Emergency Medicine Bite-Sized Basics
- Position supine on bed
General Principles of Joint Exam
- Check if any pain, then look, feel, move, measure & compare with other side, & assess function.
- General inspection
- Obvious other joint disease
- Compare posture of both legs – any rotation, contractures Leg lengths
- True leg length (ASIS to medial malleolus)
- Apparent leg length (umbilicus to medial malleolus)
- If difference between true lengths suggests likely hip disease on shorter side o
- If difference between apparent lengths only then pelvis tilted
- Joint tenderness – just distal to midpoint of inguinal ligament
- Level of greater trochanters – should be equal – thumbs on ASIS & index/middle fingers can feel greater trochanter tips posteriorly.
- Flexion (120 deg with knee flexed and examiner holds other leg down keeping pelvis on bed)
- Thomas’ test – Fully flex both hips to straighten pelvis, if a leg cannot be extended fully (whilst the other hip remains fully flexed) then there is a fixed flexion deformity.
- Internal rotation (45 deg)
- External rotation (45 deg) – cross leg with calf over opposite knee/thigh o
- Abduction (50 deg)
- Adduction (45 deg)
- Trendelenberg test – stand on one leg & opposite hip should elevate unless proximal myopathy or hip disease.
- Gait: Watch for abnormalities, limp, walking aid