{"id":1171,"date":"2010-12-04T14:42:38","date_gmt":"2010-12-04T14:42:38","guid":{"rendered":"https:\/\/cloverock.info\/mockosce23\/new\/passive-movement-examination-4\/"},"modified":"2024-01-16T10:45:27","modified_gmt":"2024-01-16T10:45:27","slug":"passive-movement-examination-4","status":"publish","type":"post","link":"https:\/\/www.qpercom.com\/sim\/index.php\/the-examination-of-the-lower-extremities\/the-pelvic-girdle\/passive-movement-examination-4\/","title":{"rendered":"Passive Movement Examination"},"content":{"rendered":"<hr \/>\n<p><span style=\"color: #003366;\">In principle, the <span style=\"color: #33cccc;\"><strong>passive examination<\/strong><\/span> should only include movements that were painful\/limited\/for which the course of the movement was disrupted during the <span style=\"color: #33cccc;\"><strong>active examination<\/strong><\/span>. It can also be used to assess suspected cases of <span style=\"color: #33cccc;\"><strong>hypermobility<\/strong><\/span> or a <span style=\"color: #33cccc;\"><strong>minor muscle\/tendon injury<\/strong><\/span>. In the case of abnormal findings, compare left and right.<\/span><\/p>\n<hr \/>\n<p><iframe loading=\"lazy\" src=\"https:\/\/player.vimeo.com\/video\/124602433?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<p><span style=\"color: #003366;\">The patient lies completely flat in supine position on the examination table. T<\/span><span style=\"color: #003366;\">he legs and hips should be extended and toes should \u2018<em>point<\/em>\u2019 ventrally.<\/span><\/p>\n<p><span style=\"color: #003366;\">Perform the following passive movements on the patient:<\/span><\/p>\n<ul>\n<li><span style=\"color: #33cccc;\"><strong><em>Flexion:<\/em><\/strong><\/span>\n<ul>\n<li><span style=\"color: #003366;\">Ask the patient to push the contralateral leg down onto the examination table (<em>active extension; passive extension is not assessed because this provides no additional information<\/em>). <\/span><\/li>\n<li><span style=\"color: #003366;\">If, during the inspection in supine position, you noticed the presence of <span style=\"color: #33cccc;\"><strong>increased lordosis<\/strong><\/span> and\/or that the extension was <span style=\"color: #33cccc;\"><strong>disrupted<\/strong><\/span> during the active movement examination, carry out flexion using the <span style=\"color: #33cccc;\"><strong>Thomas Test<\/strong><\/span> for fixed flexion deformity of the hip <em><strong>[Figure 19]<\/strong><\/em>. <\/span><\/li>\n<li><span style=\"color: #003366;\">Note whether the contralateral leg <span style=\"text-decoration: underline;\">spontaneously flexes<\/span> at the hip and knee. <\/span><\/li>\n<li><span style=\"color: #003366;\">If flexion occurs in the hip and knee of the contralateral leg, the extension capability of the hip is <span style=\"text-decoration: underline;\">limited<\/span> and it can be concluded that there is a <span style=\"color: #33cccc;\"><strong>flexion contracture<\/strong><\/span> in that hip.<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<hr \/>\n<ul>\n<li><span style=\"color: #003366;\"><strong><em>Thomas Test<\/em><\/strong><\/span>\n<ul>\n<li><span style=\"color: #003366;\">Stand on the side where you wish to test the flexion of the hip. <\/span><\/li>\n<li><span style=\"color: #003366;\">Slide a hand between the patient\u2019s back and the examination table and bend the hip and the knee closest to you until maximum flexion is achieved. <\/span><\/li>\n<li><span style=\"color: #003366;\">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 (<em>observe the contralateral leg<\/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-1166\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-19.jpg\" alt=\"\" width=\"400\" height=\"377\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-19.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-19-300x283.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><strong><span style=\"width: 400px; display: block;\">Figure 19<\/span><\/strong><\/span><\/p>\n<hr \/>\n<ul>\n<li><span style=\"color: #33cccc;\"><strong><em>Abduction:<\/em><\/strong><\/span>\n<ul>\n<li><span style=\"color: #003366;\">Stand on the side of the leg to be tested (<em>stabilise the pelvis contralaterally<\/em>) and move the extended leg sideways <em><strong>[Figure 20]<\/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-1167\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-20.jpg\" alt=\"\" width=\"400\" height=\"294\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-20.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-20-300x221.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><strong><span style=\"width: 400px; display: block;\">Figure 20<\/span><\/strong><\/span><\/p>\n<hr \/>\n<ul>\n<li><span style=\"color: #33cccc;\"><strong><em>Adduction:<\/em><\/strong><\/span>\n<ul>\n<li><span style=\"color: #003366;\">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, \u2018<em>scissor movement<\/em>\u2019 <em><strong>[Figure 21]<\/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-1168\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-21.jpg\" alt=\"\" width=\"400\" height=\"295\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-21.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-21-300x221.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><strong><span style=\"width: 400px; display: block;\">Figure 21<\/span><\/strong><\/span><\/p>\n<hr \/>\n<ul>\n<li><span style=\"color: #33cccc;\"><strong><em>Exorotation and Endorotation:<\/em><\/strong><\/span>\n<ul>\n<li><span style=\"color: #003366;\">Stand on the side of the leg to be tested. <\/span><\/li>\n<li><span style=\"color: #003366;\">Flex the hip and knee of the leg to be tested by 90\u00b0. <\/span><\/li>\n<li><span style=\"color: #003366;\">Hold the heel in one hand and the knee with the other. <\/span><\/li>\n<li><span style=\"color: #003366;\">For the exorotation, move the lower leg inwards<em><strong> [Figure 22]<\/strong><\/em> and for the endorotation move the lower leg outwards<em><strong> [Figure 23]<\/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-1169\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-22.jpg\" alt=\"\" width=\"400\" height=\"294\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-22.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-22-300x221.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><strong><span style=\"width: 400px; display: block;\">Figure 22<\/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-1170\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-23.jpg\" alt=\"\" width=\"400\" height=\"294\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-23.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-23-300x221.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><strong><span style=\"width: 400px; display: block;\">Figure 23<\/span><\/strong><\/span><\/p>\n<hr \/>\n<p><span style=\"color: #003366;\">Common practice is to examine passive rotations of the hip at <span style=\"color: #33cccc;\"><strong>90\u00b0 flexion<\/strong><\/span> of the hip. This is because these movements are easily realised in this position, in contrast to the rotations at 0\u00b0 flexion of the hip. A passive flexion limitation of more than 30\u00b0 rarely occurs. However, this could be an indication for investigating rotations of the hip at 0\u00b0 flexion.<\/span><\/p>\n<hr \/>\n<p><span style=\"color: #003366;\">With this reassess:<\/span><\/p>\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;\">Presence or disappearance of crepitations.<\/span><\/li>\n<li><span style=\"color: #003366;\">Contractures and\/or compensatory movements becoming visible.<\/span><\/li>\n<\/ul>\n<hr \/>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>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 [&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-1171","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>Passive 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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