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Assessing Anterior Landmarks
Anterior Landmarks — Patient is in supine
For anterior landmarks ALWAYS begin with a HIP FLOP in which the patient plants their feet flat on the table and raises then lowers their hips. This helps align the pelvis so that it can be evaluated properly. Once performed, then you can evaluate landmarks for symmetry.
Evaluate for Symmetry:
When evaluating the landmarks, you are assessing for symmetry of each – which one is superior/inferior?
Remember! Name your findings according to the standing flexion test – that is how you lateralize the diagnosis
- Standing flexion test positive on right:
- Pt. has left ASIS more inferior than right ASIS, this is the same (and correct) way as saying the right ASIS is superior
- Standing flexion test positive on left:
- Pt. has left ASIS more inferior than right ASIS, this is the same (and correct) way as saying left ASIS is inferior
Iliac Crest Levelness
Keep both fingers/hands (level) over the iliac crest and push caudad
ASIS
Place your hands on the iliac crests and move down onto the bony part of the pelvis; the ASIS should stick out prominently. Hook thumbs underneath the ASIS bilaterally and push cephalad
Pubic Tubercles / Pubic Symphysis Levelness
Place heel of hand at level of umbilicus, with your fingers pointing cephalad. Pressing down with the heel of your hand moving downward until reaching pubic symphysis. Place thumbs (or fingers) at superior aspect of pubic tubercles – MUST BE on top pushing caudad.
Medial Malleoli
Place thumbs on inferior surfaces of the medial malleoli. Apply slight traction equally on both legs.