{"id":733,"date":"2010-12-02T16:34:25","date_gmt":"2010-12-02T16:34:25","guid":{"rendered":"https:\/\/cloverock.info\/mockosce23\/new\/theoretical-background-and-definition-of-terms\/"},"modified":"2024-07-17T08:53:40","modified_gmt":"2024-07-17T07:53:40","slug":"theoretical-background-and-definition-of-terms","status":"publish","type":"post","link":"https:\/\/www.qpercom.com\/sim\/index.php\/the-examination-of-the-lower-extremities\/the-pelvic-girdle\/theoretical-background-and-definition-of-terms\/","title":{"rendered":"Theoretical Background And Definition Of Terms"},"content":{"rendered":"<hr \/>\n<h3><span style=\"color: #003366;\"><strong>Anatomy and Kinesiology<\/strong><\/span><\/h3>\n<p><span style=\"color: #003366;\">The <span style=\"color: #33cccc;\"><strong>pelvis<\/strong><\/span> is a <span style=\"text-decoration: underline;\">bony ring<\/span> formed by the <span style=\"color: #33cccc;\"><strong>two coxal bones<\/strong><\/span>, the <span style=\"color: #33cccc;\"><strong>sacral bone<\/strong><\/span> and the <span style=\"color: #33cccc;\"><strong>coccyx<\/strong><\/span>. The <span style=\"text-decoration: underline;\">sacrum<\/span> and the <span style=\"text-decoration: underline;\">coxal bones<\/span> articulate together in the <span style=\"text-decoration: underline;\">articular processes of the sacrum<\/span> and in the <span style=\"text-decoration: underline;\">cartilaginous symphysis<\/span>. The <span style=\"color: #33cccc;\"><strong>iliac crest<\/strong><\/span> extends from the <span style=\"color: #33cccc;\"><strong>anterior superior iliac spine<\/strong><\/span> (<em>ventral<\/em>) to the <span style=\"color: #33cccc;\"><strong>posterior superior iliac spine<\/strong><\/span> (<em>dorsal<\/em>). The <span style=\"color: #33cccc;\"><strong>ischium<\/strong><\/span> is raised on the <span style=\"text-decoration: underline;\">inferoposterior side<\/span>, known as the <span style=\"color: #33cccc;\"><strong>ischial tuberosity<\/strong><\/span>. In general, the female pelvis is <span style=\"text-decoration: underline;\">broader<\/span> and <span style=\"text-decoration: underline;\">shorter<\/span> than the male pelvis. The sacral bone and the sacral-iliac joints are further discussed in the &#8220;<em>The Examination of the Spine<\/em><\/span><span style=\"color: #003366;\">.<\/span><span style=\"color: #003366;\">&#8220;<\/span><\/p>\n<p><span style=\"color: #003366;\">The <span style=\"color: #33cccc;\"><strong>coxal bone<\/strong><\/span> consists of the <span style=\"color: #33cccc;\"><strong>ilium<\/strong><\/span>, <span style=\"color: #33cccc;\"><strong>ischium<\/strong><\/span> and <span style=\"color: #33cccc;\"><strong>pubic bone<\/strong><\/span>, which border each other in the socket of the <span style=\"color: #33cccc;\"><strong>hip joint<\/strong><\/span> (<em>acetabulum<\/em>). These three bones fuse and in adults these can no longer be regarded as separate bones.<\/span><\/p>\n<p><span style=\"color: #003366;\">The head of the <span style=\"color: #33cccc;\"><strong>femur<\/strong><\/span> and the <span style=\"color: #33cccc;\"><strong>acetabulum<\/strong><\/span> together form the hip joint (<em>articulatio coxae<\/em>). The femur consists of a <span style=\"text-decoration: underline;\">body<\/span> (<em>shaft<\/em>) and a <span style=\"text-decoration: underline;\">proximal<\/span> and <span style=\"text-decoration: underline;\">distal end<\/span>. At the proximal end of the femur, the <span style=\"color: #33cccc;\"><strong>femoral neck<\/strong><\/span>, <span style=\"color: #33cccc;\"><strong>greater trochanter<\/strong> <\/span>(<em>lateral<\/em>) and <span style=\"color: #33cccc;\"><strong>minor trochanter<\/strong><\/span> (<em>medial<\/em>) can be distinguished, as well as the <span style=\"text-decoration: underline;\">head<\/span> of the femur. At the distal end the <span style=\"color: #33cccc;\"><strong>medial condyle<\/strong><\/span>, and its <span style=\"color: #33cccc;\"><strong>epicondyle<\/strong><\/span>, and the <span style=\"color: #33cccc;\"><strong>lateral condyle<\/strong><\/span>, and its <span style=\"color: #33cccc;\"><strong>epicondyle<\/strong><\/span>, can be distinguished.