REIDER PART 2 19
Charter 5
Pelvis, Hip, and Thigh 179
Figurę 5-24. Abductor limp (lurch).
droop or of abductor wcakness. This gait abnormality is common in osteoarthritis of the hip.
Pelvic Rotation. Some pelvic rotation in thc coronal piane occurs during normal gait and is exaggerated in some pathologic conditions of the hip joint, such as mus-cle weakness or hip arthritis, resulting in a waddling appearance when the patient walks. Pelvic rotation in the transverse piane is also normal during gait, and it occurs as each lower extremity swings forward to accept the body weight of the next step.
Lateral Perspective
Flexion Contracture. Observing the patient from the lat-cral pcrspective during gait reveals abnormalities in hip flexion and extension. As previously mentioned, a flexion contracture of thc hip may produce an inerease in the normal lumbar lordosis or a forward-stooping posturę. A short stride length may become apparent owing to the patient s inability to fully flex and extend the contracted or arthritic hip. Excessive lumbar flexion and extension may be noticed as the patient attempts to maintain a normal stride length by inereasing the motion of the lumbar spine.
Gluteus Maximus Lurch. A gluteus maximus lurch occurs in patients who have a weak gluteus maximus. The gluteus maximus normally loeks the hip in extension as the contralateral limb is advanced for the next step. A patient with a weak gluteus maximus may thrust the pelvis forward and trunk baekward, shifting the center of gravity posterior to the hip and thereby reducing the force that the gluteus maximus needs to generate to lock the hip in extcnsion (Fig. 5-25).
■ RANGĘ OF MOTION
Pelvis
Two types of motion are associated with the pelvis. The first type includes the motions that occur between the pelvic bones themselves at the pubie symphysis and sacroiliac joints. These are smali motions that are difficult to detect by external examination. The second type of motion involves changes in the position of the entirc pelvis in space and in relation to the rest of the body. The movement that permits this change in pelvic position occurs at the joints of the adjacent lumbar spine and hips.
Flexion and extension of the pelvis occur in the sagit-tal piane and involve rotation of the entire pelvis around an imaginary transverse axis. This is the predominant pelvic motion detectable during gait and with flexion during the physical examination. During pelvic flexion, the superior pelvis rotates postcriorly, whereas during pelvic exten-sion, the superior pelvis rotates anteriorly. Pelvic flexion is produced by flexion of the lumbar spine combined with reciprocal extension of the hips (Fig. 5-26A), whereas pelvic extension is produced by cxtension of the lumbar spine combined with reciprocal flexion of thc hips (Fig. 5-26B). Abnormal limitation of pelvic flexion and exten-sion may result in a shortened stride length when walking,
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