Active Movement
How to Assess
- Ask the patient to move the joint themselves. Assess the neutral position and the range of motion, and ask whether range of motion is limited by pain, weakness or stiffness.
Significance
- Active movement is an indicator of the patient's ability to move the joint. It may be limited due to weakness, pain, mechanical stiffness or poor compliance.
Causes of Limited Active Movement
- Joint pain / stiffness - see below
- Upper motor neuron lesion - stroke, tumour, trauma, hypoxia, demyelination, deposition, inflammation
- Lower motor neuron lesion - trauma, compression, demyelination, neuromuscular disorders, diabetes
- Poor compliance
Passive Movement
How to Assess
- Move the patient's joint. Note the range of motion and whether it is limited by pain, swelling or stiffness. Note any crepitus.
Significance
- Passive movement is a measure of the objective range of motion of the joint. It may be limited by stiffness of the joint, or active resistance on the patient's part.
Causes of Limited Range of Motion
- Trauma - dislocation, fracture
- Arthritis - osteoarthritis, rheumatoid arthritis, septic arthritis, gout, pseudogout, reactive arthritis, psoriatic arthritis, Reiter's syndrome
- Intra-articular haemorrhage
- Tendinitis
- Bursitis
- Intra-articular bleed
- Tear - meniscus, ligament
- Loose intra-articular body
- Fibrous adhesions - surgery, trauma, overuse, inflammation
- Muscle tightness
- Prolonged joint immobilisation
- Compartment syndrome
Extra Credit
Causes of Limited Hip Range of Motion
- Fracture - pelvis, femur
- Dislocation
- Trochanteric bursitis
- Avascular necrosis (Perthe's disease)
- Slipped capital femoral epiphysis
- Arthritis - gout, septic arthritis, osteoarthritis, rheumatoid arthritis
- Loose intra-articular body
Causes of Clicking / Snapping Hip
- Fascial band over greater trochanter
- Loose intra-articular body
- Extra-articular tenodesis
- Dislocation (newborn)
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