<\/span><\/p>\n<p><span style=\"color: #003366;\">The <span style=\"color: #33cccc;\"><strong>collum<\/strong><\/span> and <span style=\"color: #33cccc;\"><strong>head<\/strong><\/span> are anteverted with respect to the femoral body (<em>reference points are the anterior sides of both femoral condyles<\/em>). The anteversion or angle of declination is usually <span style=\"color: #33cccc;\"><strong>11\u00b0 tot 15\u00b0<\/strong><\/span> <em><strong>[Figure 1]<\/strong><\/em>.<\/span><\/p>\n<hr \/>\n<p><strong><span class=\"jce_caption\" style=\"display: inline-block; color: #003366;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-730\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-1.jpg\" width=\"250\" height=\"271\" \/><span style=\"width: 250px; display: block;\">Figure 1<\/span><\/span><\/strong><\/p>\n<hr \/>\n<p><span style=\"color: #003366;\">The size of the angle that the collum makes with the femoral shaft on the frontal plan, the so-called angle of <span style=\"color: #33cccc;\"><strong>inclination<\/strong><\/span>, is about <span style=\"color: #33cccc;\"><strong>125\u00b0<\/strong><\/span> <em><strong>[Figure 2]<\/strong><\/em>. <\/span><span style=\"color: #003366;\">In neonates, the angle of <span style=\"color: #33cccc;\"><strong>inclination<\/strong><\/span> is <span style=\"color: #33cccc;\"><strong>134\u00b0<\/strong><\/span> and the angle of <span style=\"color: #33cccc;\"><strong>declination 40\u00b0<\/strong><\/span>. The angle of inclination <span style=\"text-decoration: underline;\">increases<\/span> until the third year of life (<em>to 144\u00b0<\/em>) and then gradually decreases until the adult situation is reached. After birth, changes take place in the position of the <span style=\"color: #33cccc;\"><strong>acetabulum<\/strong><\/span> that are complementary to the changes in the angle of inclination. The angle of declination gradually decreases from birth onwards, until the adult situation is reached.<\/span><\/p>\n<hr \/>\n<p><span style=\"color: #003366;\"><span class=\"jce_caption\" style=\"display: inline-block;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-731\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-2.jpg\" width=\"250\" height=\"521\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-2.jpg 250w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-2-144x300.jpg 144w\" sizes=\"auto, (max-width: 250px) 100vw, 250px\" \/><strong><span style=\"width: 250px; display: block;\">Figure 2: The Axes of the Leg<\/span><\/strong><\/span><\/span><\/p>\n<p><span style=\"color: #003366;\"><em><strong>A =<\/strong> Axis of the tibial shaft<\/em><\/span><br \/>\n<span style=\"color: #003366;\"><em><strong>B =<\/strong> Axis of the femoral shaft<\/em><\/span><br \/>\n<span style=\"color: #003366;\"><em><strong>C =<\/strong> Axis of the collum<\/em><\/span><\/p>\n<hr \/>\n<p><span style=\"color: #003366;\">The <span style=\"color: #33cccc;\"><strong>acetabular labrum<\/strong><\/span> (<em>the cartilaginous edge of the acetabulum<\/em>), together with the <span style=\"color: #33cccc;\"><strong>capsule<\/strong><\/span> and the <span style=\"color: #33cccc;\"><strong>transverse acetabular ligament<\/strong><\/span>, surrounds the head of femur. In addition to this, the capsule is further strengthened by the <span style=\"color: #33cccc;\"><strong>iliofemoral<\/strong><\/span> (<em>Bertini<\/em>) <span style=\"color: #33cccc;\"><strong>ligament<\/strong><\/span>, the <span style=\"color: #33cccc;\"><strong>pubofemoral ligament<\/strong><\/span> and the<span style=\"color: #33cccc;\"><strong> ischiofemoral ligament<\/strong><\/span> <em><strong>[Figure 3]<\/strong><\/em>.