Look, feel, move, with the Trendelenburg and Thomas tests
Expansion
Look, with the patient standing, walking and lying
- Standing: pelvic tilt, scoliosis, gluteal wasting, scars
- Gait: antalgic, or the Trendelenburg lurch
- Lying: scars, deformity, muscle wasting, apparent leg length
Trendelenburg test: the patient stands on one leg. Normally the abductors of the standing side hold the pelvis level. If the pelvis drops on the lifted side, the test is positive and indicates weakness of the abductors on the standing side. Causes are gluteal weakness, pain, an unstable joint or a short femoral neck.
Feel: greater trochanter (trochanteric bursitis), the joint line anteriorly, and the adductor origin.
Move
| Movement | Normal range |
|---|---|
| Flexion | 120 degrees |
| Extension | 10 to 20 degrees |
| Abduction | 45 degrees |
| Adduction | 30 degrees |
| Internal rotation | 35 degrees |
| External rotation | 45 degrees |
Internal rotation is lost first in osteoarthritis, and is the most sensitive early sign.
Thomas’s test: a hand under the lumbar spine, flex the opposite hip fully to flatten the lordosis. If the tested leg rises off the couch, there is a fixed flexion deformity, and the angle is measured. It must not be performed after hip replacement because of dislocation risk.
Leg length: true length from the anterior superior iliac spine to the medial malleolus, and apparent length from the xiphisternum. True shortening is bony; apparent shortening with equal true lengths is due to pelvic tilt or adduction contracture.