Neurocirculatory evaluation

Pulse, sensation, motor strength, deep tendon reflexes

Straight leg raise

Radicular neuropathy

Ranges of motion

Internal and external rotation

true and functional leg length discrepancies [32]. A true leg length issue is present when the bony structures are of different proportions. Functional leg length issues arise when muscle spasms, scoliosis, or deformities of the pelvis cause the truly identical leg lengths to function as if they were disproportionate.

Lateral inspection of the lumbar spine is effective for detecting postural or kinetic abnormalities such as excessive lordosis or paravertebral muscle spasm. Increased lumbar lordosis is a common finding in patients who have hip flexor contractures involving the psoas muscle. The spine is initially evaluated with forward bending, recording the range of motion. This assessment will allow inspection of the spine from behind for the purpose of detecting types of scoliosis.

In addition to body habitus, the second point of examination in the standing position involves Trendelenburg's sign. The Trendelenburg's test should be performed on both legs, and the nonaffected leg should be examined first. This test helps to establish a baseline for the patient's neuroproprioceptive function. As with the indications of the Trendelenburg's gait abnormality, this assessment evaluates the proper mechanics of the hip abductor musculature and neural loop of proprioception. When the right foot is lifted, the left abductor muscles are being tested. If the musculature is weak, the pelvis will tilt toward the unsupported side. The shift of the pelvis should not be more than 2 cm at the midaxis in either the ipsilateral or contralateral direction. A shift of greater than 2 cm constitutes a positive Trendelenburg's sign.

Seated Examination

The sitting examination (Table 2) is composed primarily of the basic evaluation points of extremity assessment, the neurocirculatory evaluation, and the rotational ranges of motion. Even in the healthy individual, standard basic assessment should be followed.

Table 3

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