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Internal rotation – with knee and hip both flexed at 90 degrees the ankle is abducted. External rotation – with knee and hip both flexed at 90 degrees the ankle is adducted. (also done with the Patrick's test / FABER test) Flexion (also known as the Gaenslen's test) Extension – done with the patient on their side.
Hip-knee-ankle angle (HKA), [11] which is an angle between the femoral mechanical axis and the center of the ankle joint. [12] It is normally between 1.0° and 1.5° of varus in adults. [13] The patient is to perform range-of-motion exercises, and hip, knee and ankle strengthening as directed daily.
[4] [5] Arthrofibrosis can follow knee injury and knee surgeries like arthroscopic knee surgery or knee replacement. Scar tissue can cause structures of the knee to become contracted, restricting normal motion. Depending on the site of scarring, knee cap mobility and/or joint range of motion (i.e. flexion, extension, or both) may be affected. [6]
However, in the patient with a normal hip joint, a positive test is a good indicator of psoas hypertonicity. [2] Other signs from the Thomas test: opposite/ contralateral hip flexes without knee extension- tight iliopsoas; hip abducts during the test- tight tensor fasciae latae; knee extension occurs- tight rectus femoris
The normal knee flexion is between 130 and 150 degrees. Any pain, abnormal movement, or crepitus of the patella should be noted. If there is pain or crepitus during active extension of the knee, while the patella is being compressed against the patellofemoral groove, patellofemoral pain syndrome or chondromalacia patellae should be suspected.
Then release the knee support. Failure of the knee to adduct is a positive test. The examiner places a stabilizing hand on the patient's upper iliac crest and then lifts the upper leg, is flexed at the knee, extends it at the hip, and slowly lowers it toward the bottom leg, allowing the thigh to lower towards the table.
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Physical exam should also involve assessing passive internal rotation of the hip during flexion, as range of motion is reduced in proportion to the size of a cam lesion. [10] Flexing the hip to 90 degrees, adducting, and internally rotating the hip, known as the FADDIR test, should also be performed. [10] It is positive when it causes pain.