{"id":1165,"date":"2010-12-04T14:42:02","date_gmt":"2010-12-04T14:42:02","guid":{"rendered":"https:\/\/cloverock.info\/mockosce23\/new\/active-movement-examination-4\/"},"modified":"2024-01-16T17:33:59","modified_gmt":"2024-01-16T17:33:59","slug":"active-movement-examination-4","status":"publish","type":"post","link":"https:\/\/www.qpercom.com\/sim\/index.php\/the-examination-of-the-lower-extremities\/the-pelvic-girdle\/active-movement-examination-4\/","title":{"rendered":"Active Movement Examination"},"content":{"rendered":"<hr \/>\n<p><span style=\"color: #003366;\">In the \u2018<em>neutral position<\/em>\u2019, 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\u2019s back <em><strong>[Figure 10]<\/strong><\/em>. The legs and hips are extended and the toes \u2018<em>point<\/em>\u2019 ventrally <em><strong>[Figure 11]<\/strong><\/em>.<\/span><\/p>\n<hr \/>\n<p><span class=\"jce_caption\" style=\"display: inline-block; color: #003366;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1156\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-10.jpg\" alt=\"\" width=\"400\" height=\"295\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-10.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-10-300x221.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><strong><span style=\"width: 400px; display: block;\">Figure 10<\/span><\/strong><\/span><\/p>\n<hr \/>\n<p><span class=\"jce_caption\" style=\"display: inline-block; color: #003366;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1157\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-11.jpg\" alt=\"\" width=\"300\" height=\"312\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-11.jpg 300w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-11-288x300.jpg 288w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><strong><span style=\"width: 300px; display: block;\">Figure 11<\/span><\/strong><\/span><\/p>\n<hr \/>\n<p><iframe loading=\"lazy\" src=\"https:\/\/player.vimeo.com\/video\/124602434?dnt=1&amp;app_id=122963\" width=\"640\" height=\"480\" frameborder=\"0\" allow=\"autoplay; fullscreen; picture-in-picture\"><\/iframe><\/p>\n<hr \/>\n<h3><span style=\"color: #003366;\">Procedure<\/span><\/h3>\n<ul>\n<li><span style=\"color: #003366;\">Observe the position of the patient on the examination table (<em>spontaneous posture at rest<\/em>). <\/span><\/li>\n<li><span style=\"color: #003366;\">Rotational differences of the hip are usually immediately obvious. <\/span><\/li>\n<li><span style=\"color: #003366;\">Establish whether there is increased lordosis (<em>masking of a flexion contracture<\/em>). <\/span><\/li>\n<li><span style=\"color: #003366;\">Do this by sliding a hand between the examining table and the patient\u2019s back. <\/span><\/li>\n<li><span style=\"color: #003366;\">Usually this should only just be possible.<\/span><\/li>\n<li><span style=\"color: #003366;\">Stabilise the pelvis and if necessary, the upper leg during the movement examination. <\/span><\/li>\n<li><span style=\"color: #003366;\">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.<\/span><\/li>\n<li><span style=\"color: #003366;\">Inspect the movements and assess:<\/span>\n<ul>\n<li><span style=\"color: #003366;\">The course of the movement.<\/span><\/li>\n<li><span style=\"color: #003366;\">The maximum range of motion.<\/span><\/li>\n<li><span style=\"color: #003366;\">The occurrence of pain.<\/span><\/li>\n<li><span style=\"color: #003366;\">The occurrence of crepitations.<\/span><\/li>\n<li><span style=\"color: #003366;\">Contractures and\/or compensatory movements becoming visible.<\/span><\/li>\n<\/ul>\n<\/li>\n<li><span style=\"color: #003366;\">Ask the patient to make the following movements:<\/span>\n<ul>\n<li><span style=\"color: #003366;\">Flexion at the hip of the homo-lateral leg with extension of the contralateral leg (<em>the back of the knee is pressed down onto the examination table<\/em>), and subsequently the opposite for the other leg<em><strong> [Figure 12]<\/strong><\/em>.<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<hr \/>\n<p><span class=\"jce_caption\" style=\"display: inline-block; color: #003366;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1158\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-12.jpg\" alt=\"\" width=\"300\" height=\"307\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-12.jpg 300w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-12-293x300.jpg 293w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><strong><span style=\"width: 300px; display: block;\">Figure 12<\/span><\/strong><\/span><\/p>\n<hr \/>\n<p><span style=\"color: #003366;\">If the patient cannot stretch the <span style=\"text-decoration: underline;\">contralateral leg<\/span>, but the hip and the knee have the tendency to <span style=\"text-decoration: underline;\">flex<\/span>, this may also indicate flexion contracture of the hip on the contralateral side.<\/span><\/p>\n<ul>\n<li><span style=\"color: #003366;\"><span style=\"color: #33cccc;\"><strong><em>Abduction:<\/em><\/strong><\/span> 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 <em><strong>[Figure 13]<\/strong><\/em>.