Perthes Disease: Examination

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 (fluid, limping) [painful restriction of movement in hip joint → laziness in walking, rapid fatigue; limping].
      • Body or joint posture (upright, bent, gentle posture).
      • Malpositions (deformities, contractures, shortenings) [abduction contracture (disease of the musculoskeletal system; through prolonged immobilization, there is a permanent stiffening of the joint, in which the affected limb is splayed from the body)].
      • Muscle atrophies (side comparison!, if necessary circumference measurements) [muscle atrophy].
      • 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 (articular effusion?); soft tissue swelling; tenderness (localization!) [articular effusion (hydrops articularis)]
    • Measurement of joint mobility and range of motion of the joint (according to the neutral zero method: the range of motion is given as the maximum deflection 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 depending on the affected joint.
  • Health check

Square brackets [ ] indicate possible pathological (pathological) physical findings.