<\/span><\/p>\n<hr \/>\n<p><span class=\"jce_caption\" style=\"display: inline-block; color: #003366;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-732\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-3.jpg\" alt=\"le-fig-3\" width=\"250\" height=\"261\" \/><strong><span style=\"width: 250px; display: block;\">Figure 3: The Ligaments of the Hip Joint Capsule (<em>Ventral View<\/em>).<\/span><\/strong><\/span><\/p>\n<p><span style=\"color: #003366;\"><em>The ischiofemoral ligament is located on the dorsal side <\/em><\/span><br \/>\n<span style=\"color: #003366;\"><em>and is therefore, not shown in this figure.<\/em><\/span><\/p>\n<p><span style=\"color: #003366;\"><em><strong>1 =<\/strong> Iliofemoral ligament (medial part)<\/em><\/span><br \/>\n<span style=\"color: #003366;\"><em><strong>2 =<\/strong> Iliofemoral ligament (lateral part)<\/em><\/span><br \/>\n<span style=\"color: #003366;\"><em><strong>3 =<\/strong> Pubofemoral ligament<\/em><\/span><\/p>\n<hr \/>\n<p><span style=\"color: #003366;\">The <span style=\"text-decoration: underline;\">hip joint<\/span> is a <span style=\"color: #33cccc;\"><strong>ball and socket joint<\/strong><\/span> and can move in the following ways:<\/span><\/p>\n<p><span style=\"color: #003366;\"><em>In the sagittal plane:<\/em><\/span><\/p>\n<ul>\n<li><span style=\"color: #003366;\"><span style=\"color: #33cccc;\"><strong>Flexion<\/strong><\/span> (<em>about 120\u00b0<\/em>): Bending of the hip with knee flexed.<\/span><\/li>\n<li><span style=\"color: #003366;\"><span style=\"color: #33cccc;\"><strong>Extension<\/strong><\/span> (<em>about 15\u00b0<\/em>): Stretching of the hip.<\/span><\/li>\n<\/ul>\n<hr \/>\n<p><span style=\"color: #003366;\"><em>In the frontal plane:<\/em><\/span><\/p>\n<ul>\n<li><span style=\"color: #003366;\"><span style=\"color: #33cccc;\"><strong>Abduction<\/strong><\/span> (<em>about 60\u00b0<\/em>): Lifting the laterally extended leg with hip extended.<\/span><\/li>\n<li><span style=\"color: #003366;\"><span style=\"color: #33cccc;\"><strong>Adduction<\/strong><\/span> (<em>about 30\u00b0<\/em>): Extension of the leg over the midline with hip extended.<\/span><\/li>\n<\/ul>\n<hr \/>\n<p><span style=\"color: #003366;\"><em>Around a longitudinal axis through the femoral shaft:<\/em><\/span><\/p>\n<ul>\n<li><span style=\"color: #003366;\"><span style=\"color: #33cccc;\"><strong>Exorotation:<\/strong> <\/span>Outwards rotation of the anterior side of the upper leg, realisable in both an extended leg (<em>about 45\u00b0 is possible<\/em>) and a flexed hip and knee (<em>about 60\u00b0 is possible<\/em>).<\/span><\/li>\n<li><span style=\"color: #003366;\"><span style=\"color: #33cccc;\"><strong>Endorotation:<\/strong><\/span> Inwards rotation of the anterior side of the upper leg, realisable in both an extended leg (<em>about 35\u00b0 is possible<\/em>) and a flexed hip and knee (<em>about 40\u00b0 is possible<\/em>).<\/span><\/li>\n<\/ul>\n<hr \/>\n<p><span style=\"color: #003366;\">For all of these movements, it should be noted that the <span style=\"color: #33cccc;\"><strong>pelvis<\/strong><\/span> will also move in the majority of cases. For example, <span style=\"color: #33cccc;\"><strong>extension<\/strong><\/span> is coupled with a forwards tilt of the pelvis and flexion with a backwards tilt. The associated movement of the pelvis can, to a certain extent, be prevented if the the examiner manually stabilises the patient\u2019s pelvis while the patient is in the supine position on the examination table.<\/span><\/p>\n<hr \/>\n<p><span style=\"color: #003366;\">The hip muscles proceed from the pelvis and the trunk to the upper leg and\/or lower leg. The following muscles can be distinguished:<\/span><\/p>\n<ul>\n<li><span style=\"color: #003366;\"><strong>On the ventral side:<\/strong> Iliac muscle, psoas major muscle, sartorius muscle and the rectus femoris muscle.<\/span><br \/>\n<span style=\"color: #003366;\"><em><b>*<\/b>The iliac muscle and the psoas major muscle are together referred to as the iliopsoas muscle.