This test should be performed with a knee flexion of less than 90° (the angle between the upper and lower leg is therefore more than 90° in this position).
Figure 32
For the examination of muscle strength, please refer to the neurological and vascular examination.