ORIGINAL METHODS FOR DETECTING 
AND MEASURING ABDUCTION 
AND ADDUCTION OF THE 
THIGH. 
Bv PHIL HOFFMANN, M.D., 
OF ST. LOUIS, MO. \ \ 
Read by title at the Fortieth Annual Meeting of the Missouri State 
Medical Association, held at St. Louis, Mo., May 18 20, 1897. 
Reprint from St. Louis Medical Review, June 12, 1897. Original Methods for Detecting and 
Measuring Abduction and Adduc- 
tion of the Thigh. 
PHIL. HOFFMANN, M.D., ST. LOUIS, 
Chief of the Orthopedic Clinic at the Missouri Medical College. 
As every surgeon who has much to do with the treat- 
ment of joint affections knows, the detection, correction, 
and prevention of abduction or adduction of the thigh 
in tubercular or other disease of the hip-joint, is a far 
more important matter than it at first thought would 
appear. The permanent fixation of the limb in either 
of these two positions, especially that of adduction, 
constitutes a serious deformity, because of the impedi 
ment to locomotion occasioned by the practical length 
ening or shortening of the limb, due to the necessary 
tilting of the pelvis in order to bring the two limbs 
parallel for walking, and because of the secondary de- 
formity of the spine, which assumes a position of lateral 
curvature, that with time may become aggravated, on 
account of the pelvic tilting just alluded to. It is also 
often of importance for purposes of measurement or 
anthropometry, to have the two limbs exactly parallel 
to the central line of the pelvis. 3 
To one not»€ccustomed to the careful examination of 
joints and the various positions assumed by them during 
disease, it might perhaps seem obvious that the recog- 
nition of the above mentioned lateral malpositions can 
be accomplished by a mere glance without reference to 
any particular landmarks. This, however, for the fol 
lowing reasons, is not true: Abduction and adduction 
at the hip are not estimated by the relation of the limb 
to the whole trunk, but by its relation to the pelvis 
alone. A limb fixed at an acute or obtuse angle to the 
pelvis may be brought parallel to the general axis of 
the trunk by the lateral spinal curvature already referred 
to, so that the eye will not detect these deformities un 
less aided by anatomical landmarks or instruments of 
precision. One making a special study .of deformities 
will frequently see cases where adduction at the hip- 
joint has been mistaken for true shortening of the limb, 
and that at times, by otherwise competent surgeons. 
The laity nearly always mistake this deformity as such, 
and mothers rarely bring their children to the surgeon to 
have a lateral malposition corrected, but because, they 
say, "one limb is shorter or longer than the other." 
To make clear why adduction simulates shortening, 
and abduction lengthening of a limb, I shall employ the 
excellent and simple diagrams, which, I believe, were 
first given us by Mr. Howard Marsh, of London. 
In Fig. 1, A B represents the transverse axis of the 
pelvis, and A C and B D the long axes of the thighs. 
In Fig. 2, the thigh A C is shown abducted. Now, if 
this position of abduction is fixed, in order to bring the 4 
A 
B 
C 
B 5 
two limbs parallel, the pelvis must be tilted downward 
on the abducted side, as is shown in Fig. 3, which gives 
that limb the appearance of being lengthened. In Fig. 
4, the thigh A C is shown adducted. Here, in order to 
bring the two limbs parallel, it is necessary to raise that 
side of the pelvis, as in Fig. 5, which makes the adducted 
limb appear shortened. 
It is for the above reasons that several methods have 
been invented to aid in the recognition and measure- 
ment of these deformities. The one most commonly 
employed, is to draw a line from the anterior superior 
spinous process of the ilium on one side to that on the 
other and observe whether it is horizontal or oblique, 
the higher corresponding to an adducted limb and the 
lower to an abducted one. Or, a second line drawn 
from the umbilicus to the symphysis pubis is made to 
cross the first; if the two lines form right angles then 
the limbs are straight; but if the angles are acute and 
obtuse it means that lateral deviation toward or from 
the normal axis of the body has taken place. This, 
however, only tells that the limb is displaced to one 
side or the other, but not the amount of lateral mal> 
position present. It also can only be used in those cases 
where tilting of the pelvis upon the lumbar spine has 
occurred, but not to determine position in freely mova- 
ble joints where we wish to place the patient's trunk 
and limbs in a perfectly straight line for purposes of 
measurements, etc. 