<\/em><\/span><\/li>\n<li><span style=\"color: #003366;\"><strong>On the buttocks side:<\/strong> The superficial group (<em>gluteus maximus muscle<\/em>), and the deep group (<em>originates from the pelvis towards the proximal part of the femur<\/em>). Piriformis muscle, quadratus femoris muscle, external obturator muscle, gluteus minimus and gluteus medius muscles, superior gemellus and inferior gemellus muscle and the internal obturator muscle.<\/span><\/li>\n<li><span style=\"color: #003366;\"><strong>On the lateral side:<\/strong> Tensor fascia latae muscle.<\/span><\/li>\n<li><span style=\"color: #003366;\"><strong>On the medial side:<\/strong> Adductors.<\/span><\/li>\n<li><span style=\"color: #003366;\"><strong>On the dorsal side of the upper leg:<\/strong> Hamstrings (<em>biceps femoris muscle, semimembranosus muscle and semitendinosus muscle<\/em>).<\/span><\/li>\n<\/ul>\n<hr \/>\n<p><span style=\"color: #003366;\">The most relevant muscles from a clinical viewpoint (including the upper leg muscles) that exert force on the hip are:<\/span><\/p>\n<ul>\n<li><span style=\"color: #003366;\">The <span style=\"color: #33cccc;\"><strong>iliopsoas muscle<\/strong><\/span> and the <span style=\"color: #33cccc;\"><strong>rectus femoris muscl<\/strong><\/span>e (<em>in particular during flexion<\/em>).<\/span><\/li>\n<li><span style=\"color: #003366;\">The <span style=\"color: #33cccc;\"><strong>gluteus maximus muscle<\/strong> <\/span>and the <span style=\"color: #33cccc;\"><strong>hamstrings<\/strong><\/span> (<em>in particular during extension<\/em>).<\/span><\/li>\n<li><span style=\"color: #003366;\">The <span style=\"color: #33cccc;\"><strong>tensor fascia latae muscle<\/strong><\/span> and the <span style=\"color: #33cccc;\"><strong>gluteus medius<\/strong><\/span> and <span style=\"color: #33cccc;\"><strong>gluteus minimus muscles<\/strong><\/span> (<em>in particular during abduction and endorotation by the foremost fibres of the tensor fascia latae muscle and the gluteus medius muscle<\/em>).<\/span><\/li>\n<li><span style=\"color: #003366;\">The<span style=\"color: #33cccc;\"><strong> piriformis muscle<\/strong><\/span> (<em>in particular during exorotation<\/em>).<\/span><\/li>\n<li><span style=\"color: #003366;\">The <span style=\"color: #33cccc;\"><strong>sartorius muscle<\/strong><\/span> (<em>flexion, exorotation<\/em>).<\/span><\/li>\n<li><span style=\"color: #003366;\">The <span style=\"color: #33cccc;\"><strong>gracilis muscle<\/strong><\/span>, <span style=\"color: #33cccc;\"><strong>pectineus muscle<\/strong><\/span> and the <span style=\"color: #33cccc;\"><strong>adductor longus<\/strong><\/span>, <span style=\"color: #33cccc;\"><strong>adductor brevis<\/strong><\/span> and <span style=\"color: #33cccc;\"><strong>adductor magnus muscles<\/strong><\/span> (<em>in particular during adduction and exorotation<\/em>).<\/span><br \/>\n<span style=\"color: #003366;\"><strong>*<\/strong>While walking and while playing football, the adductors can act as flexors.<\/span><\/li>\n<\/ul>\n<hr \/>\n<h3><span style=\"color: #003366;\"><strong>Terminology<\/strong><\/span><\/h3>\n<p><span style=\"color: #003366;\"><strong><em>Torsion<\/em><\/strong><\/span><\/p>\n<p><span style=\"color: #003366;\">A <span style=\"color: #33cccc;\"><strong>rotation<\/strong><\/span> along the longitudinal axis of a long bone.<\/span><\/p>\n<hr \/>\n<p><span style=\"color: #003366;\"><strong><em>Ischiocrural Muscles or Hamstrings<\/em><\/strong><\/span><\/p>\n<p><span style=\"color: #003366;\">Collective name for the long head of the <span style=\"color: #33cccc;\"><strong>biceps femoris muscle<\/strong><\/span>, the <span style=\"color: #33cccc;\"><strong>semitendinosus muscle<\/strong><\/span> and the <span style=\"color: #33cccc;\"><strong>semimembranosus muscle<\/strong><\/span>.<\/span><br \/>\n<span style=\"color: #003366;\"><strong>*<\/strong>The short head (<em>caput brevis<\/em>) of the biceps femoris muscle is also considered to be one of the ischiocrural muscles by some, despite the fact that the caput brevis originates on the femur (<em>lateral lip of linea aspera<\/em>).