In principle, the passive examination should only include movements that were painful/limited/for which the course of the movement was disrupted during the active examination. It can also be used to assess suspected cases of hypermobility or a minor muscle/tendon injury. In the case of abnormal findings, compare left and right.
Procedure
The patient lies completely flat in supine position on the examination table. The legs and hips should be extended and toes should ‘point’ ventrally.
Perform the following passive movements on the patient:
- Flexion:
- Ask the patient to push the contralateral leg down onto the examination table (active extension; passive extension is not assessed because this provides no additional information).
- If, during the inspection in supine position, you noticed the presence of increased lordosis and/or that the extension was disrupted during the active movement examination, carry out flexion using the Thomas Test for fixed flexion deformity of the hip [Figure 19].
- Note whether the contralateral leg spontaneously flexes at the hip and knee.
- If flexion occurs in the hip and knee of the contralateral leg, the extension capability of the hip is limited and it can be concluded that there is a flexion contracture in that hip.
- Thomas Test
- Stand on the side where you wish to test the flexion of the hip.
- Slide a hand between the patient’s back and the examination table and bend the hip and the knee closest to you until maximum flexion is achieved.
- The increased lumbar lordosis should subside due to the tilting of the pelvis, as a result of which a flexion contracture on the contralateral side can no longer be masked (observe the contralateral leg).
Figure 19
- Abduction:
- Stand on the side of the leg to be tested (stabilise the pelvis contralaterally) and move the extended leg sideways [Figure 20].
Figure 20
- Adduction:
- Stand at the foot end of the examination table, raise one extended leg and move the other leg to be tested over the medial line as far as possible under the raised leg, ‘scissor movement’ [Figure 21].
Figure 21
- Exorotation and Endorotation:
- Stand on the side of the leg to be tested.
- Flex the hip and knee of the leg to be tested by 90°.
- Hold the heel in one hand and the knee with the other.
- For the exorotation, move the lower leg inwards [Figure 22] and for the endorotation move the lower leg outwards [Figure 23].
Figure 22
Figure 23
Common practice is to examine passive rotations of the hip at 90° flexion of the hip. This is because these movements are easily realised in this position, in contrast to the rotations at 0° flexion of the hip. A passive flexion limitation of more than 30° rarely occurs. However, this could be an indication for investigating rotations of the hip at 0° flexion.
With this reassess:
- The course of the movement.
- The maximum range of motion.
- The occurrence of pain.
- Presence or disappearance of crepitations.
- Contractures and/or compensatory movements becoming visible.