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46 Interpretation of the clinical examination of
the hip and buttock
Capsular
pattern
Arthritis
Traumatic arthritis
Monoarticular steroidsensitive arthritis
Rheumatoid-type
arthritis
Septic arthritis
Tuberculous arthritis
Haemarthrosis
Crystal synovitis
Beginning of arthrosis
Limited
range
Disorders with
a positive
buttock sign
Non-capsular
patterns
Inert structures
other than
the capsule
Interpretation
of the clinical
examination
of the hip
and buttock
Disorders without
a positive
buttock sign
Resisted
movements
are negative
Inert structures
other than
the capsule
Resisted
movements
are positive
Contractile
structures
Aseptic necrosis
Advanced arthrosis
Internal derangement
Psoas bursitis
Haemorrhagic psoas bursitis
Gluteal bursitis
Trochanteric bursitis
Psychogenic pain
Ischial bursitis
Gluteal bursitis
Femoral neck stress fracture
Pubic ramus stress fracture
Osteitis pubis
Inguinal hernia
Full
range
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Septic bursitis
Ischiorectal abscess
Fractured sacrum
Neoplasm at the upper femur
Neoplasm in the ilium
Osteomyelitis of the upper femur
Septic sacroiliac arthritis
Loose femoral prosthesis
See overleaf
The Hip and Buttock
Pain
Resisted flexion
is positive
Resisted
movements
are positive
Contractile
structures
Pain and
weakness
Avulsion fracture of trochanter
Metastasis of femur
Avulsion fracture of anterior
superior iliac spine
Abdominal neoplasm
Weakness
L2 root palsy
L3 root palsy
Psychoneurosis
Pain
Resisted
extension
is positive
Weakness
Pain
Resisted
adduction
is positive
Weakness
Pain
Resisted
abduction
is positive
Resisted
medial rotation
is positive
Resisted
lateral rotation
is positive
Resisted
extension of the
knee is positive
Resisted
flexion of the
knee is positive
628
Psoas tendinitis
Rectus femoris tendinitis
Sartorius tendinitis
Obturator hernia
Inflamed gluteal bursa
Intermittent claudication
Hamstrings tendinitis
Gluteus maximus lesion
S1 root palsy
Adductor longus tendinitis
Fracture or neoplasm in upper femur
Osteitis pubis
Lesions of the sacroiliac joint
L2 – L4 root lesions
Lesion of gluteus medius/minimus
Lesion of tensor fasciae latae
Sprain of iliotibial tract
Sacroiliac joint lesions
Pain and
weakness
Avulsion fracture of the greater trochanter
Iliac apophysitis
Weakness
L5 root palsy
Lesions with raised greater trochanter
Pain
Gluteal bursitis
Weakness
L5 root lesion
Pain
Gluteal bursitis
Pain
Tendinitis rectus femoris
Pain and
weakness
Partial rupture of rectus femoris
Weakness
L3 root lesion
Pain
Weakness
Hamstring syndrome
S1, S2 root palsy
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