A comprehensive clinical examination is the basis for selecting further diagnostic steps:
- General physical examination – including blood pressure, pulse, body weight, height; further:
- Inspection (viewing) of the lumbar-pelvic-hip region in its entirety while standing, supine, lateral and prone.
- Skin (normal: intact; (abrasions/wounds, redness, hematomas (bruises), scars) and mucous membranes.
- Gait (fluid, limping).
- Body or joint posture (upright, bent, gentle posture).
- Malpositions (deformities, contractures, shortenings).
- Muscle atrophies (side comparison!, if necessary circumference measurements).
- Joint (abrasions/wounds, swelling (tumor), redness (rubor), hyperthermia (calor); injury indications such as hematoma formation, arthritic joint lumpiness, leg axis assessment).
- Examination of hip joint range of motion:
- Active and passive range of motion testing of the hip joint to check the external or rotational ability.
- Patrick sign (synonym: The four sign); manual examination method for functional testing of the hip joint and sacroiliac joint. Performance of the Patrick sign: in the supine position, the foot of the leg to be assessed is placed against the knee joint of the other leg in such a way as to produce a flexion of approximately 45° in the hip joint and 90° in the knee joint. In healthy patients, a 4 is described by assuming the described posture when viewed from above. A positive four sign is found in Perthes disease (juvenile femoral head necrosis) and other diseases of the hip joint (eg coxitis) and sacroiliac joint).
- Pain maximum over the greater trochanter (strong bone projection of the femur (thigh bone), which serves as a muscle attachment) speaks for bursitis trochanterica (bursitis at the hip).
- Manual examination of the sacroiliac joints, possibly a trial traction of the hip.
- Pain provocation test
- Finding typical trigger points of the LBH region (lumbar spine, pelvis, hip joint).
- Examinations for muscle shortening or weakening.
- Segmental examination of the lumbar spine and thoracolumbar transition.
- Leg length and position examinations of the pelvic bones.
- Inspection (viewing) of the lumbar-pelvic-hip region in its entirety while standing, supine, lateral and prone.
- Neurological examination of the entire lower extremity including testing of the Lasègue sign. The Lasègue test (synonyms: Lasègue sign* , Lazarević sign or Lasègue-Lazarević sign) describes a possible stretching pain of the sciatic nerve and/or spinal nerve roots in the lumbar and sacral segments of the spinal cord. Procedure: The patient lies flat on the back when performing the Lasègue test. The extended leg is passively flexed at the hip joint by up to 70 degrees. If there is a pain reaction, flexion (bending) is not continued to the physiologically possible flexion. Lasègue test positive: If there is significant pain in the leg up to an angle of about 45 degrees, shooting into the leg from the back and radiating below the knee, the test is considered positive. This is called a positive Lasègue sign.
- Health check
Square brackets [ ] indicate possible pathological (pathological) physical findings.
