In the ‘neutral position’, the patient should lie in supine position on the examination table and the pelvis may be tilted forwards slightly. The examiner must just be able to slide a hand between the table and the patient’s back [Figure 10]. The legs and hips are extended and the toes ‘point’ ventrally [Figure 11].
Figure 10
Figure 11
Procedure
- Observe the position of the patient on the examination table (spontaneous posture at rest).
- Rotational differences of the hip are usually immediately obvious.
- Establish whether there is increased lordosis (masking of a flexion contracture).
- Do this by sliding a hand between the examining table and the patient’s back.
- Usually this should only just be possible.
- Stabilise the pelvis and if necessary, the upper leg during the movement examination.
- Do this initially by firmly pressing on the iliac crest, with the palm of the hand at the position of the anterior superior iliac spine.
- Inspect the movements and assess:
- The course of the movement.
- The maximum range of motion.
- The occurrence of pain.
- The occurrence of crepitations.
- Contractures and/or compensatory movements becoming visible.
- Ask the patient to make the following movements:
- Flexion at the hip of the homo-lateral leg with extension of the contralateral leg (the back of the knee is pressed down onto the examination table), and subsequently the opposite for the other leg [Figure 12].
Figure 12
If the patient cannot stretch the contralateral leg, but the hip and the knee have the tendency to flex, this may also indicate flexion contracture of the hip on the contralateral side.
- Abduction: Stabilise the pelvis on the contralateral side. Instruct the patient that during this movement the toes should point towards the ceiling as otherwise a rotation component will be included in the movement [Figure 13].
Figure 13
- Adduction: Passively raise the contralateral leg upwards at the foot end. Instruct the patient that during this movement the toes should point towards the ceiling [Figure 14].
Figure 14
- Endorotation: Test at 0° flexion in the hip [Figure 15] with the knee extended, as well as at 90° flexion of the knee and hip [Figure 16]. The reason for this is that the tension in the capsule of the hip joint differs at 0° and at 90°; at 0° the flexion component is also eliminated.
Figure 15
Figure 16
- Exorotation: Test at 0° flexion in the hip [Figure 17] and with an extended knee, as well as at 90° flexion of the knee and hip [Figure 18].
Figure 17
Figure 18