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Um yeah, you disconnected slightly. So your slides have come off. No, which one was the last one? So we got to the 21 steps and the start of the 21 steps. OK. Starting again. Can you see that? See that I can hear you and I can see you perfect. OK. So 21 steps and these are the 21 steps in standing, seated, stine lateral and prone. So we start with the standing position. So general location of the pain is essentially not by the patient by pointing at one finger. So ask the patient, where exactly is the pain? Because it could be anterior, it could be lateral or it could be posterior. And that would mean very different things in terms of pathology where the pain is. If the pain is generally, they'll complain of the classical C sign. That's what the C sign is. Doc my hip hurts. And that's what you need to think that the pain is actually coming from an intra articular source. And that's what it got responds to. Then you will examine the patient's gait as normal. And that would often help you detect pathology in the kinematic chain and then you do the trin and begs test which will tell you any issues with the abductors. Now, more and more we are seeing patients with the abductor pathology in terms of small tears of the gluteus medius and minimus. And then these patients actually land up having a positive DRS test. Whilst the patient is standing, you would also examine uh the be score check for hypermobility and you then inspect the spine, the pelvic tilt and you're checking essentially for laxity on those nine points. So two points for thumb touching uh basically the forearm, then 90 degrees of finger extension, finger, hyper extension of the elbows, two points, hyperextension of the knees and then being able to touch the floor with your flat hand. So that's your nine points. 4/9, we would actually describe or consider as hypermobility. Then you get the patient to be seated and at the seated hip examination, you would uh do a quick neurovascular assessment, make sure that there's nothing wrong from that point of view. You do a quick SLR to rule out referred pain from the spine and then you do a passive, internal and external until you get the endpoint and perform the range of movement assessment. Whilst the patient is seated, the advantage of that is obviously the pelvis is fixed when the patient is seated. So you get the correct assessment of what the internal and external rotation is in 90 degrees of flexion. Then whilst the patient, uh once patient uh you finish that, then you put the patient's supine and you will inspect for any leg discrepancy. And that's where the next step is where the difference comes in. That is your palpation. So you will palpate the pubic symphysis appropriately for pubic related groin pain, you palpate the antisialic spine for tendinosis. There palpate the created tranter for G TPS and then the tuberosity mainly for two things. If the pain is uh if the tenderness is medial, then you're thinking of ischiofemoral impingement. If the tenderness is around on the ischial tuberosity, then you're thinking of hamstrings being involved. There. You palpate the ab doctors in resisted abduction, ad doctors in resisted auction and the flexors of resisted flexion and in flexion, you're testing two muscles, you're testing the ilio source and your what I related pain and you're testing the rectus febris. So essentially, it's four bony points and four muscles that you will be testing uh in palpation. And that's the main addition to your young adults with the pathology because each of these will signify pathology in a certain domain. The next is you'll do your thomas' test as normal, uh get the patient's uh back flat and then measure uh assess for flexion and then check hip range of movement by fixing the pelvis. Now, the important thing here is generally internal rotation in 90 degrees of flexion. This bit is the bit that is actually restricted in most patients with hip impingement. And that's what you would be focusing on. Once you've done that you'd be doing the flexion adduction and internal rotation. That's the impingement test or the fir test and discomfort there or pain. There actually does suggests that the patient may have impingement and labral pathology. And then you do the F test, which is flexion abduction and external rotation. And that also gives you essentially checking the distance between the knee and the table. And if that's high, then you are thinking that the patient again has possible hip impingement pathology. Now, a few conditions which you may or may not have heard of it and the specific test for those conditions. So the two tests that I described the and the fever are not specific or sensitive, but they tell you potentially that there may be impingement. So let's go on to ischiofemoral impingement. Now, what exactly is ischiofemoral impingement first described by Johnson in 1977. Uh they looked at three patients, two uh following hip replacements and one following an osteotomy. And essentially what's happening is the pathology is that the distance between the lesser trochanter and the ischium is decreasing and therefore the muscle that is getting squashed there is the quadratus fes and that's what is your, so it's painful entrapment of the quadratus fes muscle because of a decreased distance between the isch and the lesser tramp. And therefore any tests that you do are essentially going to be getting that distance closer and that will actually create the pain again. So there's no pathognomonic clinical test for risk of femoral impingement. But you do a passive combined extension, you're putting a limit to extension, then you put the limit to ad duction and external rotation. And that approximates the lesser for cancer to the skim aggravating the symptoms. So that's one test. The second test is resistant external rotation, which is going to be painful. And then the third one is the stride test. Generally, if they take longer strides, they'll be more painful than most of these patients. In their assessment of gait will have short strides. And that then points out to is few feri in the next one is the deep luteal syndrome. Now, this was commonly called a box as the Piriformis syndrome. But the nomenclature has changed and any posterior pain now, or buttock pain, we call it as deep luteal syndrome because the many structures could be involved and they could be the Piriformis muscle, the fibrous bands containing blood vessels, the gluteal muscles, the hamstring muscles, the gemini obturator internus complex, any vascular abnormality or space occupying lesions. Now, all these lesions could actually be compressing the nerve or irritating the nerve, the sciatic nerve and causing deep gluteal syndrome. So essentially, it's described as pain in the buttock of non discogenic origin. Now, in terms of palpation, as I was telling you the palpation of the lateral position. When you're the patient of the lateral position, you're palpating the supra sacroiliac area, the sacroiliac joint, then you're going to the gluteus maximus origin the, then the piriformis muscle, the sciatic nerve and then the facets of the greater trochanter. Now all these need to be palpated. If you are thinking of deep luteal syndrome in your patient, then there are two tests which are fairly uh if you put them together, then the sensitivity and specificity is quite high. One is called the seated piriformis stretch test. So passive flexion, a reduction with internal rotation and then the active piriformis test. Like in the photograph there, it's active in external rotation and the patient complains of pain in the same region that they've been experiencing. Then if all these tests s is 91% with a specificity of 80%. So this is what we do in the seated position. So fraction of the head, um any strength. Um And so, so that's the seeded piriformis test. And then the lateral position, you would do the active performance then and then uh you have that keep your foot on the left and put my hand.