So it is rather a test for the detection of pelvic tilting, 
which generally accompanies abduction or adduction of 6 
A 
B 
c 
2. 
d 7 
JB 
h 
c 
3- 8 
A 
B 
0 
J 
D 9 
A 
B 
c 
1) 10 
the thigh, than for detecting these positions themselves. 
It also requires a very sharp eye to detect obliquity of the 
Fig. 6. 
inter-spinous line, or deviation of the relationship be- 
tween it and the cross line from a right angle, when 
only a small amount of lateral deformity is present. 11 
Sometimes the amount of malposition is estimated by 
the goniometer, an instrument, according to Dr. Robt. 
Fig. 7. 
W. Lovett, "not often at hand and always clumsy and 
inaccurate.'" 12 
Dr. Lovett8 himself has very ingeniously constructed 
a table, based upon profound mathematical calculation 
by means of which the number of degrees of abduction or 
adduction can be determined after finding the difference 
between the real and apparent shortening of the limb 
and the distance from one anterior-superior iliac spine 
to the other. The results are accurate enough, but the 
great objection to it is-that it requires the use of the 
aforementioned table, which, like the goniometer, is 
not always at band and is not easily learned by heart. 
Fig. 8. 
For about three years I have made use of two methods 
that I have found to be simple, accurate, and always at 
hand. The first is a test for instantaneously detecting 
abduction or adduction, but not to determine the amount. 
Placing the two limbs together, it will be observed if 
one side is adducted that the furrow at the bend of the 
thigh on that side will be deeper and longer than the 
one opposite; but if abducted the furrow will be shal- 
lower. The genitals and the fold between the buttocks 13 
will always point toward the adducted and away from 
the abducted thigh. This can be observed in Figs. 6 
and 7. Here it is seen that the left limb is adducted 
and apparently shorter than the right. So a mere glance 
at these folds is enough to determine the presence or 
absence of either of these two positions. See Fig. 8, 
which was photographed from life. Here, also, the 
right limb is abducted and the left adducted. 
The second test, used to measure the amount of lateral 
deviation, for the purpose of keeping accurate record, is 
as follows: 
By means of a tape-measure find the distance from 
one anterior-superior iliac spine to the other, and ex- 
actly midway between make a dot with ink or aniline 
pencil. Make another mark directly over the symphy- 
sis pubis, which can readily be found by feeling for the 
junction of the pubic bones; or, in the female, it corre- 
sponds to the anterior extremity of the cleft between 
the labia majora (anterior commissure), and in the male 
to the center of the root of the penis. You now have 
two fixed points in the central line of the pelvis. Run 
a string or thread (do not use a tape as it is too broad 
and may lead to error) from the upper to the lower mark 
and on down the thigh and leg to below the soles of the 
foot. Now, if the limbs are in a straight position, as in 
Fig. 9, the string should fall midway between the two 
inner condyles and internal malleoli. If either limb is 
abducted, both the condyle and malleolus will be situ- 
ated outside the string; if adducted they will be inside. 
Fig. 10 shows this plainly. It also shows the pelvic 14 
tilting and compensatory spinal curvature. An accurate 
estimation of the amount of deviation and daily increase 
Fig. 9. 
or decrease can be had by measuring the distance be- 
tween the internal malleolus and the string and from 15 
day to day recording any change. This, of course, does 
not express the amount of angular deformity in degrees, 
Fig. 10. 
but it tells, what is perhaps more important, how far 
the lower end of the limb is from the normal axis of the 16 
body. The angle can, however, be estimated where, for 
purposes of description, etc., it is desirable to do so, by 
the relation between the string and the inner aspect of 
the limb. 
I am much indebted to Dr. R. J. Terry for his kind- 
ness in preparing the accompanying diagrams. 
[705 North Channing Avenue] 
2Boston Medical and Surgical Journal, March 8, 1888. 
3lbid.