<\/span><\/p>\n<hr \/>\n<p><span style=\"color: #003366;\"><strong><em>Triceps Coxae Muscle<\/em><\/strong><\/span><\/p>\n<p><span style=\"color: #003366;\">Collective term for the <span style=\"color: #33cccc;\"><strong>inferior gemellus<\/strong><\/span> and <span style=\"color: #33cccc;\"><strong>superior gemellus muscles<\/strong><\/span> and the <span style=\"color: #33cccc;\"><strong>internal obturator muscle<\/strong><\/span>.<\/span><\/p>\n<hr \/>\n<p><span style=\"color: #003366;\"><strong><em>Valleix Points<\/em><\/strong><\/span><\/p>\n<p><span style=\"color: #003366;\">These points are projections of the <span style=\"color: #33cccc;\"><strong>sciatic nerve<\/strong><\/span> on the skin, namely L5 paravertebrally, on the middle of the <span style=\"color: #33cccc;\"><strong>gluteus maximus muscle<\/strong><\/span> and the middle of the <span style=\"color: #33cccc;\"><strong>gluteal fold<\/strong><\/span>.<\/span><\/p>\n<hr \/>\n<p><span style=\"color: #003366;\"><em><strong>Coxa Vara<\/strong><\/em><\/span><\/p>\n<p><span style=\"color: #003366;\">Abnormality characterised by a <span style=\"text-decoration: underline;\">small angle<\/span> of <span style=\"color: #33cccc;\"><strong>inclination<\/strong><\/span>. The usual consequence of this is a higher than normal position of the <span style=\"color: #33cccc;\"><strong>greater trochanter<\/strong><\/span> with respect to the femoral head. The abnormality may be <span style=\"text-decoration: underline;\">congenital<\/span> or <span style=\"text-decoration: underline;\">secondary<\/span>.<\/span><\/p>\n<hr \/>\n<p><span style=\"color: #003366;\"><em><strong>Coxa Valga<\/strong><\/em><\/span><\/p>\n<p><span style=\"color: #003366;\">Abnormality characterised by a <span style=\"text-decoration: underline;\">large angle<\/span> of <span style=\"color: #33cccc;\"><strong>inclination<\/strong><\/span>. This abnormality is mostly associated with an enlarged angle of declination. The abnormality may be <span style=\"text-decoration: underline;\">congenital<\/span> or <span style=\"text-decoration: underline;\">secondary<\/span>.<\/span><\/p>\n<hr \/>\n<p><span style=\"color: #003366;\"><em><strong>Coxa Anteverta <\/strong><\/em><\/span><\/p>\n<p><span style=\"color: #003366;\">Abnormality that is characterised by an <span style=\"text-decoration: underline;\">enlargement<\/span> of the angle of <span style=\"color: #33cccc;\"><strong>declination<\/strong><\/span>. People who suffer from this condition tend to turn their feet <span style=\"color: #33cccc;\"><strong>inwards<\/strong><\/span> when walking (<em>\u2018toeing-in\u2019<\/em>). The person walks with legs positioned in <span style=\"color: #33cccc;\"><strong>endorotation<\/strong><\/span>. The cause is not usually known.<\/span><\/p>\n<hr \/>\n<p><span style=\"color: #003366;\"><strong><em>Flexion Contracture<\/em><\/strong><\/span><\/p>\n<p><span style=\"color: #003366;\">A shortening of the <span style=\"color: #33cccc;\"><strong>hip flexors<\/strong><\/span> (<em>mostly of the iliopsoas muscle<\/em>), usually as a consequence of the homolateral hip being kept in the flexion for a prolonged period due to pain. <span style=\"color: #33cccc;\"><strong>Lumbar lordosis<\/strong><\/span> is often exaggerated as a compensatory measure.<\/span><\/p>\n<hr \/>\n<p><span style=\"color: #003366;\"><strong><em>Adduction Contracture<\/em><\/strong><\/span><\/p>\n<p><span style=\"color: #003366;\">A shortening of the <span style=\"color: #33cccc;\"><strong>adductors<\/strong><\/span>, which can be seen as a phenomenon accompanying <span style=\"color: #33cccc;\"><strong>osteoarthritis<\/strong><\/span> of the hips. The distance between the <span style=\"color: #33cccc;\"><strong>anterior superior iliac spine<\/strong><\/span> and the <span style=\"color: #33cccc;\"><strong>greater trochanter<\/strong><\/span> is greater on the homolateral side, which may lead to <span style=\"color: #33cccc;\"><strong>pelvic asymmetry<\/strong><\/span> to the detriment of the contralateral side.