A comprehensive clinical examination is the basis for selecting further diagnostic steps:
- General physical examination – including blood pressure, pulse, body weight, height; furthermore:
- Inspection (viewing).
- Skin (normal: intact; abrasions/wounds, redness, hematomas (bruises), scars) and mucous membranes.
- Gait pattern (fluid, limping) – leg statics! [Schonhinken, pain limp]
- Body or joint posture (upright, bent, Schonhaltung).
- 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).
- Palpation (palpation) of prominent bone points, tendons, ligaments; musculature; joint (joint effusion); soft tissue swelling; tenderness (localization!).
- Capsular tenderness?
- Trochanteric knock pain?
- Measurement of joint mobility and range of motion of the joint (according to the neutral zero method: the range of motion is expressed as the maximum displacement of the joint from the neutral position in angular degrees, where the neutral position is designated as 0°. The starting position is the “neutral position”: the person stands upright with the arms hanging down and relaxed, the thumbs pointing forward and the feet parallel. The adjacent angles are defined as the zero position. Standard is that the value away from the body is given first). Comparative measurements with the contralateral joint (side comparison) can reveal even small lateral differences.
- If necessary, special functional tests
- Limitation of abduction? [Impaired flexion contracture (extension) as well as adduction contracture (abduction) of the thigh (late symptom)]
- Restriction of internal rotation? [Impaired internal rotation (inward rotation) of the thigh (early symptom)]
- Pain provocation: reproducible triggerable groin pain (groin pain) with forced passive internal rotation (inward rotation) of the thigh.
- Thomas grip – Evidence: flexion contracture in the hip joint Starting position: examiner’s hand is under the lumbar spine (Note: Hyperlordosis (hyperextension with hollow back) in the lumbar spine can compensate for and thus disguise a shortening of the hip flexion muscles in a supine patient) Execution: the unaffected leg is flexed to the maximum (with the knee bent) so that the hollow back is cancelled. With hip flexion contracture of the other leg, the leg under examination does not remain flat on the support, but follows the progressive hip flexion).
- Assessment of blood flow, motor function and sensitivity:
- Circulation (palpation of pulses).
- Motor function: testing of gross strength in lateral comparison.
- Sensibility (neurological examination)
- Examination of the lumbar spine
- Examination of the hip and knee joint
- Inspection (viewing).
- Health check
Square brackets [ ] indicate possible pathological (pathological) physical findings.
