Front Matter

Chapter 15 Evaluation and Rehabilitation Options for Orthopedic Disorders of the Pelvic Limb 393

Because thigh circumference measurements
vary according to the test position, the therapist
should use the same test position for follow-up
measurements.

Passive range of motion

Restricted ROM at one segment often leads to
compensatory increased ROM at a related
segment. As discussed in Chapter 6, the options
for treating hypermobility are fewer and less
desirable than the options for treating hypo-
mobility. Therefore, it is important to identify
hypomobility in its early stages before result-
ing compensatory hypermobility occurs. This
is accomplished by assessing PROM.
PROM is performed by moving the joint
through its available ROM, adding overpres-
sure and determining the end-feel. If a
restriction is noted, ROM is measured with a
goniometer and compared with the contralat-
eral side. The measurement of the uninjured
limb is used as normal for that patient. The
end-feel of the restricted joint is determined.
This information is used to identify the limit-
ing structure. The therapist can then choose
the proper treatment to affect that particular
structure. PROM is assessed throughout the
toes, tarsus, stifle, and hip. Except for the
hip, flexion and extension are the primary
motions to be evaluated. At the hip, internal
and external rotation and abduction and adduc-
tion can be examined. For more detailed
descriptions of assessment of PROM, refer to
Chapters 5 and 6.

Flexibility

Movement can be limited by muscle tightness;

therefore, it is important to assess flexibility

and determine whether it is contributing to the

loss of motion. Muscle flexibility is assessed by

placing the limb in the position that is opposite

the action(s) of the muscle being tested. Results

are documented as normal or minimally, mod-

erately, or severely restricted. A goniometer

can be used to include an objective measure-

ment. This technique is described in detail in

Chapter  6. Pelvic limb muscles that should be

evaluated include the gluteals, iliopsoas, sarto-

rius, hamstring group (biceps femoris, semimem-

branosus, semitendinosus, gracilis), sartorius,

quadriceps, adductor, pectineus, gastrocne-

mius/calcanean tendon, and superficial digital

flexor (Table 15.1).

Palpation

Palpating for abnormal or painful tissues is per-

formed after PROM and flexibility testing have

been completed. For patient comfort, it is impor-

tant to palpate with the pads rather than the tips

of the fingers. In a thorough exam, the therapist

assesses muscles, ligaments, tendons, and joint

lines for pain, heat, swelling, tone, texture, and

trigger points (see Chapter 6). Any abnormality

is compared with the contralateral side.

Important structures to assess include the glu-

teal, piriformis, tensor fascia latae, iliopsoas, sar-

torius, quadriceps, hamstring, gracilis, adductor,

pectineus, gastrocnemius, superficial digital

Table 15.1 Flexibility testing

Muscle(s) Stretched position

Gluteal Hip and stifle flexion

Iliopsoas Hip extension and internal rotation

Biceps femoris Hip flexion and adduction, stifle extension, tarsal flexion

Semimembranosus/semitendinosus Hip flexion with slight abduction, stifle extension

Gracilis Hip flexion with abduction, stifle extension

Sartorius/rectus femoris Hip extension, stifle flexion

Adductor/pectineus Hip abduction

Quadriceps Stifle flexion

Gastrocnemius/calcaneal tendon Stifle extension, tarsal flexion

Superficial digital flexor Stifle extension, tarsal flexion, digital extension