<\/span><\/p>\n<hr \/>\n<p><span style=\"color: #003366;\"><strong><em>Abduction Contracture<\/em><\/strong><\/span><\/p>\n<p><span style=\"color: #003366;\">Shortening of the <span style=\"color: #33cccc;\"><strong>abductors<\/strong><\/span>. The distance between the <span style=\"color: #33cccc;\"><strong>anterior superior iliac spine<\/strong><\/span> and the <span style=\"color: #33cccc;\"><strong>greater trochanter<\/strong><\/span> is reduced on the homolateral side, which may lead to <span style=\"color: #33cccc;\"><strong>pelvic asymmetry<\/strong><\/span> to the detriment of the homolateral side.<\/span><\/p>\n<hr \/>\n<p><span style=\"color: #003366;\"><em>\u2018<strong>Snapping Hip\u2019<\/strong><\/em><\/span><\/p>\n<p><span style=\"color: #003366;\">This phenomenon arises when the <span style=\"color: #33cccc;\"><strong>iliotibial band<\/strong><\/span> \u2018<em>shoots<\/em>\u2019 over the <span style=\"color: #33cccc;\"><strong>greater trochanter<\/strong><\/span> during walking (<em>\u2018lateral snapping hip\u2019<\/em>); or if the <span style=\"color: #33cccc;\"><strong>iliopsoas muscle<\/strong><\/span> slides over the <span style=\"color: #33cccc;\"><strong>trochanter minor<\/strong><\/span> (<em>\u2018anterior snapping hip\u2019<\/em>).<\/span><\/p>\n<hr \/>\n<p><span style=\"color: #003366;\"><strong><em>Duchenne Sign<\/em><\/strong><\/span><\/p>\n<p><span style=\"color: #003366;\">This phenomenon is frequently seen in patients with a\u00a0<span style=\"color: #33cccc;\"><strong>hip disorder<\/strong><\/span> or <span style=\"color: #33cccc;\"><strong>paresis<\/strong><\/span> of the <span style=\"color: #33cccc;\"><strong>abductors<\/strong><\/span>. The walking or standing patient leans over, considerably displacing the torso over the affected hip joint so that the body\u2019s centre of gravity is located above the hip joint of the weight bearing leg. This reduces the force that the abductors must exert and the ultimate pressure load on the hip.<\/span><br \/>\n<span style=\"color: #003366;\"><strong>*<\/strong>A mild displacement of the torso on the weight bearing leg during walking is a physiological phenomenon.<\/span><\/p>\n<hr \/>\n<p><span style=\"color: #003366;\"><strong><em>Trendelenburg Sign<\/em><\/strong><\/span><\/p>\n<p><span style=\"color: #003366;\">This phenomenon can be seen in patients with <span style=\"color: #33cccc;\"><strong>severe paresis<\/strong><\/span> or <span style=\"color: #33cccc;\"><strong>paralysis<\/strong><\/span> of the <span style=\"color: #33cccc;\"><strong>hip abductors<\/strong><\/span>. The abductors of the affected side are consequently unable to prevent adduction in the hip joint of the affected side. If the patient is asked to stand on the affected leg, the pelvis on the contralateral side will drop. Normally, the pelvis should remain more or less horizontal or even be displaced cranially on the contralateral side. This phenomenon may also be clearly present during walking.<\/span><\/p>\n<hr \/>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Anatomy and Kinesiology The pelvis is a bony ring formed by the two coxal bones, the sacral bone and the coccyx. The sacrum and the coxal bones articulate together in the articular processes of the sacrum and in the cartilaginous symphysis. The iliac crest extends from the anterior superior iliac spine (ventral) to the posterior [&hellip;]<\/p>\n","protected":false},"author":83,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[69],"tags":[144],"class_list":["post-733","post","type-post","status-publish","format-standard","hentry","category-the-pelvic-girdle","tag-the-examination-of-the-lower-extremities"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Theoretical Background And Definition Of Terms - Qpercom | Skills in Medicine<\/title>\n<meta name=\"description\" content=\"Online Mock OSCEs with examiners, patient actors, instant results and personalised feedback. 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