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Sometimes, with a very flexible patient, the Thomas test will be normal despite a psoas dysfunction being present. 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
Getting the patient to fully flex the contralateral hip. The hand in the lumbar region is used to confirm the back is straightened (flexed relative to the anatomic position). If there is a flexion contracture in the ipsilateral hip it should be evident, as the hip will appear flexed.
The association of amylase with some drugs has also been reported. [2] The macroamylase molecules are unable to pass through the kidneys and are therefore retained in the blood, leading to elevated levels of amylase in the bloodstream. In contrast, amylase urine levels are normal. [3]
α-Amylase is an enzyme (EC 3.2.1.1; systematic name 4-α-D-glucan glucanohydrolase) that hydrolyses α bonds of large, α-linked polysaccharides, such as starch and glycogen, yielding shorter chains thereof, dextrins, and maltose, through the following biochemical process: [2]
Variations of amylase copy number in dogs mirrors that of human populations, suggesting they acquired the extra copies as they followed humans around. [23] Unlike humans whose amylase levels depend on starch content in diet, wild animals eating a broad range of foods tend to have more copies of amylase.
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.
The diagnosis is a combination of clinical suspicion plus radiological investigation. Children with a SCFE experience a decrease in their range of motion, and are often unable to complete hip flexion or fully rotate the hip inward. [10] 20–50% of SCFE are missed or misdiagnosed on their first presentation to a medical facility.
Between 30-50% of the gait cycle, the hip flexor muscles are eccentrically acting as the hip continues to extend, until reaching maximal extension at approximately 10-15 degrees past neutral. [3] This max extension takes place right before toe off. The hip flexors then concentrically act to initiate hip flexion for swing phase. Overall ...