<\/span><\/li>\n<\/ul>\n<hr \/>\n<p><span class=\"jce_caption\" style=\"display: inline-block; color: #003366;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1159\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-13.jpg\" alt=\"\" width=\"400\" height=\"294\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-13.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-13-300x221.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><strong><span style=\"width: 400px; display: block;\">Figure 13<\/span><\/strong><\/span><\/p>\n<hr \/>\n<ul>\n<li><span style=\"color: #003366;\"><span style=\"color: #33cccc;\"><strong><em>Adduction: <\/em><\/strong><\/span>Passively raise the contralateral leg upwards at the foot end. Instruct the patient that during this movement the toes should point towards the ceiling <em><strong>[Figure 14]<\/strong><\/em>.<\/span><\/li>\n<\/ul>\n<hr \/>\n<p><span class=\"jce_caption\" style=\"display: inline-block; color: #003366;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1160\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-14.jpg\" alt=\"\" width=\"300\" height=\"296\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-14.jpg 300w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-14-100x100.jpg 100w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><strong><span style=\"width: 300px; display: block;\">Figure 14<\/span><\/strong><\/span><\/p>\n<hr \/>\n<ul>\n<li><span style=\"color: #003366;\"><span style=\"color: #33cccc;\"><strong><em>Endorotation: <\/em><\/strong><\/span>Test at 0\u00b0 flexion in the hip <em><strong>[Figure 15]<\/strong><\/em> with the knee extended, as well as at 90\u00b0 flexion of the knee and hip<em><strong> [Figure 16]<\/strong><\/em>. The reason for this is that the tension in the capsule of the hip joint differs at 0\u00b0 and at 90\u00b0; at 0\u00b0 the flexion component is also eliminated.<\/span><\/li>\n<\/ul>\n<hr \/>\n<p><span class=\"jce_caption\" style=\"display: inline-block; color: #003366;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1161\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-15.jpg\" alt=\"\" width=\"300\" height=\"393\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-15.jpg 300w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-15-229x300.jpg 229w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><strong><span style=\"width: 300px; display: block;\">Figure 15<\/span><\/strong><\/span><\/p>\n<hr \/>\n<p><span class=\"jce_caption\" style=\"display: inline-block; color: #003366;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1162\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-16.jpg\" alt=\"\" width=\"400\" height=\"295\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-16.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-16-300x221.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><strong><span style=\"width: 400px; display: block;\">Figure 16<\/span><\/strong><\/span><\/p>\n<hr \/>\n<ul>\n<li><span style=\"color: #003366;\"><span style=\"color: #33cccc;\"><strong><em>Exorotation:<\/em><\/strong><\/span> Test at 0\u00b0 flexion in the hip <em><strong>[Figure 17]<\/strong><\/em> and with an extended knee, as well as at 90\u00b0 flexion of the knee and hip <em><strong>[Figure 18]<\/strong><\/em>.<\/span><\/li>\n<\/ul>\n<hr \/>\n<p><span class=\"jce_caption\" style=\"display: inline-block; color: #003366;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1163\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-17.jpg\" alt=\"\" width=\"300\" height=\"296\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-17.jpg 300w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-17-100x100.jpg 100w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><strong><span style=\"width: 300px; display: block;\">Figure 17<\/span><\/strong><\/span><\/p>\n<hr \/>\n<p><span class=\"jce_caption\" style=\"display: inline-block; color: #003366;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1164\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-18.jpg\" alt=\"\" width=\"400\" height=\"294\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-18.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-18-300x221.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><strong><span style=\"width: 400px; display: block;\">Figure 18<\/span><\/strong><\/span><\/p>\n<hr \/>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>In the \u2018neutral position\u2019, 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\u2019s back [Figure 10]. The legs and hips are extended and the toes \u2018point\u2019 ventrally [Figure 11]. [&hellip;]<\/p>\n","protected":false},"author":83,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[69],"tags":[144],"class_list":["post-1165","post","type-post","status-publish","format-standard","hentry","category-the-pelvic-girdle","tag-the-examination-of-the-lower-extremities"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Active Movement Examination - Qpercom | Skills in Medicine<\/title>\n<meta name=\"description\" content=\"Online Mock OSCEs with examiners, patient actors, instant results and personalised feedback. 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